You are asked to review a 75-year-old man who has developed sudden onset hypotension, with a systolic BP of 70mmHg and an associated sinus tachycardia of 140 bpm, 30 minutes post TAVR (transcatheter aortic valve replacement) via the trans-femoral approach.
a) List four cardiac differential diagnoses of hypotension. (20% marks)
b) List four non-cardiac differential diagnoses of hypotension. (20% marks)
c) Explain which features on history, clinical examination, and investigations, may help differentiate cardiac from non-cardiac causes? (60% marks)
Aim: To explore the complications of a common cardiology procedure.
Key sources include: Common cardiology procedure seen in clinical practice. CanMEDS Medical Expert.
Discussion: This topic was generally well addressed by candidates with the non-cardiac causes of hypotension e.g., femoral access retroperitoneal bleed or anaphylaxis, well recognised. Candidates would have improved their answers if they gave cardiac differentials specific to the clinical case provided outlining post-TAVR instability. For example, a discussion around severe AR/paravalvular leak from TAVR malposition or ventricular perforation/aortic root rupture related tamponade would have allowed the candidate to demonstrate competency with the assessment of the post TAVR unstable patient and improve their answer in part a and c.
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