4.6 of 30 Ratings
A 78-year-old male with a 35-pack-year smoking history, hyperlipidemia, and peripheral vascular disease is at home eating dinner with his wife when he suddenly has acute onset, crushing chest pain. He lives in a remote rural area, and, by the time the paramedics arrive 30 minutes later, he is pronounced dead. What is the most likely cause of this patient's death?
Ventricular septum rupture
Chordae tendineae rupture
Select Answer to see Preferred Response
A 55-year-old man presents to the emergency department with chest pressure and diaphoresis. His symptoms started at work when he was lifting boxes. He states that he currently feels crushing pressure over his chest. He is given aspirin and an ECG is performed in triage, as seen in Figure A. His past medical history is notable for diabetes and obesity. He has smoked 1 pack of cigarettes per day for the past 30 years. His temperature is 97.9°F (36.6°C), blood pressure is 155/99 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam reveals an uncomfortable, diaphoretic man. His heart and breath sounds are unremarkable. A repeat ECG in the emergency department is performed, also seen in Figure A. The patient’s chest pain is worse when the ECG in the emergency department is taken, compared to the one taken in triage. He is given nitroglycerin, with minimal improvement in his symptoms. A troponin level is drawn. Which of the following is the most appropriate next step in management?
Repeat ECG in 10 minutes
A 67-year-old man presents to the emergency department after fainting. He was outside tending to his lawn for several hours in the heat, when he stood up suddenly from pulling weeds and fainted. He denies any preceding symptoms and returned to baseline within 1 minute. The patient is not aware of any medical problems and just started seeing a primary care physician last week. He recently used a friend's prescription for ondansetron for nausea that he had experienced last week. His temperature is 99.3°F (37.4°C), blood pressure is 142/88 mmHg, pulse is 107/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals intact cranial nerves, normal strength and sensation, and a stable gait. His abdomen is soft and nontender. An ECG is performed as seen in Figure A. Which of the following is the most likely diagnosis based on this patient’s ECG?
Acute myocardial infarction
Intermittent torsades des pointes
Previous myocardial ischemia
A 70-year-old man presents to the emergency department with severe substernal chest pain of one hour’s duration. The patient was taking a morning walk when the onset of pain led him to seek care. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram reveals ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6. The ST elevations found in leads V5-V6 are most indicative of pathology in which of the following areas of the heart?
Inferior wall, right coronary artery
Interventricular septum, left anterior descending coronary artery
Lateral wall of left ventricle, left circumflex coronary artery
Left atrium, left main coronary artery
Right ventricle, left main coronary artery