We read with interest the national consensus document for the diagnosis, risk stratification and treatment of patients with pulmonary thromboembolism (PTE).1 The prognostic stratification of PTE patients is based on their hemodynamic status, and patients with hypotension (sustained systolic blood pressure less than 90mmHg) or cardiogenic shock are considered high risk. The recommended treatment for cardiogenic shock is the administration of fibrinolytics.

The term “shock” describes a clinical situation with circulatory failure causing hypoperfusion and hypoxia.2 We are indebted to Dr Max Harry Weil3 for his major contribution to the understanding of the physiopathology of shock and his proposed classification of stages of shock, published in the early 1970s.4 There are 4 potential, non-exclusive, forms of shock: hypovolemic, cardiogenic, obstructive and distributive (mainly associated with sepsis and anaphylaxis). Cardiogenic shock occurs as a consequence of heart failure associated with diminished cardiac output. It can be caused by acute myocardial infarction, end-stage myocardial or valve disease, myocarditis or arrhythmias.5 Obstructive shock is less common and comprises different entities: pulmonary embolism, cardiac tamponade, aortic dissection and tension pneumothorax. The basic mechanism is increased afterload.3 Our understanding is that the correct denomination would be obstructive shock, or simply shock.

Nevertheless, the clinical presentation of pulmonary embolism can be similar to that of cardiogenic shock, and some authors consider the first as a form of the second. Indeed, there is no agreement on the denomination in the 2 referenced guidelines on the treatment of thromboembolic disease1 from the American College of Chest Physicians and the National Institute for Health and Clinical Excellence. The former only refers to the term “shock”, while the latter calls it cardiogenic shock. Irrespective of how this entity is called, there is no doubt that the new consensus document is of invaluable help in patient management.