A patient is brought to the emergency department with a sudden onset of severe shortness of breath, chest pain, and hypotension. A massive pulmonary embolism is strongly suspected. Which of the following is the most direct and immediate pathophysiologic cause of this patient's clinical deterioration?
Systemic inflammatory response syndrome (SIRS) leading to widespread vasodilation.
Bronchoconstriction and mucus plugging resulting in severe hypoxemia.
Left ventricular failure caused by decreased systemic vascular resistance.
Acute right ventricular failure due to a sudden increase in pulmonary vascular resistance.
A massive pulmonary embolism causes a sudden and significant blockage of the pulmonary artery, leading to a rapid increase in pulmonary vascular resistance and pulmonary artery pressure. This imposes an extreme afterload on the right ventricle, which is not conditioned to pump against such high pressures. The result is acute right ventricular dilation, dysfunction, and failure, leading to decreased cardiac output, hypotension, and obstructive shock. While hypoxemia and inflammatory responses occur, the most direct cause of hemodynamic collapse is acute right ventricular failure.
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BCEN CEN
Respiratory Emergencies
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