Shock Solution 5

Clinical Scenario 5

A 63 year old male is admitted to the coronary care unit for thrombolysis following an anterior wall myocardial infarction. Eight hours after admission, and apparent resolution of ischemia, his blood pressure falls precipitously, his pulse rises to 140, his pulse oximeter registers a SpO2 of 88%. On examination, his lung fields are clear, his heart sounds are inaudible and his jugular veins are distended and a pulsation can not be identified.

The differential diagnosis is left ventricular failure, pneumothorax, valvular incompetence or cardiac tamponade. The latter is the most likely scenario, presumably as a result of cardiac rupture. The pericardium has filled with blood and this is externally compressing the heart, causing inflow obstruction. Drainage of the pericardium is urgent.

Dx: cardiogenic shock due to inflow obstruction