Which of the following best describes the hemodynamic profile of neurogenic shock?

• A. Hypotension with bradycardia
• B. Hypertension with tachycardia
• C. Hypotension with tachycardia
• D. Hypertension with bradycardia

Answer: (A)

Neurogenic shock is defined by loss of sympathetic nervous system tone after a high spinal cord injury or other disruption, which causes widespread vasodilation and pooling of blood in the venous system. With the sympathetic input to the heart impaired, the heart loses its usual stimulatory drive and the parasympathetic (vagal) influence remains, so heart rate tends to be slow. This combination produces hypotension from reduced systemic vascular resistance and decreased venous return, along with bradycardia from unopposed vagal activity.

So the best description of its hemodynamic profile is low blood pressure coupled with a slow heart rate. The other patterns—high blood pressure with rapid heart rate, or low blood pressure with a fast heart rate, or high blood pressure with slow heart rate—don’t fit the typical loss of sympathetic tone and unopposed parasympathetic activity seen in neurogenic shock.