Key messages

• The causes of hypotension can be categorized as cardiogenic, obstructive, hypovolemic, or distributive.

• The most frequent cause of cardiogenic hypotension is lack of functional myocardium due to coronary thrombosis. Other important causes are structural and mechanical abnormalities of the heart and electrical dysfunction.

• Obstructive hypotension reflects a hemodynamically relevant impediment of blood flow from either extravascular (extrinsic) or intravascular (intrinsic) compartments.

• Categorization of hypovolemic hypotension as being due to either erythrocyte or salt/water loss is important to direct replacement of the right type of fluid.

• Sepsis and the systemic inflammatory response syndrome are the most frequent causes of distributive hypotension and reflect the same pathophysiology, either with (sepsis) or without (systemic inflammatory response syndrome) infection.

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