A 54-year-old man with a long-standing history of coronary artery disease was admitted to the ICU with hypotension following a 24-hour episode of intermittent chest pain. While on an IV nitroglycerin drip, he was free of chest pain. On the second day at the hospital, he suddenly developed chest pain, shortness of breath, and a change in mental status.
A catheter placed in his pulmonary artery that provided the following hemodynamic readings: Central nervous pressure (CVP): 12 mmHg Pulmonary artery pressure (PAP): 40/15 mmHg Pulmonary capillary occlusion wedge (PCW) pressure: 18 mmHg Cardiac output(CO): 3.0 L/min Physical examination Temperature: 38.2 o C Heart rate: 140 beats/minute Blood pressure: 75/45 mmHg Respiration rate: 35 breaths per minute The jugular venous pressure was difficult to assess. The cardiac examination revealed a regular rhythm, a normal S1 and accentuated S2, and…
