A 68y.o. male complaining of dyspnea and arrythmia,what are the differential diagnosis and cause of death?

history of RHD,CHF,CAD,cardiomegaly,hepatomegaly,sm... pack years but discontinued 10 years prior to admission,alcoholic beverage drinker-12 cans of beer daily,atrial fibrillation,pleural effusion,pulmonary edema,mitral valve prosthesis,coronary bypass,complete RBBB,oliguria,hypotension and patiet eventually expired 3 days post thoracotomy.

By what information you have given me my 1st guess would be cardiogenic shock. But you don't say why the thoracotomy was preformed. Was it for heart, heart valves, lung, thorasic aorta, esphageal or spine surgery. You also don't say wether this patient had a cardiac or pulmonary arrest or if both which occured 1st. I chose cardiogenic shock 1st due to all the already existing cardiac issues and additional symptoms. Was the CHF ( which pulmonary edema is a symptom) caused by the cardiomegaly , the A-fib, the MV prosthesis or a combination of some or all. You also mentioned a previous CABG, but you didn't mention any myocardial injury occuring. This pt. not only had mechanical issues but also had electrical problems as demonstrated by the A-fib and the RBBB. The pulmonary involvement sounds more like it's due to all the cardiac problems. You mentioned hypotention but not whether it was due to medication or if it was a symptom of the cardiomegaly. You mentioned oliguria but nothing of CRF or even ARF post surgery. So was this a new onset? You give no lab values that could indicate organ functions. Sooooooooo. I still stand with cardiogenic shock as my 1st choice (chosen from all the cardiac envolvement and the possibility that he could have thrown a clot [a-fib, PMV and had to be taken off thinners for the surgery] and had an MI. The symptoms of hypotention & oliguria occur in cardiogenic shock). My 2nd choice would be a CVA ( due to the A-fib the PMV and the fact he had to be off anticoagulants for the thoracotomy. 3rd and lastly alcohol withdrawal (just kidding! Really I was just kidding!)

Well, Any one or combination of those conditions were going to do him in very soon but he probably went into a crisis brought on by the thoracotomy.

pulmonary embolism?