new_n_lost
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An unconscious patient with sepsis in the intensive care unit undergoes a 2-hour period of severe hypotension. Blood chemistries taken during the following 48 hours show rising creatine kinase MB fraction (CK-MB), peaking at 5 times the upper limit of normal. ECG findings are equivocal, with some degree of flat S-T segment depression over several leads.
Which of the following is the most likely diagnosis?
A. Prinzmetal angina
B. Stable angina
C. Subendocardial infarction
D. Transmural infarction
E. Unstable angina
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| acintya
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I will go with B
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| hope4dabest
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C
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| silver
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Subendocardial infarction
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| SURVIVOR
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C
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| new_n_lost
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hope4dabest wrote:
C
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| new_n_lost
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The correct answer is C.
The high serum CK-MB indicates that the patient has sustained an infarction rather than angina. Subendocardial, rather than transmural, infarction is most likely in the setting of known, prolonged severe hypotension, and the equivocal nature of the ECG findings confirms this diagnosis. Subendocardial infarction occurs in settings of generalized poor perfusion complicated by increased demand or transient vasospasm. Subendocardial muscle tissue is especially vulnerable because it is farthest from the arterial supply.
In Prinzmetal angina (choice A) and stable angina (choice B), the CK-MB would not be expected to increase significantly.
Transmural infarction (choice D) is not specifically expected in the setting of shock. It produces characteristic ECG changes that are usually localized (unless a very large infarct has occurred) to a few leads.
In unstable angina (choice E), an increase in cardiac enzymes may be seen, but is usually less than 2 times the upper limit of normal.
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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."
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