doc4mindia
Forum Guru
Topics: 134
Posts: 243
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A 55-year-old man with no known cardiac history presents to the emergency department complaining of crushing substernal chest pressure that began 20 minutes prior to his arrival. He took sildenafil (Viagra) earlier in the evening prior to sexual intercourse. His past medical history is significant for bilateral inguinal hernia repairs 6 weeks ago, remote peptic ulcer disease, and prior cocaine and heroin addiction. On examination he is diaphoretic and appears anxious. His blood pressure is 150/75 mm Hg with a pulse of 100/min. An electrocardiogram (ECG) obtained while he had severe chest pain revealed tall positive T waves (hyperacute T waves) and 1-mm elevation of the ST segments in leads V2 through V5. A serum creatine kinase (CK) drawn on presentation returned at 85 U/L (normal < 250U/L).Which of the following is the most likely diagnosis?
A. Aortic dissection
B. Myocardial infarction (MI)
C. Pulmonary embolus (PE)
D. Spontaneous pneumothorax
E. Stable angina
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| prep4usmle
Administrator
Topics: 288
Posts: 1,184
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Anterior MI
- ST elevation on V2 to V5 on ECG
- CK(MB) starts to rise 3-6 hours later
"bilateral inguinal hernia repairs 6 weeks ago + remote peptic ulcer disease"
That will put some problems considering a posible thrombolytic therapy.
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| xmihaela
Forum Junior
Topics: 1
Posts: 51
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it is too easy. MI .
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