In a post-operative ICU patient with hypotension, haemodynamic monitoring shows cardiac index 1.6 L/min/m2, pulmonary capillary wedge pressure 22 mmHg, and systemic vascular resistance 1900 dynes.s/cm5. Which shock state do these values define?

• A Hypovolaemic shock
• B Septic (distributive) shock
• C Cardiogenic shock ✓
• D Neurogenic shock

Explanation

Cardiogenic shock shows low cardiac index (below 2.2 L/min/m2), high wedge pressure (above 18 mmHg reflecting pulmonary congestion), and high SVR from compensatory vasoconstriction. In hypovolaemic shock the wedge pressure is low because filling pressures are depleted, and in septic shock the SVR is low with a normal to high cardiac output. These three patterns form the classic haemodynamic discrimination table.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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