Question

A patient developed breathlessness and chest pain on the second postoperative day after a total hip replacement. Echocardiography showed right ventricular dilatation and tricuspid regurgitation. What is the most likely diagnosis?

• A. Acute MI
• B. Pulmonary embolism
• C. Hypotensive shock
• D. Cardiac tamponade

Hint:

Day two after hip surgery with a sudden dilated right heart points to a clot in the lungs.

Answer 1

The Correct Option is B

Think about what changes inside the chest right after a hip replacement. The leg has been immobile, the veins are sluggish and surgery itself thickens the blood, so a thrombus forms in a deep vein and then flicks off into the lung circulation around day two. That is a pulmonary embolism. When a sizeable clot blocks the pulmonary arteries, the resistance the right ventricle has to overcome jumps almost instantly. A thin walled right ventricle cannot generate that pressure, so it stretches and balloons out. As it dilates, the tricuspid ring it carries widens and the valve leaks, which the echo reads as right ventricular dilatation plus tricuspid regurgitation. That picture is acute cor pulmonale and points straight at PE. Run the other choices against this logic. A myocardial infarction would damage the left ventricle and give a localised wall motion defect, not a globally dilated right ventricle. Shock describes low blood pressure, not a specific chamber pattern. Tamponade compresses the heart from outside with fluid in the pericardium, so the right ventricle looks squeezed and small, not dilated. Only PE explains the combination of the operation, the day two onset, the chest pain, the breathlessness and the strained right heart. \[\boxed{\text{Pulmonary embolism}}\]