Thu7October1232PM 8

A 58-year-old man is admitted to the coronary care unit (CCU) post anterior myocardial infarction.

On examination you are concerned about him. He is breathless and appears clinically to be in pulmonary oedema. There is also evidence of a new pansystolic murmur.

The central venous pressure is approximately 20 cmH2O, blood pressure 80/50 mmHg. He is currently being treated with boluses of intravenous furosemide. The patient has central access and an arterial line. A cardiac output monitor reveals low cardiac output, low cardiac index and a high systemic vascular resistance.

Which of the following investigations would be most appropriate?

(Please select 1 option)

Chest x ray

Electrocardiogram

Troponin

Transthoracic echocardiogram Correct

Transoesophageal echocardiogram

Explanation

From the examination here it appears that the patient may have ruptured a papillary muscle post myocardial infarction and has proceeded to go into cardiogenic shock. He is demonstrating signs of circulatory failure with a low cardiac output and cardiac index. The jugular venous pressure is high indicating he is in fluid overload.

The pansystolic murmur is likely to reflect an underlying mitral regurgitation. A transthoracic echocardiogram would be sufficient to diagnose this (a transoesophageal echocardiogram is not required).

This is a common occurrence in the CCU setting and needs to be recognised and managed early to reduce morbidity and mortality.

Answer Statistics

1

1%

2

3%

3

1%

4

86%

5

11%

Times answered: 301