Cardio 19-29 - ben

[ArchivalUser]

A 63-year-old Caucasian male is admitted for sudden onset of severe chest pain. His ECG revealed ST elevation in leads V2-V6. He was given thrombolytic therapy, heparin, aspirin, metoprolol, morphine, and nitrates. His coronary angiogram, after thrombolytic therapy, revealed a 50% obstruction in the left anterior descending artery. On the 3rd day of his hospitalization the patient suddenly developed severe shortness of breath at rest and quickly became hypotensive. Examination reveals a soft S1, an apical pansystolic murmur (PSM) radiating to the axilla, and bibasilar crackles. His vitals are BP: 90/60 mm of Hg; HR: 102/min; RR: 30/min; Temperature: 37.8C (100F). An echocardiogram performed on the 2nd hospital day revealed an anterior akinetic segment. What is the most likely explanation for this patient's deterioration?

A. Pericardial tamponade
B. Pulmonary embolism
C. Rupture of ventricular septum
D. Papillary muscle dysfunction
E. Acute aortic dissection

[ArchivalUser]

ddd

[ArchivalUser]

D, MR

[ArchivalUser]

agree with d...........

[ArchivalUser]

This patient has classic features of new onset mitral regurgitation. Sudden onset of shortness of breath (SOB), bibasilar rales, and an 'apical' murmur radiating to the axilla are quite characteristic of new onset mitral regurgitation. Papillary muscle dysfunction, or rupture, is the most common cause of MR in this setting.

Ventricular septal rupture has similar features but the murmur is heard at the left sternal border and would not radiate to the axilla.

Pericardial tamponade is a very important differential diagnosis in this patient but usually patients will not have any murmurs.

Pulmonary embolism (PE) and aortic dissection are completely different from this presentation. Pulmonary edema is not seen in PE.