zzpearl
Forum Senior
Topics: 51
Posts: 138
|
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
I can not decide between B and C, Is this guy having restrictive cardiomyopathy or Pericarditis / Pericardial effusion? restrictive cardiomyopathy from neoplasia (small cell lung cancer) infiltration would impede ventricular filling and raising cardiac filling pressure from abnormal diastolic function. EKG: low voltage, conduction disturbances, Q waves.
BUT X-ray will have pulmonary congestion, Pericarditis / Pericardial effusion will have pulsus paradoxus, BUT EKG: diffuse ST segment elevation w/ upright T waves, usually have chest pain. ?? Thanks
|
| supra
Forum Elite
Topics: 16
Posts: 334
|
I THINK IT IS B,PERICARDIAL EFFUSION,CXR SHOWING INCREASE IN CARDIAC SILHOUTTE
|
| dr.ayham
Forum Newbie
Topics: 10
Posts: 20
|
B
|
| gingko
Forum Senior
Topics: 13
Posts: 226
|
pericardial metastasis so B..infiltration of myocardium by tumor is very unlikely..classical signs..
hypotension+neck vein engorgment +clear lung fields.the EKG changes u are talking about are characteristic of pericarditis, not effusion
___________________
Old McDonald had an ERAS inbox..with a reject here and a reject there..here a reject, there a reject,everywhere a reject, reject.
|
|
| |
| | | | |
