49F with PMHx non-Hodgkin’s lymphoma and severe GERD is admi…
49F with PMHx non-Hodgkin’s lymphoma and severe GERD is admitted with multifactorial distributive (septic) and cardiogenic shock. Work-up reveals an EF of 13% by echocardiogram and vegetation on the mitral valve. Physical exam reveals: Neuro: atraumatic, PERRLA, + cough + gag, moves all extremities, + commands. Obvious dental erosion. Pulm: bilateral fine crackles and diminished bases Cardiac: regular rate and rhythm, no murmurs, rubs or gallops GI: soft, nontender, + bowel sounds Ext: +1 BLE pulses, +1 BLE pitting edema Common things being common, the nurse knows the most likely explanation for her shock is:
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