Shock Quiz: Ace Your Exams

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A 52-year-old-male presents to the emergency department with increased work of breathing. He was walking to his car when he suddenly became short of breath. Past medical history includes diabetes, hypertension, and a twenty pack year smoking history. Temperature is 37.0°C (98.6°F), pulse is 121/min, respirations are 24/min, blood pressure is 87/60 mmHg, and O2 saturation is 93% on room air. On physical examination, the patient is, in moderate respiratory distress, and has his left hand held over the sternum. Cardiopulmonary exam is notable for bilateral rales without gallops, rubs, or murmurs. Distal extremities are cool to the touch. The patient’s chest x-ray and electrocardiogram are demonstrated below:

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Which of the following is the most likely etiology of this patient’s clinical findings?

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