A 40-Year-Old Woman Is Seen 48 Hours After an Uncomplicated

question 59

Multiple Choice

A 40-year-old woman is seen 48 hours after an uncomplicated repeat caesarean delivery at 39 weeks gestation.  She reports sudden-onset shortness of breath and a nonproductive cough.  The patient has no fever, chills, nausea, vomiting, or chest pain.  Her prenatal course was uncomplicated.  She has no chronic medical conditions.  The patient's previous pregnancy was uncomplicated; she had a term caesarean delivery for breech presentation.
On examination, the patient appears distressed.  Blood pressure is 196/112 mm Hg, pulse is 120/min, and respirations are 32/min.  Pulse oximetry is 86% on room air.  Auscultation of the lungs shows diffuse inspiratory crackles bilaterally.  Jugular venous pressure is normal.  Cardiac sounds are normal and there are no murmurs or additional sounds.  Abdominal examination is normal.  There is 2+ pedal edema to the bilateral mid-calves.
Laboratory results are as follows:
Chest x-ray reveals bilateral diffuse alveolar infiltrates.  ECG shows sinus tachycardia and upsloping ST-segment depressions in the inferior lateral leads.
Which of the following is the most likely diagnosis in this patient?

• A)Acute coronary syndrome
• B)Amniotic fluid embolism
• C)Aspiration of gastric contents
• D)Peripartum cardiomyopathy
• E)Preeclampsia

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Definitions:

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