WBR0461
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 62 year old heavy smoker male patient is brought to the emergency department with severe chest pain and dyspnea at rest that start 30 minutes prior to presentation. The patient has a significant history of hyperlipidemia, uncontrolled diabetes mellitus for more than 15 years, and uncontrolled hypertension. Appropriate work-up is done and the diagnosis of acute myocardial infarction (MI) is made. After a few minutes in the emergency department, the patient suffers dies despite resuscitation efforts. What is the most likely cause of death in this patient?]] |
| Answer A | AnswerA::Arrhythmia |
| Answer A Explanation | AnswerAExp::Fatal ventricular arrhythmia is the most common cause of death in the first few hours after MI. |
| Answer B | AnswerB::Ventricular rupture |
| Answer B Explanation | [[AnswerBExp::Ventricular rupture is a potentially fatal complication of MI that usually occurs several days, typically 5-7 days, after MI. For rupture to occur, the ventricular wall needs to be severely injured. Rupture then occurs during a period of ventricular wall weakness and thinning following MI during the inflammatory response induced by the infarction process.]] |
| Answer C | AnswerC::Dressler syndrome |
| Answer C Explanation | AnswerCExp::Dressler syndrome is an autoimmune fibrinous pericarditis that occurs several weeks after MI. |
| Answer D | AnswerD::Cardiac tamponade |
| Answer D Explanation | [[AnswerDExp::Cardiac tamponade is caused by a pericardial effusion that restricts the normal expansion of the ventricles and eventually leads to normalization of pressures in all cardiac chambers and results in overall cardiovascular collapse due to severe hypotension. Cardiac tamponade does not typically occur acutely after MI where myocardial rupture eventually leads to fluid accumulation within the pericardium and cardiac tamponade. Cardiac tamponade, however, is common to be present after 24-48 hours of cardiac surgery due to occlusion of chest tubes that are required to drain the fluid post-op.]] |
| Answer E | AnswerE::Endocarditis |
| Answer E Explanation | AnswerEExp::Endocarditis is not a common complication post-MI. Endocarditis, however, may arise in valvulopathies that might be caused by previous MI. However, the disease does not occur in such acute context. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The most common cause of death in patients with myocardial infarction (MI) is fatal ventricular arrhythmias before they reach the hospital. Following myocardial infarction, arrhythmia is the most common acute adverse event for at least the first 12 hours after MI. Other complications do not develop as acutely as arrhythmias.
Educational Objective:
Following acute MI, the most common complication that predisposes to patients’ death before hospitalization or during their hospitalization before appropriate treatment is fatal ventricular arrhythmias. Other complications eventually arise; but they take more time to develop. |
| Approved | Approved::No |
| Keyword | WBRKeyword::chest, WBRKeyword::pain, WBRKeyword::death, WBRKeyword::resuscitation, WBRKeyword::arrhythmia, WBRKeyword::ventricular, WBRKeyword::fibrillation, WBRKeyword::cardiac, WBRKeyword::arrest |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |