4.8 of 12 Ratings
A 68-year-old male is admitted to your care four days after coronary artery bypass grafting (CABG) for a myocardial infarction (MI). The patient has a history of insulin-controlled diabetes, hypertension, and hyperlipidemia. Of note, the patient states that after the surgery, he had resolution of his chest pain, but he has started experiencing chest pain again. The patient states that the pain is exacerbated by deep breaths but feels better when he leans forward compared to lying down flat. On exam, his vitals are normal, and there are no murmurs heard on auscultation. His CK-mB returns as normal, and his repeat electrocardiogram (ECG) is shown in Figure A. What is the most likely diagnosis for this patient?
Ventricular septal rupture
Papillary muscle rupture
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A 59-year-old woman presents to the emergency department with severe chest pain and shortness of breath. She reports that she was walking in her house when the pain began and it worsened when she laid down to go to bed later in the evening. She experiences relief of the chest pain when she sits down and leans forward with her chest over her knees. She was discharged from the hospital earlier today after suffering from an ST-elevation myocardial infarction 2 weeks that was successfully treated with coronary revascularization. Her past medical history is significant for hypertension and rheumatoid arthritis. Her temperature is 97.9°F (36.6°C), blood pressure is 155/105 mm Hg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical examination is significant for a friction rub on cardiac auscultation and an estimated jugular venous pressure of 11 cm H2O. An electrocardiogram is obtained and shown in Figure A. An echocardiogram is obtained and reveals good contractile function of the heart with an ejection fraction of 60% as well as the finding shown in Figure B. A chest radiograph reveals a cardiac silhouette within normal limits. Which of the following is the best management of this patient's condition?
A 65-year-old man presents to the emergency room with sharp chest pain and shortness of breath. He notes that he has been recovering from a gastrointestinal virus for the past several days, but that the chest pain was not present on previous days. During the physical exam, he notes that the pain seems to be decreased when he is seated and leaning forward. His systolic blood pressure is 150 mmHg on expiration and 141 mmHg on inspiration. An EKG is shown in Figure A. Assuming that the cause of this patient's cardiac condition is related to his recent viral illness, which of the following is the most appropriate treatment?
A 29-year-old woman is admitted with a two-day history of chest pain. The pain is sharp, worsens with inspiration or coughing, and improves when leaning forward. On further review, she endorses a polyarticular arthritis and has had two first-trimester spontaneous abortions. Her vitals are as follows: T 100.9 F, HR 101, BP 115/70, RR 14, SpO2 96% on room air. On exam, you auscultate a superficial squeaking sound along the anterior chest, best heard with the diaphragm of the stethoscope. You order an ECG and chest radiograph, which are pictured in Figure A and Figure B respectively. Which of the following laboratory tests would assist in your diagnosis?
Complete blood count (CBC)
Rheumatoid factor (RF)
Antinuclear antibody (ANA)
Parathyroid hormone (PTH)
Antineutrophil cytoplasmic antibody (ANCA)