While discussing the care of a morbidly obese patient with hemodynamic instability, the physi-cian expresses concern regarding aggressive IV fluid therapy
Which patient pathologies associated with obesity could be an explanation?
1. Decreased preload
2. Myocardial hypertrophy
3. Decreased heart-wall compliance
4. Reduces heart chamber volumes
a. 1 and 3 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 2, 3, and 4 only
ANS: D
Myocardial hypertrophy and diastolic dysfunction are the results of these alterations, eventually leading to heart failure, arrhythmias, or sudden cardiac arrest. Myocardial hypertrophy and the consequently reduced heart-wall compliance, as well as reduced heart chamber volumes, are re-sponsible for poor tolerance of IV fluids in these patients.
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