To diagnose cardiogenic shock, your doctor will usually do tests after you have been admitted to the hospital for a possible heart attack or for symptoms of shock.
Medical history
Your doctor will ask you or your family members about your medical history, especially any symptoms of a heart attack before you became ill. Your doctor will also want to know about any medicines you are taking.
Physical exam
During a physical exam your doctor may:
- Check your hands and feet for cold temperature or swelling.
- Check your pulse. If your heart cannot pump strongly, your pulse may be weak and rapid. If cardiogenic shock was caused by doses of heart medicines that were too high, your pulse may be normal or slow.
- Listen to your heart and lungs with a stethoscope for unusual sounds or heart rhythms.
- Measure how much you urinate to check how well your kidneys are working.
- Measure your blood pressure. Low blood pressure that does not return to normal on its own is a sign of cardiogenic shock.
Diagnostic tests and procedures
Your doctor may order one or more of the following tests and procedures to diagnose cardiogenic shock.
Chest X-ray
A chest X-ray is a fast and painless imaging test to look at the structures in and around your chest.
This test can help diagnose and check conditions such as pneumonia, heart failure, lung cancer, tuberculosis, sarcoidosis, and lung tissue scarring, called fibrosis. Doctors may use chest X-rays to see how well certain treatments are working and to check for complications after certain procedures or surgeries.
The test may be done in the doctor’s office, clinic, or hospital. You will stand, sit, or lie still for the test.
Chest X-rays have few risks. The amount of radiation used in a chest X-ray is very small. Talk to your provider if you are or could be pregnant.
Coronary angiography
Coronary angiography is a procedure that uses contrast dye, usually containing iodine, and X-ray pictures to detect blockages in the coronary arteries that are caused by plaque buildup. Blockages prevent your heart from getting oxygen and important nutrients.
This procedure is used to diagnose heart diseases or after abnormal results from tests such as an electrocardiogram (EKG) or an exercise stress test. If you are having a heart attack, coronary angiography can help your doctors plan your treatment.
Coronary angiography is often done in a hospital. You will stay awake, but you will get medicine to relax you during the procedure. Often, coronary angiography is done with a cardiac catheterization procedure. For this, your doctor will clean and numb an area on the arm, groin or upper thigh, or neck before making a small hole in a blood vessel. Your doctor will insert a catheter tube into your blood vessel. Your doctor will take X-ray pictures to help place the catheter in your coronary artery. After the catheter is in place, your doctor will inject the contrast dye through the catheter to highlight blockages and will take X-ray pictures of your heart. If blockages are detected, your doctor may use percutaneous coronary intervention, also known as coronary angioplasty, to improve blood flow to your heart.
After coronary angiography, your doctor will remove the catheter and close and bandage the opening on your arm, groin, or neck. You may develop a bruise and soreness where the catheter was inserted. You will stay in the hospital for a few hours or overnight. During this time, your healthcare team will check your heart rate and blood pressure.
Coronary angiography is a common procedure that rarely causes serious problems. However, as with any procedure involving the heart, there is some risk. These risks include bleeding, allergic reactions to the contrast dye, infection, blood vessel damage, arrhythmias, and blood clots that can trigger a heart attack or stroke. The risk of complications is higher in people who are older or who have chronic kidney disease or diabetes.
Echocardiography
Echocardiography, or echo, is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart and how well your heart is pumping blood. A type of echo called Doppler ultrasound shows how well blood flows through your heart's chambers and valves.
The illustration shows a patient having echocardiography. The patient lies on his left side. A sonographer moves the transducer on the patient’s chest, while viewing the echo pictures on a computer.
Echo can detect blood clots inside your heart, fluid buildup in the pericardium (the sac around the heart), tumors, and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body. Echo also can help your doctor find the cause of abnormal heart sounds, such as heart murmurs. Your doctor also might use echo to see how well your heart responds to certain heart treatments.
Electrocardiogram (EKG or ECG)
An electrocardiogram, also called an ECG or EKG, is a simple, painless test that detects and records your heart’s electrical activity. An EKG can show how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart. You may have an EKG as part of a routine exam to screen for heart disease.
An EKG may be recorded in a doctor’s office, an outpatient facility, in a hospital before major surgery, or as part of stress testing. For the test, you will lie still on a table. A nurse or technician will attach up to 12 electrodes to the skin on your chest, arms, and legs. Your skin may need to be shaved to help the electrodes stick. The electrodes are connected by wires to a machine that records your heart’s electrical activity on graph paper or on a computer. After the test, the electrodes will be removed.
An EKG has no serious risks. EKGs don’t give off electrical charges such as shocks. You may develop a slight rash where the electrodes were attached to your skin. This rash usually goes away on its own without treatment.
Other tests may give your doctor important information.
- Blood gas tests that check the amounts of oxygen and carbon dioxide in the veins and arteries
- Blood tests that check how well the heart, liver, and kidneys are working and look for increased lactate, or lactic acid, levels
- Other heart imaging tests that look for heart disease or problems with how well the heart or its valves are working