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 49 yr old male with severe chest pain  



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Author4 Posts
  #1

A previously healthy 49-year-old man has had severe chest pain for 2 hours. Heart rate is 74/min, blood pressure is 110/70 mm Hg, and jugular venous pressure 9 cm above the mid right atrium; lungs are clear to auscultation. Cardiac examination reveals distinct heart sounds, an S4 gallop, and no murmur. Electrocardiography reveals sinus rhythm, 0.4 to 0.6 mV of ST-segment elevation in leads II, III and aVF, and a small Q wave in lead III.
Because of persistent chest pain in the emergency room, 1 inch of nitroglycerin ointment is applied topically. Fifteen minutes later the patient is confused, diaphoretic, and agitated. Systolic blood pressure is 64 mm Hg. Heart sounds are less audible, but there is no other change in the cardiac or pulmonary examination. The electrocardiographic monitor reveals sinus rhythm at 120/min.
The most likely cause of this patient’s hypotension is:
A) A ruptured anterior papillary muscle with acute mitral regurgitation
B) A ruptured interventricular septum
(C) Acute right ventricular and inferior myocardial infarction with inadequate right ventricular filling pressure
(D) Anaphylactic reaction to nitroglycerin
E) Cardiogenic shock due to massive myocardial infarction




  #2

C is the answer


  #3

correct, the answer is c


  #4

i go for c





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