This patient presents with chest pressure at rest and an anterior ST segment elevation myocardial infraction (STEMI) seen on 12-lead EKG. This patient should be given aspirin, IV fluids to increase the preload status, and receive immediate coronary reperfusion therapy. This patient’s hypotension is likely due to infarction of the left ventricle causing poor cardiac output (Choice D). This is known as cardiogenic shock. The patient has been vomiting, but the acute onset of symptoms and STEMI on EKG make poor cardiac output (Choice D) more likely than hypovolemia (Choice A) as the cause for the patient’s condition. Systemic infection (Choice B) and pulmonary embolism (Choice C) are also less likely given the clinical information in the case and the STEMI on EKG. The best answer is Choice D. Please see the chart below for further detailing of the different types of shock.
- Morgenstern J. (2015). An approach to undifferentiated hypotension. First10EM. Retrieved from https://first10em.com/undifferentiated-hypotension/
- Nickson, C. (2021). Acute coronary syndromes. Life in the Fast Lane. Retrieved from https://litfl.com/acute-coronary-syndromes/
- Pickens, A. (2018). EM in 5: Shock. EMDocs. Retrieved from http://www.emdocs.net/em-in-5-shock/
- Richards JB & Wilcox SR. (2014). Diagnosis and management of shock in the emergency department. EB Medicine, 16(3), 1-24. Retrieved from https://www.cmua.nl/Cmua/Inwerken_files/0314%20Shock.pdf