10-02-2010, 03:27 AM
A 55-year-old Caucasian man comes to the emergency department with a sudden onset of retrosternal chest pain that began eight hours ago. An electrocardiogram revealed the presence of ST segment elevation in leads V2 to V5. He is taken emergently for cardiac catheterization, where he undergoes percutaneous transluminal coronary angioplasty with stent placement to the left anterior descending artery. After the procedure, the ST changes resolve, and the patient has an uneventful hospital course. On the third night, just prior to his discharge, he called for the nurse due to a sudden onset of sharp, retrosternal chest pain. He first noticed the pain while he was turning around in the bed. The pain gets worse with deep breathing. His vital signs are as follows: temperature 37.8°C (100F), blood pressure 134/80 mmHg, heart rate 108/min, and respiratory rate 22/min. Physical examination reveals jugular venous distention (3 cm), regular heart sounds without any murmurs, and clear lung fields. There is a scratchy sound heard during ventricular systole over the left sternal border. An EKG done during the episode reveals the presence of sinus tachycardia with Q waves in leads V2 to V5.
Which of the following is the most likely cause of this patient"s recurrent symptoms?
A) Acute pericarditis
B) Left ventricular aneurysm
C) Chordae tendineae rupture
D) Acute myocardial infarction
E) Dressler's syndrome