Question

A 27-year-old woman arrives in the emergency department 3 weeks after the vaginal delivery of her first child. She is transferred to the critical care unit after an acute onset of dyspnea and chest pain. Vital signs are blood pressure, 120/88 mm Hg; heart rate, 122 beats/min; and respiratory rate, 32 breaths/min. Arterial blood gases reveal a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of 55 mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by nonrebreathing mask. Jugular venous distention is evident, and cardiac auscultation reveals an accentuated P2 and a right-sided S3 and S4. A ventilation/perfusion scan indicates high probability of a pulmonary embolism. Which of the following is not evident by the heart sound changes?

A. Pulmonary hypertension
B. Right ventricular strain and noncompliance
C. Right ventricular failure
D. Pulmonary edema

Answer 1

The heart sound changes noted in the patient suggest pulmonary hypertension, right ventricular strain and noncompliance, and right ventricular failure, but pulmonary edema is not evident based on these heart sound changes.

Step-by-step explanation:

The question refers to a clinical scenario in which a 27-year-old woman who recently delivered her first child is presenting with signs and symptoms suggestive of a pulmonary embolism (PE). Given her arterial blood gases and the observation of jugular venous distention, an accentuated P2, and a right-sided S3 and S4 on cardiac auscultation, the changes in heart sounds suggest several underlying conditions. An accentuated P2 indicates increased pressure in the pulmonary artery, which is consistent with pulmonary hypertension. A right-sided S3 and S4 are heart sounds that typically suggest right ventricular strain and noncompliance, as well as right ventricular failure. These findings are compatible with the physiological burden of a PE on the right side of the heart. However, pulmonary edema is not directly indicated by these heart sounds.