Obstructive shock

Obstructive shock
Updated: 06/30/2022
© Jun Wang, MD, PhD

General features
  • Reduced cardiac output due to obstruction of large vessels or heart
  • Similar symptoms to cardiogenic shock, but different treatment
  • Usually clinical diagnosis, based on history and clinical presentations
Etiology
  • Pulmonary vascular
Pulmonary embolism
Severe pulmonary hypertension
Pulmonary or tricuspid stenosis, acute obstruction
  • Mechanical
Tension pneumothorax
Pericardial tamponade
Constrictive pericarditis
Restrictive cardiomyopathy
High-PEEP ventilation
Vena Cava compression syndrome
Cardiac mass 
  • Increased afterload
Aortic dissection
Aortic valve stenosis
Pathophysiology
  • Obstruction of large vessels or heart
  • Impaired diastolic filling
  • Reduced cardiac preload
  • Increased cardiac afterload
Clinical presentations
  • Non specific
  • Presentation associated with underlying cause: cardiac mass, pneumothorax, etc
  • Presentations of hypoperfusion:
Tachycardia
Hypotension
Tachypnea
  • Other findings
Distended jugular vain
Irregular peripheral pulse
Trachea deviation or subcutaneous emphysema: pneumothorax
Altered mental status
Reduced urine output
Additional exams
  • Echocardiogram: heart abnormality or tamponade
  • Image studies: Pneumothorax, pulmonary hypertension, large vessel abnormalities, etc
Management
  • Need immediate treatment
  • Hemodynamic support
  • Treat underlying cause: adjust ventilation, pericardial drainage, thoracic drainage, etc


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