Viva 4

You are the intensivist in charge of a 12-bed regional ICU.

A 50-year-old female presents to your hospital five months after heart transplant for dilated cardiomyopathy. She had been short of breath for several days. She has a temperature of 37.8 degrees. She is in atrial fibrillation with a ventricular rate of 125bpm, blood pressure is 80/50 mmHg. Oxygen saturations in air, on arrival, were 88%. Her GCS is 15. Her current medications include tacrolimus, mycophenolate and prednisone.

What are the two most important causes of this presentation to consider?

How would you distinguish between them?

(This viva dealt with the assessment of complications following heart transplantation.)

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.