WBR0461
| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 62-year-old man is brought to the emergency department (ED) for severe chest pain and dyspnea at rest for the past 30 minutes. The patient has a medical history significant for hyperlipidemia, uncontrolled diabetes mellitus for more than 15 years, and hypertension. He smokes 2 packs of cigarettes each day for the past 40 years. In the ED, ECG shows ST-segment-elevation more than 2 consecutive leads, and serum troponin level is markedly elevated. The patient is diagnosed with ST-segment-elevation myocardial infarction (STEMI). Despite appropriate and timely management in the ED, the patient dies. Which of the following is this patient's most likely cause of death?]] |
| Answer A | AnswerA::Arrhythmia |
| Answer A Explanation | [[AnswerAExp::Fatal ventricular arrhythmia is the most common cause of death in the first few hours following MI.]] |
| Answer B | AnswerB::Ventricular rupture |
| Answer B Explanation | [[AnswerBExp::A ventricular rupture is a potentially fatal complication of MI, typically occurring within the subsequent 5-7 days. The severely injured ventricular wall results in a rupture, which occurs during the inflammatory response induced by the infarction process.]] |
| Answer C | AnswerC::Dressler syndrome |
| Answer C Explanation | [[AnswerCExp::Dressler syndrome, an autoimmune fibrinous pericarditis, occurs several weeks following MI.]] |
| Answer D | AnswerD::Cardiac tamponade |
| Answer D Explanation | [[AnswerDExp::Cardiac tamponade results in an overall cardiovascular collapse due to severe hypotension. Cardiac tamponade stems from a pericardial effusion, which restricts the normal expansion of the ventricles and leads to the normalization of pressures in all cardiac chambers. Cardiac tamponade does not typically occur acutely after MI where myocardial rupture eventually leads to fluid accumulation within the pericardium and cardiac tamponade.]] |
| Answer E | AnswerE::Endocarditis |
| Answer E Explanation | [[AnswerEExp::Endocarditis, not frequently a complication of MI, may arise in valvulopathies, potentially caused by a past MI.]] |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The most common cause of death in patients with myocardial infarction (MI) are fatal ventricular arrhythmias prior to presentation. Arrhythmia is the most frequently occurring acute adverse event in the first 12 hours following MI. Educational Objective: The most common cause of death in patients with myocardial infarction (MI) are fatal ventricular arrhythmias prior to presentation. Arrhythmia is the most frequently occurring acute adverse event in the first 12 hours following MI. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Chest pain, WBRKeyword::Ventricular arrhythmia, WBRKeyword::Fibrillation, WBRKeyword::Cardiac arrest, WBRKeyword::MI, WBRKeyword::Myocardial infraction, WBRKeyword::STEMI, WBRKeyword::Arrhythmia, WBRKeyword::Death |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |