Which clinical manifestation most strongly indicates imminent death in a patient with terminal lung cancer?

• A. Tachycardia followed by bradycardia
• B. Diaphoresis
• C. Decreased blood pressure
• D. Increased cardiac output

Answer: (D)

Imminent death in advanced cancer often involves abrupt, decisive changes in cardiovascular function as the body loses the ability to maintain perfusion. An increased cardiac output reflects a hyperdynamic state the body can briefly mount in the final hours to try to sustain tissue perfusion. This makes it a more ominous and specific indicator of nearing death than the other signs listed, which are more nonspecific (diaphoresis can occur for many reasons, decreased blood pressure is common but not as predictive on its own, and a tachycardia that then becomes bradycardia is a sequence that can occur in various contexts). So, an uptick in cardiac output tends to be the strongest single signal among the options that death is imminent.