A 57-year-old man is brought to the emergency department for crushing substernal chest pain at rest for the past 2 hours. The pain began gradually while he was having an argument with his wife and is now severe. He does not take any medications. He has smoked one pack of cigarettes daily for 35 years. He is diaphoretic. His temperature is 37.1°C (98.8°F), pulse is 62/min, respirations are 21/min, and blood pressure is 85/64 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. ECG shows ST-segment elevation in leads II, III, and aVF. Chest x-ray is unremarkable. Emergent cardiac catheterization reveals complete occlusion of the proximal right coronary artery. He is persistently hypotensive in the cardiac catheterization laboratory. Which of the following hemodynamic findings is most likely to be observed in this patient?

Question

A 57-year-old man is brought to the emergency department for crushing substernal chest pain at rest for the past 2 hours. The pain began gradually while he was having an argument with his wife and is now severe. He does not take any medications. He has smoked one pack of cigarettes daily for 35 years. He is diaphoretic. His temperature is 37.1°C (98.8°F), pulse is 62/min, respirations are 21/min, and blood pressure is 85/64 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. ECG shows ST-segment elevation in leads II, III, and aVF.  Chest x-ray is unremarkable. Emergent cardiac catheterization reveals complete occlusion of the proximal right coronary artery.  He is persistently hypotensive in the cardiac catheterization laboratory.  Which of the following hemodynamic findings is most likely to be observed in this patient?

Quizplus · Accepted Answer

Eductional Objective: The dominant right coronary artery perfuses both the inferior wall of the left ventricle and the majority of the right ventricle.  Proximal occlusion can cause right ventricular myocardial infarction, which presents with hypotension (reduced cardiac output) and distended jugular veins (elevated central venous pressures).  The lungs will be clear on auscultation and x-ray (lack of pulmonary edema) unless concomitant left-sided heart failure is also present.

A 57-Year-Old Man Is Brought to the Emergency Department for Crushing