gordon
Forum Newbie
Topics: 5
Posts: 27
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a 60-year-old male presents to ED with the chief complaints of progressive dyspnea and fatigue. He denies any chest pain , syncope, cough or edema. He had an acute anterior MI one month ago. Chest auscultation reveals bilaternal crackles in his lower chest. Examination of the precordium reveals a double apical impulse. Cardiac auscultation reveals a S3 and a pansystolic murmur at the mitral area that radiates to the apex. Chest x-ray shows prominence of the left heart border. EKG shows a previously unchanged Q wave and persistent ST elevation in the anterior leads. Based on these findings, what is the most likely underlying cause of his symptoms?
A. Ventricular septal defect
B. Papillary muscle rupture
C. Free ventricular wall rupture
D. Rupture of chordea tendinae
E. Left ventricular aneurysm
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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E
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| kpmle2
Forum Guru
Topics: 77
Posts: 454
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E. Left ventricular aneurysm---late complication of acute MI.
Precordial exam shows double apical impulse.
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| spmvj
Forum Newbie
Topics: 3
Posts: 36
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E.left ventricular aneurysm
Left ventricular aneurysm is a late complicationof MI.Aneurysm might lead to the rupture of papillary muscle causing systolic murmur.Pt will have double apical impulse &EKGshows peresistent ST elevations.
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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E
Papillary muscle rupture usually occurs 1st week post MI leads to MR and audible pansystolic murmur
Free Vent wall rupture leads to cardiac tamponade,one will see it's signs with hypotension,distended neck veins,pulsus paradoxus usually 1st week post MI
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| gordon
Forum Newbie
Topics: 5
Posts: 27
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Yes, the correct answer is E.
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| dr.wad
Forum Senior
Topics: 3
Posts: 350
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yes
causes of elevated ST segment MI , variant angina , pericarditis ( except in aVR and V1...in which it is depressed ) , aortic aneurysm.....and finally it can occur in normal individuals........
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