Chapter 32

A patient who is 4 days post–coronary artery bypass surgery reports she is having new chest pain that is “different from my angina pain.” The pain’s onset was 5 or 6 hours ago upon first waking up in the morning. The patient has a new pericardial friction rub and a low-grade fever of 100.5°F. The patient is diagnosed with acute pericarditis.

a. Why was this patient at risk for developing pericarditis?

b. Why is this patient now at risk for cardiac tamponade?

c. What are the signs or symptoms that would be indicative of cardiac tamponade in this patient? What is the underlying pathophysiology of these signs and symptoms?

Chapter 34

A patient who is 48 hours post–mitral valve replacement surgery has become progressively more hypotensive, tachycardic, tachypneic, and restless over the past several hours. You suspect that the patient is going into shock.

a. Since this patient is at high risk for both cardiogenic and septic shock, how would you go about determining what type of shock (if any) is present? Support your approach.

b. What special challenges are associated with trying to treat septic shock in a patient with cardiovascular disease?