A 55-year-old man with a long-standing history of coronary artery disease is admitted to the ICU with hypotension following a 24-hour episode of intermittent chest pain. While on an IV nitroglycerine drip, he is free of chest pain. On the second hospital day, he suddenly develops chest pain, shortness of breath, and a change in mental status. A catheter is placed in his pulmonary artery and the following hemodynamic readings are provided: CVP 12 mmHg (0–5 mmHg), PAP 40/15 mmHg (20–25/5–10 mmHg), PCW 18 mmHg (6–12 mmHg), and CO 3.0 L/min (4–8 L/min).
Physical examination Temperature: 38.2°C Heart rate: 140 bpm Blood pressure: 75/45 mm Hg Respiratory rate: 35 bpm The jugular vein pressure is difficult to assess. Auscultation of the lungs reveals bilateral rales. The cardiac examination reveals regular rhythm, a normal S 1 and accentuated S 2 , and a new S 3. The legs are noted to have…
