A previously healthy 58 years old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Inseion of a pulmonary aery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge-4 mm Hg; pulmonary aery- 22/4 mmHg: and mean right atrial- 11 mmHg. This man would best be treated with :
Correct Answer: Fluids
Description: Answer is A (Fluids) The man in question has a right ventricular infarction as indicated by signs of low cardiac output and shock following an inferior MI. The fact that right atrial pressure is elevated out of propoion to left atrial pressure almost confirms the iffagnosis. Therapy consists of volume expansion or fluid loading to maintain adequate RV preload. Pulmonary Aery pressure 22/4 mmHg Represent Right Atrial pressure Pulmonary Capillary Wedge pressure 4 mmHg Represents Left Atrial pressure Cardiac output is depressed due to an insufficient left hea tilling pressure. The best treatment consists of administration of fluids.
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