Which description best characterizes decompensated shock?

• A. Patient can maintain preload.
• B. Patient can temporarily compensate by increasing heart rate.
• C. Preload is not a concept in shock.
• D. Patient can no longer maintain preload.

Answer: (D)

Decompensated shock is when the body's compensatory mechanisms fail to preserve adequate perfusion, so the heart can no longer be adequately filled and pushed to maintain blood pressure. Preload—the volume of blood returning to the heart during diastole—depends on venous return; during the compensated stage, the body preserves this return through vasoconstriction and tachycardia. When decompensation occurs, those safeguards fail, venous return drops, the end-diastolic volume falls, and cardiac output and perfusion collapse. That’s why the description that best fits decompensated shock is that the patient can no longer maintain preload.