study_ing
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A 45-year-old man presents to the emergency department complaining of chest pain, which began twenty minutes before he was preparing to go home.. He describes the pain as substernaI, intense, dulI, and squeezing. It does not change with respiration. He alsocomplains that he is nauseated an dhas been sweating.He has never experienced anything like this before. His temperature is 37.5 C (99.5 F), blood pressure is124/76 mm Hg, pulse is 80/min, respiratory rate is 22/min, and oxygen saturation is 95% on room air. On physical examination, he sdiaphoretic. His lungs are clear, his heart rate is regular, and he has a normaI S1 and S2 without murmur, rub, or gallop. The examinerestimates that his jugular venous pressure is elevated to the angle of the jaw. His abdomen is nontender, with normal bowel sounds. Anelectrocardiogram is performed, which reveals sinus rhythm, normal axis, normal intervals, and ST elevation in leads lI, III, and aVF. A chest x-ray film reveals no apparent cardiac or pulmonary abnormalities.
Which of the following vessels is most likely to be diseased in this patient?
/ A. Coronary sinus
/ B. Left anterior descending coronary artery
/ C. Left circumflex coronary artery
/ D. Left main coronary artery
/ E. Right coronary artery
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| study_ing
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Three days after hospital admission, the patient suddenly develops shortness of breath and becomes hypotensive. His heart rate is 100/min, with a normaI PR and QRS intervaI. His blood pressure is 75/50 mm Hg. His respiratory rate is 38/min and his oxygen saturation on 2 Iitersvia nasal cannula drops to 60%. A chest x-ray reveals bilateral fluffy infiltrates in the lung fields. Which of the following complications of hiscondition has most likely occurred?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
/ A. Dilation of the left ventricle
/ B. Dressler syndrome
/ C. Rupture of the left ventricular free wall
/ D. Rupture of the posteromedial papillary muscle
/ E. Ventricular tachycardia
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| star1
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B. Left anterior descending coronary artery
??????
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| study_ing
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no answer without explanation 
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| sheeezooo
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E?? RT coronary artery?
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| study_ing
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one line explanation please..
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| sarika
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E right coronary artery area of ischemia is inferior.
2.c rupture of ventricular wall...dressler is late complication, others dont fit
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| Mars-Aris
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1.ST elevation in leads II, III, aVF : inferior wall MI --> infarction of right coronary artery
2.D since RCA supplies the posteromedial papillary muscle --> (patient develops acute valvular insuff --> pulmonary edema and hypotension]
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| study_ing
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good going mars!!
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| sarika
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Why such acute hypotension? it seems much more serious ...
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| study_ing
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This patient has EKG signs of an inferior myocardial infarction, with ST elevation in the inferior leads, II, III, and aVF. He also has a physical sign of right ventricular dysfunction (elevated jugular venous pressure).
The coronary sinus is not a common site for atherosclerotic disease or for obstruction.
The left anterior descending artery --> produce ST elevation in the anterior (V2-V6) and occasionally the lateral (I, aVF) leads of the EKG,
The left circumflex artery -->typically produces EKG lead changes in the lateral (I, aVL, V5, V6) leads.
The left main coronary artery --> Obstruction makes the entire left ventricle ischemic, often resulting in cardiogenic shock. This would produce ST segment elevation in leads I, aVL, and V2-V6.
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| sarika
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http://www.clevelandclinic.org/heartcenter/pub/pr...
Just found this
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| study_ing
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suddenly in cardiogenic shock with severe pulmonary edema.
DIFFERENTIAL=arrhythmia, cardiac tamponade, or left ventricular valvular dysfunction
The posteromedial papillary muscle is supplied by the RCA alone in most patients and is prone to rupture in inferoposterior MI. Rupture leads to acute and severe mitral valve dysfunction, resulting in pulmonary edema and poor forward ejection
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| study_ing
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sarika--free wall rupture leading to cardiac tamponade cud present similarly. however the probability wud be greater if it hadnt been an IMI.
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| study_ing
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nice link ..and it mentions in the discussion 'Angiographically the infarct related vessel is usually the LAD or circumflex. The RCA is rarely the culprit vessel3. '
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| sarika
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u win & nice job
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| Mars-Aris
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great discussion 
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| study_ing
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Heey everybody wins
( if i didnt have the answer with me, id probably get it wrong :P)
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| study_ing
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A 52-year-old man presents to the emergency department because of severe chest pain. The excruciating pain began abruptly, 30 minutespreviously, and feels to the patient as if something were "ripping." When asked to point to where the pain is worst, the patient points to the precordium. The man additionally reports that the pain seems to be changing in position slowly. If enzyme chemistries were sent, which would be the most likely results?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
/ A. Decreased AST, elevated CK, decreased LDH
/ B. EIevated AST, elevated CK, normal to decreased LDH
/ C. EIevated AST, normaI CK, normaI LDH
/ D. NormaI AST, elevated CK, elevated LDH
/ E. NormaI AST, normaI CK, normal to elevated LDH
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| AAAAA
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study_ing wrote:
A 45-year-old man presents to the emergency department complaining of chest pain, which began twenty minutes before he was preparing to go home.. He describes the pain as substernaI, intense, dulI, and squeezing. It does not change with respiration. He alsocomplains that he is nauseated an dhas been sweating.He has never experienced anything like this before. His temperature is 37.5 C (99.5 F), blood pressure is124/76 mm Hg, pulse is 80/min, respiratory rate is 22/min, and oxygen saturation is 95% on room air. On physical examination, he sdiaphoretic. His lungs are clear, his heart rate is regular, and he has a normaI S1 and S2 without murmur, rub, or gallop. The examinerestimates that his jugular venous pressure is elevated to the angle of the jaw. His abdomen is nontender, with normal bowel sounds. Anelectrocardiogram is performed, which reveals sinus rhythm, normal axis, normal intervals, and ST elevation in leads lI, III, and aVF. A chest x-ray film reveals no apparent cardiac or pulmonary abnormalities.
Which of the following vessels is most likely to be diseased in this patient?
/ A. Coronary sinus
/ B. Left anterior descending coronary artery
/ C. Left circumflex coronary artery
/ D. Left main coronary artery
/ E. Right coronary artery
right coronary artery supplies the inferior part of the heart and the pt has ST elevation in II, III, and aVF, which is the inferior leads
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