This patient with a history chronic hypertension is most likely suffering from left heart failure (decreased cardiac outpout), causing the blood to back up in the lungs (Crackles are heard bilaterally, shortness of breath) and that resulting into increased afterload for the right side of the heart, raising the pressure in the right heart chambers, which get transmitted back to central vein.
cassdawgThe way I approached the question was a little different: I realized it was heart failure and left would cause lung backup and right the venous backup. When addressing the +6
cassdawg*the question my thinking was CO = HRxSV; in heart failure we are not pumping as much blood so lower SV (and on top of that his HR is not increased and I think the low blood pressure indicates decompensated heart failure) so CO is definitely lowered. Then CVP would have to be increased because that is how we get the edema (and backup into the venous system increases CVP). +1
chaosawaits@cassdawg, I approached it very similarly. The best immediate indicator that this is cardiogenic shock is the pulse pressure (30 mmHg). Normal PP = 40-60 mmHg. Therefore, you know that CO has been compromised. The edema indicates that CVP (measurement of the venae cavae BP)has increased.+
an1because this guy has crackles and ankle edema, we know that there is LHF AND RHF respectively. the most common cause of RHF is actually LHF. So crackles mean that fluid is accumulating in the lung. Where will it back up? RV and RA causing increased CVP. Crackles mean LHF, and the the LV isn't working well, the cardiac output will decrease for sure+
submitted by metformality(15)
This patient with a history chronic hypertension is most likely suffering from left heart failure (decreased cardiac outpout), causing the blood to back up in the lungs (Crackles are heard bilaterally, shortness of breath) and that resulting into increased afterload for the right side of the heart, raising the pressure in the right heart chambers, which get transmitted back to central vein.