A 72-year-old woman has an acute onset of dyspnea and hypotension and requires immediate intubation 5 days after being admitted for an anterior ST-elevation myocardial infarction. On examination, BP 90/60mmkg, HR 120/min, RR 18/min, she has a grade 4/6 harsh pansystolic murmur at the apex associated with a palpable thrill. Bilateral crepitations are heard at the lung bases. A portable chest x-ray shows cardiomegaly and pulmonary edema. Which of the following is the most likely diagnosis?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: B. Acute mitral regurgitation
- إجابة ثانية: D. Ventricular septal defect
Sudden dyspnoea, hypotension and a new loud pansystolic murmur 3-5 days after MI is a mechanical complication. A murmur at the apex with acute pulmonary oedema fits acute mitral regurgitation from papillary muscle rupture; the lecture notes that septal rupture tends to cause right heart failure rather than pulmonary oedema. However, the sources also tie septal rupture (VSD) to LAD/anterior MI and papillary rupture to RCA (inferior) MI, and the sources say a septal rupture murmur is hard to tell apart from acute MR, so VSD is a reasonable alternative. Free wall rupture gives tamponade, not a loud murmur.
ليش كل خيار صح أو غلط
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A
ليش غلط
Free wall rupture presents as cardiac tamponade (obstructive shock, JVD, muffled heart sounds), not as a loud apical pansystolic murmur with pulmonary oedema.
✓ 4• Coronary Artery Disease [Notes].pdf · p. 6 -
B
ليش صح
The Ischemic Heart Disease lecture says papillary muscle rupture typically presents with acute pulmonary oedema and shock from sudden severe mitral regurgitation, with a pansystolic murmur and third heart sound.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 12 -
C
ليش غلط
The clinical triad of right ventricular infarction is hypotension, raised JVP and clear lung fields; this patient has bilateral basal crepitations and pulmonary oedema on x-ray.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 8 -
D
ليش صح
The Coronary Artery Disease notes link septal rupture (VSD) to LAD occlusion (anterior MI), with a holosystolic murmur at the left lower sternal border and right heart failure from the L to R shunt.
✓ 4• Coronary Artery Disease [Notes].pdf · p. 6
- المصدر
- CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 12
4• Coronary Artery Disease [Notes].pdf · p. 6 - المحاضرة
- Valvular Heart Disease · Cardiology · Module B
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- Cardio bank