A patient who is 48 hours post–mitral valve replacement surgery has become progressively more hypotensive, tachycardic, tachypneic, and restless over the past several hours. You suspect that the patient is going into shock.

a.            Since this patient is at high risk for both cardiogenic and septic shock, how would you go about determining what type of shock (if any) is present? Support your approach.

b.            What special challenges are associated with trying to treat septic shock in a patient with cardiovascular disease?