CardiovascularDifficulty 3/5
Four hours after coronary artery bypass grafting, chest-tube drainage abruptly stops, central venous pressure rises, blood pressure falls and the pulse pressure narrows. What is the priority interpretation?
- AVasoplegic syndrome after cardiopulmonary bypass requiring vasopressor titration
- BHypovolaemia from ongoing surgical bleeding requiring rapid volume replacement
- CCardiac tamponade from obstructed drainage, needing immediate surgical review
- DAcute graft occlusion causing ischaemic left ventricular failure
Show answer and rationale
Correct: C. Abrupt cessation of drainage with rising filling pressure, falling blood pressure and a narrowing pulse pressure is tamponade until proven otherwise. Volume may temporise, but the clot must be relieved surgically.
- B — Hypovolaemia lowers CVP rather than raising it.
- D — Graft occlusion typically presents with ischaemic ECG changes and does not stop chest-tube output.
- A — Vasoplegia presents with low systemic vascular resistance and warm extremities, not rising CVP.