Kamsi
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A 65-year-old man presents to your clinic for a second follow-up visit. Two months ago, he was hospitalized for an acute myocardial infarction. He currently denies chest discomfort, palpitations, shortness of breath, fever, or cough. His past medical history is significant for hypertension and hypercholesterolemia. He quit smoking three weeks ago after a 30-pack-year smoking history.
Physical examination reveals a II/VI systolic murmur at the apex with a diffuse and displaced apical impulse. No jugulovenous distension, rubs, or peripheral edema is noted. The lungs are clear bilaterally. Blood pressure is 157/98 mm Hg, respirations are 16/min, pulse is 70/min, and temperature is 98.7 F. EKG shows a sinus rhythm at 68 bpm. Q waves are noted in leads V1-V3, along with 1 mm of ST-segment elevation in the anterior leads, unchanged from his last office visit three weeks ago. Laboratory studies show: sodium 141 mEq/L, potassium 4.1 mEq/L, chloride 109 mEq/L, CO2 25 mEq/L, BUN 11 mg/dL, creatinine 0.8 mg/dL, ESR 26 mm/h, WBC 8,200/mm3, hemoglobin 14 mg/dL, hematocrit 41%, and platelets 229,000/mm3. What is the most likely diagnosis?
(A) Anterior wall myocardial infarction
(B) Ventricular aneurysm
(C) Dressler's syndrome
(D) Right heart failure
(E) Pericarditis
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| Justice
Forum Fanatic
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(B) Ventricular aneurysm
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| hgheith
Forum Elite
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 How did you find the answer Justice? I looked in kaplan, and bp and nothing about it. I had to look in current dx and tx.
Where is this q from ?  nbme?
Here is the description I found, althoug I don't know why the esr is elevated, any one know?
LV Aneurysm
An LV aneurysm, a sharply delineated area of scar that bulges paradoxically during systole, develops in 10–20% of patients surviving acute infarction. This usually follows anterior Q wave infarctions. Aneurysms are recognized by persistent ST-segment elevation (beyond 4–8 weeks), and a wide neck from the LV can be demonstrated by echocardiography, scintigraphy, or contrast angiography. They rarely rupture but may be associated with arterial emboli, ventricular arrhythmias, and CHF. Surgical resection may be performed for these indications if other measures fail. The best results (mortality rates of 10–20%) are obtained when the residual myocardium contracts well and when significant coronary lesions supplying adjacent regions are bypassed.
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| epica
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'elevation in the anterior leads, unchanged from his last office visit three weeks ago".
B
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| starcraftbw
Forum Senior
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good question..... i got it wrong  .... B is the right answer
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| dr in trouble
Forum Guru
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the murmur also point towards aneurysm.
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