116A19 62歳の女性．息切れと全身倦怠感を主訴に来院した．7日前に発作性心房細動に対してカテーテルアブレーションが施行されており，3日前に退院していた．退院翌日に息切れと全身倦怠感が出現し，症状が徐々に増悪するため受診した．意識は清明．体温36.2℃．脈拍112/分，整．血圧88/72mmHg．血圧は吸気時に収縮期血圧が18mmHg低下する．呼吸数18/分．SpO2 95％（room air）．呼吸音に異常を認めない．心音は微弱だが雑音は聴取しない．頸静脈は怒張している．血液所見：赤血球462万，Hb 13.2g/dL，Ht 39％，白血球9,700，血小板39万．血液生化学所見：尿素窒素44mg/dL，クレアチニン1.7mg/dL，Na 141mEq/L，K 4.2mEq/L，Cl 110mEq/L． 最も考えられる病態はどれか． ａ 後腹膜血腫 ｂ 心室中隔穿孔 ｃ 肺血栓塞栓症 ｄ 心タンポナーデ ｅ 完全房室ブロック https://apple.co/4glE511 https://amzn.to/494DbmU
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