Physiological Adaptation Q 189
A 23-year-old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6 days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following conditions is the most likely cause of her symptoms?
A. Myocardial infarction due to a history of atherosclerosis.
B. Pulmonary embolism due to deep vein thrombosis (DVT).
C. Anxiety attacks due to worries about her baby's health.
D. Congestive heart failure due to fluid overload.
Correct Answer: B. Pulmonary embolism due to deep vein thrombosis (DVT).
In a hospitalized patient on prolonged bed rest, the most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Most pulmonary embolisms originate as lower extremity DVTs. Hence, risk factors for pulmonary embolism (PE) are the same as risk factors for DVT. Virchow’s triad of hypercoagulability, venous stasis, and endothelial injury provides an understanding of these risk factors.
Option A: Smoking and abnormal apolipoprotein ratio showed the strongest association with acute myocardial infarction. The increased risk associated with diabetes and hypertension were found to be higher in women, and the protective effect of exercise and alcohol was also found to be higher in women.
Option C: There is no reason to suspect an anxiety disorder in this patient. Pregnancy is one of the most important events in women’s lives. Being pleasant, it is one of the most stressful events in a woman’s life, as psychologists have cited, pregnancy as an emotional crisis. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands that it be considered first.
Option D: Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. Heart failure incidence has remained stable over the past decades, with more than 650,000 new cases of heart failure cases diagnosed annually, especially for individuals greater than 65 years of age. Because prevalence is greater in this age group, heart failure prevalence is expected to worsen in the near future.