WBR0461

Author	[[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::A 62-year-old male heavy smoker is brought to the emergency room for severe chest pain and dyspnea at rest, both manifesting 30 minutes prior to presentation. The patient has a history of hyperlipidemia, uncontrolled diabetes mellitus for more than 15 years, and hypertension. Upon appropriate work-up, you diagnose him with acute myocardial infarction (MI). The patient dies despite resuscitation efforts. Which of the following 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 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. References: First Aid 2014 page 290]]
Approved	Approved::Yes
Keyword	WBRKeyword::chest pain, WBRKeyword::ventricular arrhythmia, WBRKeyword::fibrillation, WBRKeyword::cardiac arrest, WBRKeyword::cardiology, WBRKeyword::cardiovascular system, WBRKeyword::MI, WBRKeyword::Myocardial infraction
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::