robin082006
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A 32-year-old married lawyer presents to the emergency department with a complaint of "having a heart attack." He explains he was "doing nothing particular" at home about 45 minutes ago when he began having chest pain with shortness of breath and nausea. His symptoms peaked within ten minutes, and he "knew this was the big one." His wife noted he was "shaking and sweaty." His wife immediately brought him to the hospitaI. He has no significant past medical history, takes no medications, and denies substance use. His family medical history is significant for a paternal grandfather that "died of a massive heart attack" at age 56. Physical examination reveals an anxious diaphoretic man taking short, shallow breaths. Vital signs, cardiac auscultation, ECG, and cardiac enzymes are completely normaI. The patient has been to the emergency department 5 times in the last 6 weeks and apologizes for "the million dollar workup," but explains "every time it happens l just know l am doomed to die."
A full cardiac workup of this patient is most likely to reveal which of the following?
/ A. Coronary vasospasm
/ B. Ebstein's anomaly
/ C. Mitral valve prolapse
/ D. Myocarditis
/ E. QTc prolongation
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| Natasa
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A?
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| druas
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A... Prinzmetal angina(recurrent history with normal findings)
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| Natasa
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Thats what I think,too.But is it the right answer?
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| druas
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lets see
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| robin082006
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| DrVirgo
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Chest Pain at rest, coronary artery vasospasm, Prinzmetal's Angina. Right?
If its not can you please explan why? thanks.
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| sarika
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lets go with E 
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| DrVirgo
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ECG is normal (QT Prolongation would have been seen on ECG)
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| Natasa
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Well it could be myocarditis as well but NOT qt prolongation for sure.
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| druas
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A 40-year-old man presents to his physician with complaints of
substernal pain radiating to his left shoulder, occurring when he is
at rest. The pain improves when he gets up and moves around, and
responds to sublingual nitroglycerin. This patient's symptoms are
thought to be caused by which of the following processes?
A. Coronary artery atherosclerosis
B. Coronary artery embolism
C. Coronary artery spasm
D. Coronary artery thrombosis
E. Coronary artery vasculitis
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| kleila
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druas i say is C for ur q. (at rest is the key)
for robin :A.no doubt
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| DrVirgo
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Robin, whats the answer? You said: for A?
Can you explain?
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| robin082006
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A is not the ans
what disease does he has?
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| DrVirgo
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Hmm... anxious, diaphoretic, chest pain...
Paternal grandfather died of heart attack.... something genetic?
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| reet
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B..EIBSTEIN anomaly...  FATHER DIED of massive heart attack..congenital disease
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| skyhigh
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mitral valve prolapse?
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| robin082006
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he has Panic disorder
high risk of mitral valve prolapse
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| DrVirgo
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How does panic disorder lead to mitral valve prolapse?
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| kleila
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yes... i was wrong , robin is right , but i can't explain why he is at risk for mitral valve prolapse....can anyone , please?
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| robin082006
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Kaplan says those with Panic disorder have 50% chance to develop mitral valve prolapse. Beta blockers are used to reduce the symtoms.
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| docsrinu
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i think ans is C for both the qs...
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| fox
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This is an excellent question...but does anyone know the mechanism how MVP develops in a panicky patient? Im really curious.
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| klimt
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How about a panic attack? Fear of dying?
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| klimt
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Oh sorry I didn't see the second page. So it's panic attack with risk of MVP, this correlation is from qbank explanations. Still, same Q as Fox's: anyone knows the mechanism of that?
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