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A 42-year-old woman with a history of active bre - elbamaritza
#1
A 42-year-old woman with a history of active breast cancer presents with acutely worsening dyspnea. Physical exam reveals tachycardia, hypotension, elevated jugular venous pressure, and distant heart sounds. An EKG shows electrical alternans. Pulsus paradoxus is performed and is 20 mm Hg. A chest x-ray reveals a large cardiac silhouette. A two-dimensional echocardiogram confirms a large pericardial effusion with tamponade physiology. All the following are true concerning cardiac tamponade, except:
a) Pulsus paradoxus can be seen in other conditions, such as chronic obstructive pulmonary disease (COPD).
b) Cardiac catheterization will show diastolic equilibration of pressures within the heart.
c) The most specific echocardiographic finding of tamponade is LV collapse.
d) Mechanical ventilation with positive airway pressure should be avoided in patients with tamponade, because this further reduces cardiac output.
e) Electrical alternans is an EKG beat-to-beat change in the QRS axis secondary to swinging of the heart within the fluid-filled pericardium
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#2
d.
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#3
is it C..?
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#4
agree w/ CCC
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#5
yes agree with C
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#6
: c
This patient has cardiac tamponade most likely secondary to metastatic breast cancer to the pericardium. Pulsus paradoxus is defined as an inspiratory systolic fall of blood pressure greater than 10 mm Hg. Other causes include massive pulmonary embolism, hemorrhagic shock, and COPD. Echocardiogram is necessary to confirm and/or diagnose tamponade. Right ventricular collapse is not sensitive but if seen, is specific for tamponade. Right atrial collapse is more sensitive but less specific. Other echocardiogram findings include mitral inflow patterns, which frequently show significant respiratory variation correlating with pulsus paradoxus. Emergent pericardiocentesis is indicated in all patients with signs and symptoms of cardiac tamponade in order to prevent intravascular collapse.

Spodick DH. Current concepts: acute cardiac tamponade. N Engl J Med. 2003; 349:684-690
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#7
YEP ..CCC
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#8
hello Iam new here.
where do you find this questions?nbme?u.w?
thanks
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