34 years old male was brought to the emergency in shock with blood pressure of 60/50 mmHg with more than 12 mmHg drop of systolic blood pressure during inspiration and barely palpable radial pulse with a rate of 100 beats per minute. His coronary angiogram was normal. Since he underwent this procedure, he felt unwell and had a very tight chest and was short of breath. While you were resuscitating him you have noticed that his Jugular venous pressure is distended. Eventually the patient was intubated and started on intravenous fluids and positive inotropic medicines at the same time an immediate trans thoracic echocardiogram was done and showed huge pericardial effusion and distended inferior vena cava during diastole. What is the most likely cause of his shock?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Obstructive shock due to cardiac tamponade
After a coronary angiogram (iatrogenic cause) he has hypotension, pulsus paradoxus (>10-12 mmHg inspiratory drop), distended JVP and a huge pericardial effusion with a plethoric IVC — this is cardiac tamponade, which produces obstructive shock. Pulmonary embolism would not explain the effusion, and hypovolaemic shock would give flat neck veins.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Cardiac wall rupture is listed as a cause of hemopericardium (blood in the pericardial space), which leads to tamponade, an obstructive picture, not a separate hypovolemic shock.
✓ CARDIOLOGY - PERICARDIAL DISEASES.pdf · p. 6 -
B
ليش غلط
PE causes obstructive shock through high afterload (pulmonary artery occlusion raising pressure behind the clot). The echo here shows a huge pericardial effusion, the preload-type cause (tamponade).
✓ 14• Shock [Notes].pdf · p. 2 -
C
ليش صح
Tamponade (pericardial fluid compressing the heart) gives hypotension, distended neck veins, pulsus paradoxus and obstructive shock; here a huge effusion followed a procedure.
✓ CARDIOLOGY - PERICARDIAL DISEASES.pdf · p. 7 -
D
ليش غلط
Septic shock is distributive: systemic infection releases cytokines that cause vasodilation and capillary leak, presenting with fever and leukocytosis. It does not explain a huge pericardial effusion with distended IVC.
✓ 14• Shock [Notes].pdf · p. 3 -
E
ليش غلط
Hypovolemic shock comes from lost plasma or blood volume (for example AAA rupture, GI bleed or trauma), which lowers venous return. It does not explain distended neck veins with a huge pericardial effusion.
✓ 14• Shock [Notes].pdf · p. 1
- المصدر
- CARDIOLOGY - PERICARDIAL DISEASES.pdf · p. 7
Step Up To Medicine 6th(Pericardial disease).pdf · p. 7 - المحاضرة
- Pericardial Disease · Cardiology · Module B
- ظهر في
- Cardio bank