robin082006
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A 68-year-old white female presents to the ER for the sudden onset of severe central chest pain associated with nausea and vomiting. She is hypertensive for which she takes atenolol and hydrochlorothiazide. Her PR: 76/min; BP: 90/60 mmHg; RR: 14/min. Significant findings on examination are jugular venous distension and a positive Kussmaul’s sign. Her lungs are clear to auscultation. Cardiac auscultation shows the presence of pansystolic murmur at the left lower sternal border. Her EKG shows significant (>1 mm) ST segment elevation in leads II, III and aVF as well as in leads V4R and V5R. ST elevation is more pronounced in lead III than in lead II. Cardiac troponins and CK-MB are elevated. Which of the following is the pathophysiologic explanation for her physical examination findings?
A. Decreased compliance of right ventricle
B. Systolic dysfunction of right ventricle
C. Diastolic dysfunction of left ventricle
D. Systolic dysfunction of left ventricle
E. Secondary pulmonary hypertension
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| prathapdoctor
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A.decreased compliance of rt ventricle.
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| Guptashutosh
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i think this is MI with transmural infarct followed by rupture and cardiac temponade , leading to systolic dysfuntion of left ventrical..... but i`m not sure , anybody have better explanation ?
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| drashishmahajan
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B---
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| Guptashutosh
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i`m sorry i read the Q again and i found that , the chst is clear on aucultation and he has symp of rt ht failure ,and he also has septal perf`n givin a systolic mumer so i`ll go with option B
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| anjushree
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a----rt heart infarction
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| robin082006
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Answer is A
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| fox
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The answer seems to be A allrite but can u explain why there is a pansystolic murmur at the left sternal border robin?
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