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(Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Pathology |SubCategory=Cardiology |MainCategory=Pathology |SubCategory=Cardiology |MainCategory=Path...")
 
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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Cardiology
|SubCategory=Cardiology
|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?
|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?
|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]].
|Explanation=The most common cause of death in patients with [[myocardial infarction]] (MI) is fatal [[ventricular arrhythmias]] prior to presentation. [[Arrhythmia]] is the most frequently occurring acute adverse event in the first 12 hours following MI.
 
|EducationalObjectives= The most common cause of death in patients with [[myocardial infarction]] (MI) is 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


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.


|AnswerA=Arrhythmia
|AnswerA=Arrhythmia
|AnswerAExp=Fatal ventricular arrhythmia is the most common cause of death in the first few hours after MI.
|AnswerAExp=Fatal [[ventricular arrhythmia]] is the most common cause of death in the first few hours following MI.
|AnswerB=Ventricular rupture
|AnswerB=Ventricular rupture
|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.
|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.
|AnswerC=Dressler syndrome
|AnswerC=Dressler syndrome
|AnswerCExp=Dressler syndrome is an autoimmune fibrinous pericarditis that occurs several weeks after MI.
|AnswerCExp=[[Dressler syndrome]], an autoimmune [[fibrinous pericarditis]], occurs several weeks following MI.
|AnswerD=Cardiac tamponade  
|AnswerD=Cardiac tamponade  
|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.
|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]].  
|AnswerE=Endocarditis
|AnswerE=Endocarditis
|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. 
|AnswerEExp=[[Endocarditis]], not frequently a complication of MI, may arise in valvulopathies, potentially caused by a past MI.  
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=chest, pain, death, resuscitation, arrhythmia, ventricular, fibrillation, cardiac, arrest
|WBRKeyword=chest pain, ventricular arrhythmia, fibrillation, cardiac arrest, cardiology, cardiovascular system, MI, Myocardial infraction
|Approved=No
|Approved=Yes
}}
}}

Revision as of 14:12, 24 July 2014
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) is 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) is 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::
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