Cardiogenic shock

The Barts Health cardiogenic shock program based on the adult critical care unit (ACCU) on ward 6A at Barts Heart Centre provides 24/7 access to a team of experts including heart muscle specialists and specialist medical and nursing in our cardiac intensive care unit. We provide the most advanced diagnostics, monitoring and therapies, including pumps that can temporarily support the function of the heart.

Most patients with cardiogenic shock require intensive care admission to provide support for their heart, lungs and kidneys. Despite intensive care only around half of patients survive. We work closely with the regional heart transplant centres to support patients who may need a heart transplant to fully recover.

For clinicians

We accept referrals from all hospitals within our catchment of North and East London and Essex, but would be happy to offer support for cases from a wider geographical area on case-by-case basis:

• Please go to the Cardiogenic Shock service Sharepoint page
• Go to “Refer a patient”
• Follow the instructions
• In an emergency call: 0203 594 0440

Other cardiology speciality referral contact numbers

These services can be contacted 24/7:

• Interventional cardiology: 07833 237 316
• Electrophysiology: 07810 878 450
• Heart Failure: 07825 976 924

Service lead: Dr Alastair Proudfoot (cardiac intensive care)

• Heart failure lead: Dr Martin Thomas
• Interventional cardiology lead: Dr Ajay Jain
• ECMO lead: Dr Sachin Shah
• Nursing lead: Clare Mellis
• Research Fellows: Dr Marie Buckel, Dr Ross Thomson, Dr Alex Warren

Email the service

This information is a general guide and does not replace discussions with the medical team caring for your relative.

What is cardiogenic shock?

Cardiogenic shock is a serious condition where the heart is too weak to pump enough blood around the body. Blood carries oxygen and energy to organs like the brain, kidneys, and liver. When the heart cannot pump properly, these organs do not get what they need to work normally. Cardiogenic shock can quickly progress to multi-organ failure and death, needing urgent treatment to diagnose and reverse it.

What causes cardiogenic shock?

Common causes include:

• A heart attack that damages a large part of the heart
• Severe heart failure
• Problems with the heart valves
• Dangerous heart rhythm problems
• Inflammation of the heart muscle (myocarditis)
• Complications after heart surgery

What symptoms and signs might occur?

Because the heart is not pumping well, the body shows signs of poor blood flow. These can include:

• Very low blood pressure
• Cold, pale, or clammy skin
• Fast heartbeat
• Breathing problems or needing oxygen or a ventilator (breathing machine)
• Confusion, drowsiness, or reduced consciousness
• Low urine output (not passing much urine)
• Chest pain (not always present)

Some patients are very unwell and may be sedated (kept asleep) to help their body cope with treatment.

How is cardiogenic shock treated?

Treatment focuses on supporting the heart and other organs while doctors and nurses treat the cause.

Patients are cared for in ACCU (Ward 6A), where they can be closely monitored. This includes:

• Continuous heart and blood pressure monitoring
• Blood tests and scans of the heart (echocardiogram)
• Support for breathing, kidneys, and other organs

Medicines may be given through an intravenous catheter to:

• Help the heart pump more strongly
• Raise blood pressure
• Control heart rhythm
• Remove fluid on the lungs

Treating the cause

Depending on the cause, treatment may include:

• Urgent heart procedures (such as opening blocked arteries)
• Heart valve repair or replacement
• Treating infection or inflammation
• Correcting abnormal heart rhythms

Mechanical Circulatory Support (MCS)

Sometimes medicines are not enough. Doctors may use machines to help the heart pump blood. This is called Mechanical Circulatory Support (MCS). Examples include:

• Intra aortic balloon pump (IABP) - helps the heart pump blood more easily
• Impella - a small pump placed in the heart to move blood around the body
• ECMO - a machine that takes blood out of the body, adds oxygen, and pumps it back in

These machines:

• Do not cure the heart problem
• Are used to buy time so the heart can recover, or further treatment can be planned

Will my relative feel pain or distress?

Doctors and nurses work tirelessly to ensure every patient is as comfortable and pain‑free as possible. For some, this involves receiving strong pain relief to help manage their symptoms. Others may be gently sedated so they can rest, remaining asleep and unaware of any discomfort. Throughout all of this, the care team checks in regularly, carefully monitoring each patient’s comfort levels to make sure their needs are being met.

What is the likely prognosis (outlook)?

Cardiogenic shock is a very serious illness, and recovery can be uncertain. Outcomes vary depending on:

• The cause of the shock
• How quickly treatment started
• Age and overall health
• How other organs (kidneys, brain, lungs) are affected

Possible outcomes include:

• Recovery of heart function (partial or full)
• Ongoing heart failure requiring long term treatment
• Need for long term heart support or transplant (in some patients)
• Sadly half of patients with cardiogenic shock do not survive

The doctors and nurses will be honest with you and update you as the situation changes.

What happens if the heart does not recover?

If the heart does not improve, doctors may discuss:

• Transfer to a regional advanced heart failure centre for assessment for longer term heart support devices or heart transplant (for selected patients)
• Focusing on comfort and quality of life

These decisions are made carefully, with families involved wherever possible.

How can families help?

• Be present if allowed - familiar voices can be comforting
• Ask questions - no question is too small
• Look after yourselves - rest, eat, and accept support
• Speak to the team about emotional or spiritual support if needed

Questions and support

It is normal to feel frightened, confused, or overwhelmed. Please speak to:

• The bedside nurse
• The ACCU doctors
• Hospital support services (the ACCU family liaison nurse, psychology, chaplaincy).

They are there to help both patients and families.

We have an active programme of both clinical and translational research led by consultant in critical care medicine Dr Alastair Proudfoot.

Barts Heart Centre is the lead UK site for the international, multicentre NORshock randomised clinical trial which is testing blood pressure targets in patients with acute myocardial infarction cardiogenic shock.

We contribute to national and international registries with opportunities for access to hypothesis driven research within these registries.

Barts Heart Centre is the host site for the GolDilOCS study, a collaboration between Barts Health, Queen Mary University of London (QMUL) and Oxford University, which is investigating genomic determinants of outcome in cardiogenic shock.

You or your relatives may be approached by a member of the research team whilst an in-patient to discuss opportunities to participate in our research studies.

For research enquiries please contact Dr Alastair Proudfoot.

What is a registry?

A registry record information about the health status and the treatments they receive. Clinical data registries typically focus on patients who share a common reason for needing healthcare. 

How do registries help patients?

There are several registries that record details about patients who suffer from cardiogenic shock. Registries are used to provide information and evidence to:

• help doctors choose the best equipment for patients
  help understand which patients benefit the treatments and monitoring we provide
  help reduce the complications
  give regular feedback to hospitals, doctors and manufacturers about their performance

What information is collected? 

We send details about patients’:

• medical condition(s)
• treatments and monitoring and which equipment was used
• procedures that were performed whilst in hospital
• length of stay in intensive care and in hospital  
• complications that occurred whilst in hospital 

We also send details of the patients’ age, dates of birth and gender.

We do not send the patients’ names, addresses, postcodes or NHS numbers. 

Is the information safe? 

We currently collect data in a local registry at Barts Health. We also share data with registries in Europe and North America. All information is stored securely and anonymously on secure servers. This means it is very difficult to identify individuals. The use of patient data to support registries has been approved by the Caldicott Guardian at Barts Health NHS Trust. They are the person who is responsible for ensuring that all patient data are safe.

What information does the registry provide for patients?

The registries do not give out specific information to patients or members of the public. It is designed to help healthcare professionals learn more about patients with severe heart or lung failure requiring intensive care.

Who can use the data in the registry?

Data in the registry can be used for medical research. The purpose of this research is to improve our understanding about patients with cardiogenic shock. All requests to use the data must be approved by the relevant registry committee. The committee checks that the requests have ethical approval and that the data will remain safe. Any data shared will be the minimum amount possible and anonymised. They will not know which hospital submitted the information.