A 26-year-old woman presents with a 3-week history of being awakened by a dull, prolonged chest pain that occurs 3-4 times a week. She is a smoker and has no family history of early IHD. Results of a 12- lead ECG are normal. Her first set of cardiac enzyme measurements are negative. If coronary angiography were taken at the time of her chest pain, which of the following findings is most likely?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Coronary artery spasm
A young woman who smokes, with chest pain that wakes her at night (at rest), normal ECG between attacks and negative enzymes fits vasospastic (Prinzmetal) angina, caused by transient coronary spasm. Angiography during an attack (or after provocation) shows coronary vasospasm. Multivessel >80% stenosis or plaque rupture would be atherosclerotic CAD/ACS, which is unlikely at 26 with no other risk factors, and plaque rupture would give positive enzymes/ECG changes.
ليش كل خيار صح أو غلط
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A
ليش صح
Rest or night pain in a smoker fits vasospastic (Prinzmetal) angina, and angiography displays coronary vasospasm, especially when provoked with ergonovine or acetylcholine.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 21 -
B
ليش غلط
Fixed multivessel stenosis is atherosclerotic CAD; for vasospastic angina, common atherosclerotic risk factors are not associated apart from smoking, which fits this young woman.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 6 -
C
ليش غلط
Vasospasm can occur in normal coronary arteries, and angiography shows it, so findings are not normal in an attack or provocation test.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 21 -
D
ليش غلط
Plaque rupture is the mechanism of MI; with a normal ECG and negative enzymes there is no infarction, which suits vasospasm, not plaque rupture.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 11
- المصدر
- CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 6
Step-Up To Medicine 6th (IHD & ACS).pdf · p. 21
CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 7 - المحاضرة
- Ischemic Heart Disease · Cardiology · Module B
- ظهر في
- Cardio bank