Obstructive Shock

What is obstructive shock?

With any type of shock, your entire body can’t get enough blood flow, which means it can’t get enough oxygen. With obstructive shock, something is obstructing or getting in the way of blood going into and out of your heart or great vessels (major blood vessels connected to your heart). This obstruction can quickly lead to a huge drop in blood pressure and the amount of blood your heart is able to pump. The shortage of oxygen this creates affects all of your organs.

Obstructive shock is an emergency. You need treatment right away.

What is the difference between cardiogenic shock and obstructive shock?

Both are medical emergencies, but they have different causes.

With cardiogenic shock, your heart is unable to meet your body’s metabolic demands due to a problem with your heart muscle itself. This occurs most commonly after a heart attack stuns or permanently injures a large portion of your heart muscle, resulting in poor output.

With obstructive shock, there’s also poor cardiac output. However, your heart muscle itself is often fine, but some other process that impairs heart performance interferes with it. Examples include:

• A large blood clot in your pulmonary artery.
• Fluid around your heart.
• High pressures in your chest because of a lung injury such as a tension pneumothorax.

How common is obstructive shock?

Obstructive shock is a rare type of shock, making up about 1% or 2% of shock cases. It has a higher survival rate than the more common types of shock.

How does obstructive shock affect my body?

If obstructive shock is not treated quickly, it can keep your major organs from getting the oxygen and nutrients they need. This can lead to organ damage and can be fatal. Quick treatment is very important to limit the damage that a lack of oxygen can cause.

What are the symptoms?

Symptoms can be similar to cardiogenic shock symptoms. Obstructive shock symptoms include:

• Unusually fast breathing.
• Hypotension (low blood pressure).
• Tachycardia (fast heart rate).
• Altered consciousness.
• Very little pee output.
• Cool, clammy skin.
• Subcutaneous emphysema (air under your skin).
• Chest or abdominal pain.

What causes obstructive shock?

Causes of obstructive shock include:

• Tension pneumothorax (collapsed lung).
• Vena cava compression syndrome (a large blood vessel that gets compressed).
• Pulmonary (lung) compression syndrome.
• High-PEEP (positive end-expiratory pressure) ventilation (pressure in your airways after the ventilator exhales).
• Tumors.
• Thromboembolism (clot) in the pulmonary artery.
• Pericardial tamponade (excess fluid around your heart compresses it).
• Aortic dissection (a rip in your aorta).
• Aortic stenosis (the opening to your aortic valve gets narrow).
• Hypertrophic cardiomyopathy (thickened heart muscle causes obstruction of flow out of your heart).
• Constrictive pericarditis (the sac around your heart gets thick).

How is obstructive shock diagnosed?

Your healthcare provider will do a physical exam that includes listening to your heart and lungs with a stethoscope. A quick diagnosis is important because obstructive shock gets worse quickly.

What tests will be done to diagnose obstructive shock?

Your provider will diagnose obstructive shock with:

• Ultrasound.
• Echocardiogram.
• Computed tomography (CT).
• Electrocardiogram (EKG).

How is obstructive shock treated?

After giving you IV fluids and checking your blood pressure and oxygen level, your healthcare provider will need to treat the cause of your obstructive shock.

Possible obstructive shock treatments include:

• Removing an embolism with surgery or a catheter.
• Replacing a severely narrowed aortic valve.
• Reducing heart muscle wall thickness, either with surgery or catheter-based alcohol ablation.
• Dissolving a blood clot.
• Draining or relieving a pericardial tamponade or tension pneumothorax.
• Adjusting your ventilation if needed.
• Changing your body position for vena cava compression syndrome.
• Decompressing high lung pressures with a needle or tube.

What medications are used?

Your provider may give you:

• IV crystalloid fluids (such as saline).
• Norepinephrine (Levophed®).
• Vasopressin (Vasostrict®).
• Phenylephrine (Vazculep® or Biorphen®).
• Blood products (red blood cells, plasma).

How soon after treatment will I feel better?

Many of the treatments for the causes of obstructive shock must be done quickly to give you the best chance of survival. Fortunately, these treatments work fairly quickly. Still, it will take time for your body to recover from the effects of obstructive shock after your provider treats the cause of it.

Outlook for obstructive shock

Obstructive shock is fatal for most people who don’t get treatment. How well you do after treatment will depend on:

• What caused your obstructive shock.
• How long it takes to get treatment.
• Your other medical problems.
• How well the treatment works for you.

Obstructive shock has a higher survival rate than more common types of shock, such as septic shock.

How do I take care of myself?

After your healthcare provider discharges you from the hospital, you should follow their instructions for taking care of yourself. You may need to rest at home for a while before going back to work. Be sure to keep taking any medicines your provider ordered for you.

When should I see my healthcare provider?

Keep going to any follow-up appointments and contact your provider if anything changes with your condition.

When should I go to the ER?

Learn to recognize the signs of the problem that caused your obstructive shock in case it happens again. When you see those symptoms or your family sees them in you, you or they should call 911.

What questions should I ask my doctor?

• How long will I need to keep taking the medicines you prescribed?
• In my specific situation, what are the chances this will happen again?
• Will this have a long-term effect on my quality of life?

A note from Cleveland Clinic

Obstructive shock is a rare but serious condition that requires immediate treatment. Once your healthcare provider finds the cause of your obstructive shock, they can work on the problem. Many people can survive obstructive shock, but most likely need time to recover. Take care of yourself and follow your provider’s instructions.