clinical quiz answer 30/9/2010

A 73-year-old woman collapses on the ward just 24hrs post permanent pacemaker insertion whilst waiting for her daughter to collect her. She had been stable after the procedure, which was performed for collapse and episodes of complete heart block on her 72hr tape. On examination she has a fever of 37.8oC, and is hypotensive at 88/50 mmHg, with a thready pulse of 110/min. Her JVP seems to increase with inspiration.

Investigations;

Hb 10.8 g/dl
WCC 8.8 x109/l
PLT 201 x109/l
Na+ 139 mmol/l
K+ 4.9 mmol/l
Creatinine 120 µmol/l
pH 7.38
pO2 12.1 kPa
pCO2 4.2 kPa


Which of the following is the most likely diagnosis?

Pulmonary embolus

Septic shock

Acute myocardial infarction

Cardiac tamponade


Mitral regurgitation