02-13-2010, 07:22 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 carcinoma of the lung 10 months ago. He has a history of twice nightly nocturia that has resolved over the past 3 days. He smoked two packs of cigarettes daily for 30 years but quit 1 year ago. His blood pressure is 96/60 mm Hg, and pulse is 116/min. There is jugular venous distention to the angle of the jaw. The lungs are clear to auscultation. Cardiac examination 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. Laboratory studies show:
Hemoglobin 10 g/dL
Serum
Na+ 135 mEq/L
Cl“ 110 mEq/L
K+ 4.2 mEq/L
HCO3“ 22 mEq/L
Urea nitrogen (BUN) 40 mg/dL
Creatinine 1.6 mg/dL
An ECG shows diminished amplitude of the QRS complexes. An x-ray film of the chest shows clear lung fields with an enlarged cardiac silhouette. Which of the following findings is most
likely to be accentuated?
A) Cardiac output
B) Fall in systolic arterial pressure with inspiration
C) Left ventricular end-diastolic pressure
D) Mitral regurgitation
E) Ventricular septal wall motion
