A 72-year-old man with coronary artery disease admitted with myocardial infarction 5 days ago. He suddenly complained of severe chest pain. His blood pressure is 90/60 mm Hg and heart rate is 65/min. Auscultation reveals no murmurs or rubs. An ECG reveals an acute ST-segment elevation in the anteroseptal area. Urgent bedside echocardiography showed anteroseptal, lateral, and apical akinesis, mild left ventricular systolic dysfunction, and severe pericardial effusion. What is the most likely cause of the patient's sudden decompensation?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Free wall rupture
Days after an anterior (LAD) MI, the infarcted LV free wall can rupture, causing hemopericardium and cardiac tamponade: sudden chest pain, hypotension and a large pericardial effusion on echo, with no new murmur. Ventricular septal rupture and papillary-muscle mitral regurgitation (D, E) both cause a new loud systolic murmur. Post-MI pericarditis gives positional pain with a rub, not shock, and an LV thrombus causes emboli, not tamponade.
ليش كل خيار صح أو غلط
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A
ليش غلط
An LV thrombus (e.g. in an apical pouch) causes emboli such as stroke, mesenteric or limb ischaemia, not a haemopericardium with tamponade.
✓ 4• Coronary Artery Disease [Notes].pdf · p. 6 -
B
ليش غلط
Post-MI pericarditis is fibrinous at 1–3 days or Dressler syndrome after 14 days, and it does not explain a severe effusion with shock; no rub is heard here.
✓ 7• Pericardial Diseases [Notes].pdf · p. 2 -
C
ليش صح
LV free wall rupture after LAD/LCX infarction causes haemopericardium and tamponade: hypotension, severe effusion and no murmur.
✓ 4• Coronary Artery Disease [Notes].pdf · p. 6 -
D
ليش غلط
Septal rupture (VSD) from LAD occlusion gives a holosystolic murmur from L-to-R shunting; this patient has no murmur.
✓ 4• Coronary Artery Disease [Notes].pdf · p. 6 -
E
ليش غلط
Papillary muscle rupture gives acute MR with a holosystolic murmur (from RCA occlusion); this patient has no murmur.
✓ 4• Coronary Artery Disease [Notes].pdf · p. 6
- المصدر
- 4• Coronary Artery Disease [Notes].pdf · p. 6
7• Pericardial Diseases [Notes].pdf · p. 2 - المحاضرة
- Acute Coronary Syndrome · Cardiology · Module B
- ظهر في
- Cardio bank