new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,085
|
A 55-year-old man presents to the emergency room with crushing substernal pain and left shoulder pain of 2 hours duration. The pain is not relieved by sublingual nitroglycerin, and the electrocardiogram shows ST elevation in several leads. Aspirin and streptokinase therapy are initiated, and the patient is admitted to the intensive care unit. The next morning, serum cardiac enzymes are elevated to 4 times the upper limit of normal, and the electrocardiographic changes are still present.
Which of the following is the most likely diagnosis?
A. Prinzmetal's angina
B. Stable angina
C. Subendocardial infarction
D. Transmural infarction
E. Unstable angina
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
is it D?
|
| silver
Forum Guru
Topics: 21
Posts: 774
|
prinzmetal has ST seg. elevation. stable angina has ST seg. depression. both are relieved by nitro. Subendocardial infarction has ST depression.
That leaves transmural infarction and unstabe angina: i think it's D. Transmural infarction cuz unstable mostly has ST depression.
___________________
Every disaster hides an opportunity.
|
| Mikeland
Forum Senior
Topics: 24
Posts: 109
|
The clue in this Q is the enzimes, only IM has it elevated. and the pt came with pain. Sub endocardic has more hemodinamic compro..more over subendocard IM course with ST depress.
Answer Transmural IM
|
| Mikeland
Forum Senior
Topics: 24
Posts: 109
|
Notes
unstabe angina never elevate enzymes
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
inequivocal transmural MI....ST elevation/ subendo would have ST depress
|
| new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,085
|
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,085
|
The correct answer is D.
The elevated serum cardiac enzymes indicate that a myocardial infarction has occurred. The setting (patient brought in from community with typical myocardial pain) and limitation of ST elevation to a few leads are typical of transmural infarction due to occlusion of a coronary artery. In contrast, hospitalized, severely hypotensive patients typically undergo the more generalized subendocardial infarction.
Prinzmetal's angina (choice A) would not cause a marked rise in serum enzymes.
Stable angina (choice B) would not cause a marked rise in serum enzymes.
Subendocardial infarction (choice C) usually occurs in the setting of shock and affects most EKG leads.
Unstable angina (choice E) may be accompanied by enzyme elevations up to 2 times the upper limit of normal.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
|
| |
| | | | | | | | |
