You are called to assess a 55-year-old man in the coronary care unit for sudden onset shortness of breath. He was admitted 2 days ago with STEMI and received thrombolytic. His BP is 110/50 mmHg, heart rate 110 beats per minute, and oxygen saturation 90% on room air, physical examination reveals crackles midway up both lung fields and a new pansystolic murmur that is loudest at the apex and radiates to the left axilla. ECG reveals Q-waves in leads II, Ill, and aVF. Chest radiograph shows pulmonary edema. Which of the following is the most likely diagnosis of this patient's current condition?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. Papillary muscle rupture
Inferior STEMI (Q waves in II, III, aVF → RCA) followed by sudden pulmonary oedema and a new apical pansystolic murmur radiating to the axilla = papillary muscle rupture → acute MR. A post-MI VSD also gives a pansystolic murmur, but it does not radiate to the axilla. It is heard at the lower left sternal border. Dressler's syndrome is a later pericarditis.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Aortic stenosis gives a harsh crescendo-decrescendo systolic murmur radiating to the carotid arteries, not a new pansystolic apical murmur radiating to the axilla.
✓ Step Up To Medicine 6th (Valvular Heart Disease).pdf · p. 3 -
B
ليش صح
A new pansystolic murmur after MI that radiates to the axilla is mitral regurgitation from papillary muscle dysfunction or rupture; Q waves in II, III, aVF mean an inferior (RCA) infarct.
✓ Cardiology 🫀.pdf · p. 7 -
C
ليش غلط
Dressler syndrome (persistent fever, pericarditis, pleurisy) occurs a few weeks or months after MI, not 2 days after.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 11 -
D
ليش غلط
A post-MI VSD also gives a pansystolic murmur, but it does not radiate to the axilla; this murmur is loudest at the apex and radiates to the left axilla.
✓ Cardiology 🫀.pdf · p. 7
- المصدر
- Cardiology 🫀.pdf · p. 7
4• Coronary Artery Disease [Notes].pdf · p. 6 - المحاضرة
- Valvular Heart Disease · Cardiology · Module B
- ظهر في
- Cardio bank