S4 Gallop Question - its from NBME

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S4 Gallop Question - its from NBME

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8 Posts

amitdoc2b
Forum Senior

Topics: 42
Posts: 97

08/10/06 - 08:47 PM

If a 65 y/o has an S4 gallop and grade 2 of 6 murmur heard at the apex, along with ST elevation - what is the best treatment for him (and can you explain why)?

A. Captopril
B. Digoxin
C. Furosemide
D. Magnesium
D. Tissue Plasminogen Activator

It sounds to me he has a myocardial infarction, but I don't really understand the point of the S4 gallop and how to treat it.

Ivil
Forum Senior

Topics: 8
Posts: 169

08/10/06 - 09:10 PM

Please label NBME questions. as some people are taking it to assess their performance...

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amitdoc2b
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Topics: 42
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08/11/06 - 11:59 AM

can someone please help? thanx so much

rn
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08/11/06 - 12:38 PM

i think its tissue plasminogen activator,tpa for mi

Dragonfly
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08/11/06 - 12:45 PM

A. S4 gallop means ventricular hypertrophy due to anything : HT, HOCM, etc. and since ST is elevated, he might have just ischemia related to the hypertrophic myocardium. among all these drugs ACE-I is more applausable. it not only slows down the myocardial remodelling (thus good for MI too) but also decreases both Afterload + Preload (Angiotensin+Aldosteron system) which is good Hypertrophy.

let me remind you that in case of HOCM, "Digitalis" is CONTRAINDICATED !! it puts so much pressure on the already hypertrophic heart and heart fails.

Edited by Dragonfly on 08/11/06 - 12:51 PM

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amitdoc2b
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Topics: 42
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08/15/06 - 08:46 PM

Dragonfly wrote:
A. S4 gallop means ventricular hypertrophy due to anything : HT, HOCM, etc. and since ST is elevated, he might have just ischemia related to the hypertrophic myocardium. among all these drugs ACE-I is more applausable. it not only slows down the myocardial remodelling (thus good for MI too) but also decreases both Afterload + Preload (Angiotensin+Aldosteron system) which is good Hypertrophy.

let me remind you that in case of HOCM, "Digitalis" is CONTRAINDICATED !! it puts so much pressure on the already hypertrophic heart and heart fails.

someone was saying its TPA, im not quite sure which to go by, even what u said seems plausible..ugh..this is so frustratiing

study_ing
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08/15/06 - 09:27 PM

id vote for tpi...i think thats the significance of mentioning ST elevation.

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Dragonfly
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08/16/06 - 12:23 AM

i think you`re right study_ing. ST elevation can not be neglected. but neither can the S4 gallop !!

S3 and new murmurs (valvular dysfunction) would be consistent with MI but S4 definitely points to some other disease such as HT or HOCM.

it is possible that a patient with a e.g. long standing HT suddenly developes MI. and in that case, yes i also think that tPA is the DOC.
i wish we had the whole question sad

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