jump to exam page:
yousif7000
ummmm choice D has the same values but different PCWP so you gotta know the PCWP! I don't know what are you talking about, have a look again at the choices
+1
fatboyslim
I think OP mistook adding his input for a different, but similar, question that was asking about PVR. PVR is not the same as PCWP, that's why I think his input is misplaced.
+
giggidy
Depends on where the infarct is I guess? Crackles in lung base means increased left sided pressure and therefore PCWP. At least that's how I thought of it.
+13
titanesxvi
Because think the circulation as a closed circuit, in this case the heart isn't pumping well and the pressure is going to backup. that is why the PCWP is increased
+4
mw126
It depends if the patient goes into heart failure because of the infarct or whatever the insult is. The crackles in the lungs gave it away. If crackles are present then there is blood backing up. the increased pressure in the pulmonary vasculature causes leaking into the alveoli which we hear as crackles when the lung expands.
+1
cheeseheadkids
If it was a posterior MI (or even an inferior MI, assuming its right sided dominant) this would affect the posterior descending artery which provides block to the right ventricle and the posteromedial papillary muscle. This would ultimately cause blood to fill up in the right ventricle and decrease blood being pumped to the lungs and to the LA leading to a decrease in PCWP. There is a good UWorld question with the explanation of this exactly but Im not entirely sure what the question number is.
+2
hunter_dr
Because of the decrease in Cardiac Output, alot of blood stayed back in the heart, which increases the PCWP --> LA pressure
+
davidw
If the Infarct was on the right side they you would have a decrease in PCWP
+1
usmile1
yes exactly. Cardiogenic shock always has decreased CO and increased SVR. PCWP is the tricky part. If its right sided, there isn't enough blood making it to the LA (which is what PCWP measures) thus PCWP would decrease. If it is left sided, as indicated in this question by the crackles in the lungs, the blood is backing up in the left side of the heart so the PCWP would go up.
+9
submitted by โtea-cats-biscuits(273)
Patient has cardiogenic shock, specifically the LV since itโs an anterior wall MI isnโt pumping. Honestly you donโt need to know what happens to PVR to answer correct since the only choice that has increased SVR and decreased PCWP is the one w/decreased PVR. Iโm not absolutely sure if you could figure it out given the values in cardiogenic shock. The equation linking the values is:
PVR = (pulmonary arterial pressure - wedge) รท CO