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cardio - veronica92 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: cardio - veronica92 (/showthread.php?tid=193419) |
cardio - veronica92 - ArchivalUser - 06-10-2007 S 51 yr old man is undergoing abdominal surgery and becomes hypotensive while under general anesthesia. The patient had been doing well during most of the procedure but now has a blood pressure of 80/40 mm of Hg. His past medical history is significant for coronary artery disease and diabetes mellitus. A pulmonary artery catheter placed prior to the procedure gives the folowing data: Central venous pressure 10mmHg Pulmonary artery pressure60/30mmHg Pulmonary capillary occlusion pressure 24mm Hg Cardiac output 2.3L/min Which of the following is the most likely diagnosis? a acute left heart failure b Acute mitral regurgitation c. Acute right heart failure d Hypoxic pulmoary vasoconstriction e Sepsis syndrome 0 - ArchivalUser - 06-10-2007 Normal CVP is 2-6 mm Hg . in this case it is elevated which may indicate Rt heart pathology or increased pressure in the pulmonary artery( which is elevated here]. DDD 0 - ArchivalUser - 06-10-2007 I think D may be a 2ndary to C + Hx of CAD + DM --So I say C 0 - ArchivalUser - 06-10-2007 CC 0 - ArchivalUser - 06-10-2007 The ans is a..the pat has high filling pressure and low cardiac output..thereby indicating cardiogenic shock. Cardiogenic shock could be due to a variety of reasons but the end result is left ventricular failure. This accounts for the secondarily high right sided pressures and filling pressures( left sided failure causes right sided failure). 0 - ArchivalUser - 06-11-2007 a... just look for Pulmonary capillary occlusion pressure 24mm Hg... which is high. so cardiogenic shoch , here, it is dueo to LVF. 0 - ArchivalUser - 06-11-2007 is Pulm Cappilary occlusion pressure sam as PCWP? |