40-year-old male underwent liver transplant 20 years ago due to biliary cirrhosis. He is now listed for a redo liver transplant in view of recurrent cirrhosis. He is admitted to the ICU with upper gastrointestinal variceal bleeding requiring massive transfusion. He is intubated and on mechanical ventilation. Bedside echocardiography reveals an ejection fraction of 70% and absence of diastolic dysfunction. Electrocardiogram exhibits sinus tachycardia with a normal QT interval. Chest x-ray appears normal. Patient’s invasive arterial pressure is 100/60 mm Hg and central venous pressure is 8 mm Hg. A pulmonary artery catheter is inserted and the following values are obtained: Cardiac output of 10 L/min, mean pulmonary artery pressure of 30 mm Hg, and pulmonary artery occlusion pressure of 10 mm Hg. This is MOST likely due to:
A. Porto pulmonary hypertension Wrong Choice!
B. Hyper dynamic circulation Correct Choice
C. Transfusion-associated circulatory overload Wrong Choice!
D. Cirrhotic cardiomyopathy Wrong Choice!
Answer:B
40-year-old male underwent liver transplant 20 years ago due to biliary cirrhosis. He is now listed for a redo liver transplant in view of recurrent cirrhosis. He is admitted to the ICU with upper gastrointestinal variceal bleeding requiring massive transfusion. He is intubated and on mechanical ventilation. Bedside echocardiography reveals an ejection fraction of 70% and absence of diastolic dysfunction. Electrocardiogram exhibits sinus tachycardia with a normal QT interval. Chest x-ray appears normal. Patient’s invasive arterial pressure is 100/60 mm Hg and central venous pressure is 8 mm Hg. A pulmonary artery catheter is inserted and the following values are obtained: Cardiac output of 10 L/min, mean pulmonary artery pressure of 30 mm Hg, and pulmonary artery occlusion pressure of 10 mm Hg. This is MOST likely due to:
A. Porto pulmonary hypertension Wrong Choice! B. Hyper dynamic circulation Correct Choice C. Transfusion-associated circulatory overload Wrong Choice! D. Cirrhotic cardiomyopathy Wrong Choice!