Coronary Artery Disease - STEMI Case #5 - Question #2

She is taken for coronary angiography, and a large posterior descending coronary artery was found to be thrombotically occluded. This was treated with a drug-eluting stent.

On hospital day three, she becomes suddenly hypotensive with a blood pressure of 60/40 mm Hg and heart rate of 120 beats per minute. Her cardiac physical examination remains unchanged. A pulsus paradoxus of 16 mm Hg is present, and she is still wheezing on examination. She is taken for emergency coronary angiography, and her stent is widely patent. Right heart catheterization shows that the diastolic pressures are elevated and equal. The oxygen saturation measured in the right atrium was 63%, right ventricle 63% and pulmonary artery 65%. There is a small V wave in the pulmonary capillary wedge pressure tracing.

An arterial pressure tracing is below:

pulsus

Which of the following is the likely diagnosis?

A. Acute ventricular septal defect

B. Acute left ventricular free wall rupture

C. Acute mitral valve regurgitation

D. Right ventricular infarction

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