Cardiovascular

Shock Types at a Glance

Septic vs Cardiogenic vs Obstructive vs Hypovolemic

Shock Types at a Glance
Feature	Septic	Cardiogenic	Obstructive	Hypovolemic
Mechanism
Mechanism	Vasodilatory state from infection — capillary leak + vasopressor deficiency	Pump failure (MI, myocarditis, arrhythmia, valve)	Mechanical obstruction of filling or output (PE, tamponade, tension pneumothorax)	Intravascular volume loss (hemorrhage, GI/renal losses)
Assessment
Preload	Low–normal (capillary leak)	Often elevated (congested); can be low	High (obstructed filling)	Low
Cardiac output	Normal or high early; may fall late	Low	Low	Low
SVR	Low	High (compensatory)	High	High
CVP	Low	High	High — tamponade: blunted y descent	Low
SvO₂ / ScvO₂	High (impaired extraction)	Low	Low–variable	Low until late
Skin / perfusion	Warm early; cool in late/decompensated phase	Cool, mottled	Cool	Cool, pale
POCUS	Hyperdynamic LV, collapsing IVC; hunt the source	Reduced EF, dilated chambers, B-profile lungs	See obstructive trio comparison	Flat IVC, small hyperkinetic LV; free-fluid sweep
Management
First priorities	Cultures → broad antimicrobials urgently; balanced crystalloid for hypoperfusion; norepinephrine to MAP ≥65; early source control	Support pump (inotrope), treat the cause urgently (revascularization, rate/rhythm, valve) — avoid reflexive fluid stacking	Relieve the obstruction: reperfusion / pericardiocentesis / decompression	Stop the loss + restore volume — blood early if hemorrhagic
Traps & pitfalls
Common traps	Warm skin ≠ stability; delaying source control; ignoring rising lactate	Treating ACS cardiogenic shock that 'looks like sepsis' with more fluid	Fluid-loading tamponade or a failing RV — worsens both	Crystalloid-for-blood substitution in hemorrhagic shock

Comparing: Septic

Mechanism · Mechanism

Vasodilatory state from infection — capillary leak + vasopressor deficiency

Assessment · Preload

Low–normal (capillary leak)

Assessment · Cardiac output

Normal or high early; may fall late

Assessment · SVR

Low

Assessment · CVP

Low

Assessment · SvO₂ / ScvO₂

High (impaired extraction)

Assessment · Skin / perfusion

Warm early; cool in late/decompensated phase

Assessment · POCUS

Hyperdynamic LV, collapsing IVC; hunt the source

Management · First priorities

Cultures → broad antimicrobials urgently; balanced crystalloid for hypoperfusion; norepinephrine to MAP ≥65; early source control

Traps & pitfalls · Common traps

Warm skin ≠ stability; delaying source control; ignoring rising lactate

For healthcare-professional education. Clinical decisions require patient-specific assessment and local protocols.

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