12-29-2006, 08:27 AM
a 62 year old man comes to the emergency department because of progressive shortness of breath for 3 days. he has not had chest pain, orthopnea, or paroxysmal nocturnal dyspnea. he completed chemotherapy for small cell cancer of the lung 10 months ago. he has a history of twice nightly nocturia that has resolved over the past 3 days. he smoked 2 packs of ciagarettes daily for 30 years, but quit one year ago. his bp is 90/60, pulse is 116/minute. there is jvd to the angle of the jaw. the lungs are clear to auscultation. cardiac exam shows distant heart sounds, an s1 and s2 and no gallops or rubs. the liver has a span of 12 cm and is tender. there is no pedal edema.
hemoglobin is 10 g/dl,
serum na+= 135 meq/l
cl-=110
k+= 4.2
hco3-= 22
bun=40
creatinine= 1.6 mg/dl
an ecg shows diminshed amplitude of qrs . an x/r film of chest shows clear lung fields with an enlarged cardiac silhouette. which findings is most likely to be accentuated?
a) cardiac output
b) fall in systolic arterial pressure with inspiration
c) left ventricular end-diastolic presssure
d) mitral regurgitation
e) ventricular septal wall motion
hemoglobin is 10 g/dl,
serum na+= 135 meq/l
cl-=110
k+= 4.2
hco3-= 22
bun=40
creatinine= 1.6 mg/dl
an ecg shows diminshed amplitude of qrs . an x/r film of chest shows clear lung fields with an enlarged cardiac silhouette. which findings is most likely to be accentuated?
a) cardiac output
b) fall in systolic arterial pressure with inspiration
c) left ventricular end-diastolic presssure
d) mitral regurgitation
e) ventricular septal wall motion