In late septic shock, what happens to cardiac output?

• A. Increases
• B. No change
• C. Decreases
• D. Fluctuates

Answer: (C)

In septic shock, a progression occurs from a high-output, vasodilated state to a failing heart. In the late stage, inflammatory mediators and endotoxins depress myocardial function, leading to septic cardiomyopathy. This reduces contractility and stroke volume, so even if heart rate remains elevated, the overall cardiac output drops because it’s the product of heart rate and stroke volume. The pervasive vasodilation keeps afterload low, but it can’t compensate for the weakened heart, so tissue perfusion worsens and CO falls. Thus decreased cardiac output is the expected finding in late septic shock.