A 66-year-old man is evaluated 24 hours after admission for STEMI. He is cold, clammy, and oliguric. Blood pressure is 84/50 mmHg. Chest auscultation shows scattered fine crepitations but no frank pulmonary edema. According to the Killip classification, this patient belongs to which class?

• A Killip I
• B Killip II
• C Killip III
• D Killip IV ✓

Explanation

Killip IV denotes cardiogenic shock: systolic blood pressure below 90 mmHg with signs of peripheral hypoperfusion such as cold clammy skin and oliguria. The presence of hypoperfusion with hypotension places him in class IV regardless of mild lung crepitations. Killip II means rales or an S3 without hypotension, Killip III means frank pulmonary edema, and Killip I means no signs of heart failure.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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