A 58-year-old man presents with crushing chest pain and hypotension. Bedside echo shows severe left ventricular dysfunction with an ejection fraction of 25%. Which haemodynamic profile is expected?

• A High cardiac index, low systemic vascular resistance, low pulmonary capillary wedge pressure
• B Low cardiac index, low systemic vascular resistance, low pulmonary capillary wedge pressure
• C Low cardiac index, high systemic vascular resistance, high pulmonary capillary wedge pressure ✓
• D High cardiac index, high systemic vascular resistance, normal pulmonary capillary wedge pressure

Explanation

Cardiogenic shock is pump failure: the failing ventricle produces a low cardiac index, reflex sympathetic activation raises SVR, and the backed-up left atrium elevates pulmonary capillary wedge pressure above 18 mmHg. Septic (distributive) shock gives high cardiac output with low SVR, which distinguishes option A, while option B resembles late decompensated or hypovolaemic profiles.

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

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