Case 2:

63-year old woman presented with central chest pain of two hours duration. On examination her blood pressure was 90/60 mm Hg, she had a weak pulse, distended neck veins with elevated jugular venous pressure, normal first and second heart sounds and lung fields were clear on auscultation.

Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

 

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Question 9 of 17:

As this patient's jugular venous pressure is elevated, intravenous fluids such as normal saline should not be administered to treat the hypotension.

You clicked 'False'

Correct!

Volume loading with normal saline is the first critical step in the management of hypotension associated with right ventricular ischemia. Volume loading with normal saline alone often resolves the hypotension and improves cardiac output (1).

In some cases, however, volume loading can further elevate right sided filling pressure and increase right ventricular dilatation resulting in decreased left ventricular output (2).

 

Reference:

1. Goldstein JA, Vlahakes GJ, Verrier Ed et al. Volume loading improves low cardiac output in experimental right ventricular infarction. J Am Coll Cardiol 1983;2:270-278

2. Dell'Italia LJ, Starling MR, Blumhardt R, Lasher JC, O'Rourke RA. Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction. Circulation 1985;72:1327-1355.

 
 
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