Cardiogenic Shock Team: A Collaborative Approach to Treating a Life-Threatening Cardiac Condition

 

By: John Fernandez,Baptist Health South Florida

 

The Cardiogenic Shock Team at Miami Cardiac & Vascular Institute and Baptist Hospital is ready around-the-clock to assist with the immediate evaluation and management of “cardiogenic shock” — a life-threatening condition in which the heart is unable to pump sufficient blood throughout the body.

 

Cardiogenic shock most often occurs soon after a heart attack, but it can also occur after heart surgery or with an acute illness such as cardiomyopathy, which is a weakening of the heart muscle. Patients with this condition must be treated immediately to restore perfusion, which refers to the proper flow of blood to the body’s organs, and prevent further deterioration so that the heart can recover. 

 

Currently there are no routine screening tests for cardiogenic shock. Tests are usually done after you have been admitted to a hospital for a possible heart attack or symptoms of cardiogenic shock. If the heart is not pumping strongly enough, then the diagnosis likely will be cardiogenic shock.

 

“The initial step involves getting the patient’s history and doing a physical exam — then the patient undergoes a screening electrocardiogram,” explains Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure program at Miami Cardiac & Vascular Institute. “Blood tests will help evaluate the severity of the cardiogenic shock.”

 

If the patient needs emergency support, such as in the case of a heart attack, they are treated initially in the Emergency Department, Dr. Chaparro adds. In the case cardiogenic shock, “the patient will be transferred to the cardiac catheterization to open the vessels in case of an acute myocardial infarction (heart attack) and to implant a mechanical temporary support device if needed,” says Dr. Chaparro. 

 

Dr. Chaparro leads the Cardiogenic Shock Team, assisted by Joseph T. McGinn, M.D., chief of cardiac surgery at Miami Cardiac & Vascular Institute; Marcus St. John, M.D., medical director of the Cardiac Catheterization Lab at Baptist Hospital; and Ramon Lloret, M.D., medical director of Clinical Cardiology.

 

“The idea is that with a single phone call a group of  four or so specialists (the shock team) can be brought together to discuss the care of a patient in cardiogenic shock,” says Dr. St. John.

Creating the ‘Shock Team’

 

Dr. St. John recounts how the idea for this team was launched. In 2018, a Miami Cardiac & Vascular Institute committee of doctors and administrators from Baptist Hospital and South Miami Hospital developed an algorithm to try to standardize and optimize the management of a patient with a heart attack complicated by cardiogenic shock, he explains.

 

“This year, Dr Sandra Chaparro, who is an advanced heart failure specialist and new addition to the cardiology group, recognized an opportunity to further improve the process and utilization of the algorithm by having a shock team,” said Dr. St. John. “With her input, as well as input from Dr. McGinn and many of the interventional cardiologists, a shock team process was put in place.”  

 

Treatment for cardiogenic shock can include medicines, heart procedures, and medical devices to support or restore blood flow in the body and prevent organ damage. Because this is a serious medical condition affecting multiple body organs, a team of medical specialists usually provides care.

 

A heart attack is the most common cause because it can damage the heart’s structure in different ways. Less often, a problem elsewhere in the body blocks blood flow coming into or out of the heart and leads to cardiogenic shock. 

You can reduce your risk for cardiogenic shock by adopting heart-healthy lifestyle changes, including proper diet and regular exercise, to help prevent heart disease, or underlying risk factors such as high blood pressure, high cholesterol or diabetes. If you already have heart disease or another heart condition, follow your doctor’s instructions about taking care of your health, getting regular check-ups, and taking prescribed medicines to treat high blood pressure or other conditions.

 

Signs and Symptoms of Cardiogenic Shock

The most common signs of cardiogenic shock are: Low blood pressure, which can make you feel dizzy, confused and nauseous

Weak or irregular pulse. Adds Dr. Chaparro: “Sometimes the symptoms can be unspecific and vague such as weakness, fatigue, nausea, vomiting, or abdominal pain.”

Other signs and symptoms of cardiogenic shock may include:

•Breathing problems, including rapid breathing and severe shortness of breath

•Bulging of large veins in the neck

•Clammy skin

•Cold hands and feet

•Loss of consciousness

•Swelling of feet

•Urinating much less than usual or not at all

•Any of these alone is not likely to be a sign or symptom of cardiogenic shock.