4 Hours Of Worsening in Medicine / Internal Medicine — 74yo Woman | Cardiology | SMLE Q#12318
SMLE Question #12318
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 74-year-old woman with chronic atrial fibrillation and HFrEF presents with 4 hours of worsening dyspnea and profound weakness after 2 days of increasing orthopnea and paroxysmal nocturnal dyspnea. She is drowsy and confused. Examination shows cold, clammy, mottled extremities, elevated JVP, bilateral basal crackles, and an S3 gallop. ECG shows atrial fibrillation with rapid ventricular response and no ST-elevation. Which type of shock best explains this patient’s presentation?
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