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A 68 year old male with history of Hypertension, Diabetes and Urinary retention awoke feeling nauseated and light headed. He did not respond to questions from his wife. When the emergency medical technicians arrived, his blood pressure was 60 mmHg by palpation. IV fluids and oxygen were administered. Vital signs obtained in the ER were blood pressure 60 mmHg, heart rate 120 (regular), temp 39 degree celsius and respiratory rate 30/min. A brief physical examination revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds. An indwelling urinary catheter was placed with drainage of 10-20 ml of dark urine. Chest X-ray revealed bilateral interstitial infiltrates. ECG was unremarkable except for sinus tachycardia. Antibiotics were administered and patient was transferred to the ICU where right heart catheterization was performed. Pulmonary capillary wedge pressure was 28 mmHg. Cardiac output was 1.9 L/min. Right atrial mean pressure was 10 mmHg. The most likely cause for this man`s hypertension was...

left ventricular Dysfunction

Right ventricular Infarction

Gram Negative Sepsis

Gastrointestinal Bleeding

Pulmonary Emboli

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