COVID-19-associated cardiogenic shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Alieh Behjat, M.D.[2]

Synonyms and Keywords: : Novel coronavirus, COVID-19, Wuhan coronavirus, coronavirus disease-19, coronavirus disease 2019, SARS-CoV-2, COVID-19, 2019-nCoV, 2019 novel coronavirus, cardiovascular finding in COVID-19, cardiogenic shock, COVID-19 associated cardiogenic shock


The first confirmed instance of cardiogenic shock due to COVID-19 infection through myocardial infiltration by viral particles was in a 69-year-old patient from Italy. This was confirmed via biopsy. Since then, the two most probable mechanisms of cardiogenic shock related to COVID-19 are direct invasion and cytokine storm. According to a recent study out of an ICU in Washington state, one-third of critically ill patients with COVID-19 had clinical signs of cardiogenic shock and cardiomyopathy. According to another observational study in China, COVID-19 associated cardiogenic shock has a poor prognosis.

Historical Perspective

To view the historical perspective of COVID-19, click here.



The two most likely mechanisms that contribute to COVID-19 cardiogenic shock are: [5] [6]


Common causes of cardiogenic shock in patients with covid-19 include:[7]

The causes of cardiogenic shock related to COVID-19 may include: [8] [9]

Differentiating COVID-19 associated cardiogenic shock from other Diseases

Cardiogenic shock related to COVID-19 must be differentiated from other diseases which include: [10] [11]

Some hemodynamic parameters would help differentiate significant types of shock: [12]

Cardiac Output Pulmonary Capillary Wedge Pressure Systemic Vascular Resistance Pulmonary artery diastolic pressure SVO2
COVID-19-associated cardiogenic shock ↑↔
Septic shock
Hypovolemic shock

Epidemiology and Demographics




Risk Factors

  • There are no established risk factors for COVID-19-associated cardiogenic shock.
  • To view risk factors for the severe form of COVID-19 disease, click here.
  • Moreover, in order to read more on the risk factors of cardiogenic shock, generally, click here.


Natural History, Complications and Prognosis


Diagnostic Study of Choice

To view cardiogenic shock diagnostic criteria, click here.

History and Symptoms:

  • A 69-year-old patient from Italy has been reported by Tavazzi et al., as a COVID-19-associated cardiogenic shock case.

Physical Examination

Physical examination findings that may be of note for the diagnosis of Covid-19 associated cardiogenic shock include:[17]

Laboratory Findings

  • In addition, the increase of some biomarkers demonstrates poor prognosis, increased mortality, and more severe symptoms in COVID-19 patients:[19]



Echocardiography or Ultrasound

CT scan

  • Generally, aCT scan is not suggested as a primary imaging study for evaluating a case of cardiogenic shock related to COVID-19. However, it can useful for observing coexisting ARDS by demonstrating a ground-glass opacity.[21]

To view the CT scan findings on COVID-19, click here.


To view the MRI findings on COVID-19, click here.

Other Imaging Findings

  • To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies

  • To view other diagnostic studies for COVID-19, click here.


Cardiogenic shock medical therapy:

The maistay of therapy of cardiogenic shock in covid-19 patients is respiratory and circulatory support. (doi:10.1016/j.rec.2020.04.012)

Mechanical Support:

  • In treating patients with cardiogenic shock related to COVID-19, the efficacy of extracorporeal membrane oxygenation (ECMO) is indistinct, however it may be used in the most critically ill and highly selective patients.
  • Although specialists implicate ECMO and mechanical circulatory support devices in severe cased of COVID-19 related cardiogenic shock, the mortality rate if high in those patients who undergo this treatment.
  • It has been reported in a case series from China, that most of these patients had a poor prognosis and did not survive despite implicating ECMO. [23] [15]


Primary Prevention

For primary preventive measures of COVID-19, click here.

Secondary Prevention

  • There are no established measures for the secondary prevention of COVID-19-associated myocarditis.

For secondary preventive measures of [COVID-19], click here.


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