A patient with substernal chest pain for 30 minutes, hypotension, pale moist skin, and ST elevation in lead III is suspected to have which condition?

• A. Cardiogenic shock
• B. Hypovolemic shock
• C. Anaphylactic shock
• D. Septic shock

Answer: (A)

Cardiogenic shock is the scenario described here. The patient has chest pain consistent with an acute myocardial infarction, and the ECG shows ST elevation, which confirms ischemia/infarction of the heart muscle. When the heart is unable to pump effectively because of a failed infarct, cardiac output falls and tissue perfusion drops, producing hypotension and pale, moist skin from sympathetic vasoconstriction and poor perfusion. An inferior MI (ST elevation in lead III) can involve the right ventricle and worsen hypotension, reinforcing the pump-failure picture of cardiogenic shock.

If the issue were hypovolemia, the problem would be loss of volume rather than an infarct causing pump failure, so the ECG would not show ST elevations related to MI. Anaphylactic shock centers on widespread vasodilation and airway involvement rather than a primary heart pump failure, and septic shock involves infection-related vasodilation and often a different clinical trajectory with fever and possible warm skin early on. The combination of chest pain, ST elevations, and hypotension with signs of poor perfusion specifically points to cardiogenic shock due to myocardial infarction.