WBR0431
| Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 63-year-old male presents to the emergency room with complaints of severe chest pain and shortness of breath. Upon work-up, you diagnose him with myocardial infarction (MI) following appropriate management he is discharged. The patient returns 5 weeks later with complaints of a new-onset low grade fever and chest pain that radiates to the back and is relieved when he leans forward. Cardiac auscultation demonstrates a friction rub. Which of the following pathologic processes is most likely responsible for this patient’s condition?]] |
| Answer A | AnswerA::Increased left ventricular (LV) preload due to left ventricular failure post-MI |
| Answer A Explanation | AnswerAExp::LV failure is a complication of MI, but the patient's symptoms and manifestations do not suggest LV failure. |
| Answer B | AnswerB::Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac |
| Answer B Explanation | [[AnswerBExp::Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Frequent manifestations of cardiac tamponade are chest pain, hypotension, jugular venous distension, and pulsus paradoxus.]] |
| Answer C | AnswerC::New onset cardiac arrhythmia that abolishes the atrial kick |
| Answer C Explanation | AnswerCExp::Cardiac arrhythmias could result post-MI but their manifestation would likely not resemble what is described in the vignette. |
| Answer D | AnswerD::Autoimmune process that causes fibrinous disease |
| Answer D Explanation | [[AnswerDExp::Dressler syndrome is an autoimmune process that frequently results in fibrinous pericarditis.]] |
| Answer E | AnswerE::Post-procedural stent thrombosis |
| Answer E Explanation | [[AnswerEExp::Post-procedural stent thrombosis is frequently a complication of percutaneous interventions (PCI). The manifestations in the patient in the vignette are suggestive of a pericardial disease rather than a coronary disease.]] |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Dressler syndrome, an autoimmune process that occurs 4-6 weeks proceeding MI, results in fibrinous pericarditis and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is frequently described as radiating to the back and relieved by leaning forward. Patients typically demonstrate signs of pericarditis, such as pericardial friction rub. Educational Objective: Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically manifests 4-6 weeks following MI. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Dressler syndrome, WBRKeyword::myocardial infarction, WBRKeyword::MI, WBRKeyword::pericarditis fibrinous, WBRKeyword::chest pain, WBRKeyword::autoimmune |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |