A 45-year-old woman with a history of chronic mitral regurgitation presents to the emergency department with acute onset dyspnea, orthopnea, and pink frothy sputum. She reports palpitations that began 6 hours ago. Vital signs show blood pressure 145/92 mmHg, heart rate 142 bpm and irregularly irregular, respiratory rate 28/min, and oxygen saturation 88% on room air. Cardiac examination reveals a holosystolic apical murmur, prominent S3 gallop, and bibasilar crackles. An ECG shows atrial fibrillation with a rapid ventricular response. Chest X-ray demonstrates bilateral pulmonary edema with an enlarged cardiac silhouette. Which of the following best explains this patient's acute decompensation?
- A)Acute myocardial infarction with papillary muscle rupture
- B)Acute atrial fibrillation with rapid ventricular responseGABARITO
- C)Spontaneous rupture of the chordae tendineae
- D)Acute development of mitral stenosis
- E)Aortic valve endocarditis with aortic regurgitation
Explicação
In a patient with chronic mitral regurgitation, acute decompensation is most commonly precipitated by acute atrial fibrillation with rapid ventricular response. Loss of atrial kick and decreased ventricular filling time result in decreased cardiac output. The ... Ver explicação completa e trilha adaptativa →