Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A 59-year-old woman comes to the emergency department because of shortness of breath for 2 days. She had stage II breast cancer 5 years ago treated with lumpectomy, radiation, and
chemotherapy. Her temperature is 37.5 C (99.5 F), blood pressure is 90/60 mm Hg, and respirations
are 24/min. Examination shows jugular venous distention. Heart sounds are distant. Which of the following is the most appropriate next step in management?
A) Antibiotic therapy
B) Anticoagulant therapy
C) Intravenous digoxin therapy
D) Intravenous furosemide therapy
E) Chemotherapy
F) Radiation therapy
G) Pericardiocentesis
isnt the right answer D
diagnosis constrictive pericarditis
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Why not G, jvd distention and distant heart sound cardiac tamponed.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
i thought G first as well but then i though radiation therapy to thorax is mostly associated with constrictive pericarditis,so i wanted to know how to rule out constrictive pericarditis?
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Although there is hypotension ,distant heart sound, and raised JVP..but tamponade is a rapid, large effusion. ..radiation is not risk factor for it.
DDDD..contrictive pericarditis
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
that is what i am thinking druzma but most of them think its tamponade.. so really confused with this one
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
but remember malignancy is the most common cause for tamponade and also chest radiation is an etiology for tamponade. Clinical picture overlaps between the two so this sounds like constrictive pericarditis too. but i think what is most important here is that this patient presentation is acute, he develops this two days ago. Constrictive pericartditis takes years to form so I would say G is more reasonable and also remember tamponade is an emergency you can't miss it.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Radiational therapy can induce Dilated cardiomyopathy and then heart failure, so in that context Frusemide would be good choice. But in the question (Heart sounds are distant), which is sign of Pericardial effusion (irrespect of cause of the cause f it : tumor,radiation or others) then i think the answer is G
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
can constrictive pericarditis cause hypotension???
