American Board of Surgery Qualifying Exam (ABS QE) Practice Test

During cardiogenic shock, which of the following is NOT anticipated?

1. Increased CVP

2. Decreased CO

3. Decreased PCWP

4. Increased SVR

The correct answer is: Decreased PCWP

In cardiogenic shock, the heart's ability to pump blood effectively is compromised, leading to a series of physiological changes. One of the hallmark features of this condition is the decrease in cardiac output (CO) as the heart struggles to meet the body's metabolic demands due to impaired contractility. Increased central venous pressure (CVP) can be expected because the heart’s decreased ability to pump blood leads to fluid accumulation in the venous system. Similarly, systemic vascular resistance (SVR) tends to increase as a compensatory mechanism to maintain perfusion to vital organs despite the low output situation. Pulmonary capillary wedge pressure (PCWP) reflects left atrial pressure and is typically elevated in cases of cardiogenic shock. This occurs due to the buildup of fluid in the lungs from heart failure, indicating that the heart is unable to manage the volume return properly, resulting in pulmonary congestion. The statement regarding decreased PCWP does not align with the anticipated physiological changes during cardiogenic shock. In this condition, it is actually expected for PCWP to be elevated due to left-sided heart failure and the resulting increased pressures. Therefore, a decrease in PCWP is not consistent with what would be anticipated during cardiogenic shock, marking it as the inaccurate expectation