smitha
Forum Elite
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65 Y.O.man in CCU with an ac.ant.MI. He now experiences substernal chest pain similar in intensity to his initial pain. 3rd HS & bibasilar rales present.No murmur or friction rub. Lab.......CPK-MB PRESENT, LDH with an LDH1/LDH2 flip PRESENT.
Which of the following is the most likely diagnosis?
1.Recurrent angina
2.Dressler's syndrome
3. Reinfarction
4.A ruptured posteromedial papillary muscle
5.A pulmonary embolus.
and as i ask u usually, guys plz try to xplain with reason...........that helps, believ me!!!!!!!!! 
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| prep4usmle
Administrator
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CPK-MB PRESENT + LDH with an LDH1/LDH2 flip = Reinfarction
chest pain similar in intensity to his initial pain + CPK-MB present => small chance for recurrent angina
no rub => no Dressler's syndrome
no murmur => papillary muscle is ok
bibasilar rales present => less likely for PE
What is this "3rd HS" ?
When was this patient diagnosed with ac.ant.MI?
It would be nice to have an ECG!
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| smitha
Forum Elite
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That's perrrrrrrfect prep. Sorry, i didn't mention........but the MI is 4 days duration.........
Yes definitely an ECG wud've bee helpful but it isn' there even with the q..........sorry 
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| smitha
Forum Elite
Topics: 53
Posts: 236
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source: NMSR
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