CARDIOLOGY Flashcards
What is the most common early complication of myocardial infarction, occurring within 24-48 hours?
Cardiac arrhythmias (e.g., ventricular fibrillation, ventricular tachycardia).
What is cardiogenic shock, and when does it typically occur post-MI?
Severe decreased cardiac output and hypotension.
Occurs when more than 40% of the left ventricle is infarcted usually within the first few days post-MI.
When does ventricular free wall rupture typically occur after an MI, and what are the clinical signs?
A: Occurs 3-7 days post-MI. Clinical signs include cardiac tamponade, distant heart sounds, hypotension, and jugular venous distension.
A 59-year-old man is hospitalized after suffer- ing a severe myocardial infarction. He is ini- tially treated with nitrates, β-blockers, and aspi- rin, and subsequently undergoes cardiac catheterization with placement of two stents. Following the procedure he is hemodynami- cally stable without recurrence of chest pain. However, 5 days after admission his heart rate is 134/min, blood pressure is 72/35 mm Hg, and respiratory rate is 29/min. Physical exami- nation reveals distant heart sounds and an ele- vated jugular venous pressure. Which of the following complications is most likely causing this patient’s symptoms?
(A) Aneurysm formation
(B) Cardiac arrhythmia
(C) Fibrinous pericarditis
(D) Rupture of the papillary muscle (E) Rupture of the ventricular free wall
The most likely cause of this patient’s symptoms is ventricular free wall rupture, leading to cardiac tamponade—a serious complication that can occur 3 to 7 days after a myocardial infarction.
What is the key clinical finding in papillary muscle rupture, and when does it occur after an MI?
- Acute mitral regurgitation
- Pulmonary edema
- New holosystolic murmur.
It occurs 2-7 days post-MI, commonly in inferior wall infarctions.
What clinical findings are associated with interventricular septal rupture, and when does it occur post-MI?
- Heart failure
- New holosystolic murmur at the left sternal border
- Signs of a left-to-right shunt.
Typically occurs 3-7 days post-MI.
What is Dressler syndrome, and when does it occur?
- Autoimmune pericarditis
- Occurs 2-10 weeks post-MI
- Pleuritic chest pain
- Fever
- Pericardial friction rub
What is a late complication of MI characterized by a bulging, dyskinetic area of the ventricular wall, and when does it occur?
A: Ventricular aneurysm, which develops weeks to months post-MI. It can lead to heart failure, arrhythmias, and thromboembolism.
When does acute pericarditis typically occur after MI, and what are the key symptoms?
A: Occurs 1-3 days post-MI, presenting with pleuritic chest pain and a pericardial friction rub.
What is a mural thrombus, and when is it most likely to form post-MI?
A: A mural thrombus is a thrombus that forms on the endocardium overlying an infarcted area, typically forming days to weeks post-MI. It can lead to systemic embolism.
What are the typical timeframes for complications of MI?
A:
First 24-48 hours: Arrhythmias.
1-3 days: Acute pericarditis.
3-7 days: Ventricular free wall rupture, papillary muscle rupture, septal rupture.
Weeks to months: Ventricular aneurysm, Dressler syndrome, mural thrombus.
A 68-year-old man presents to the emergency department with acute onset of chest pain, shortness of breath, and lightheadedness. He suffered an anterior myocardial infarction 5 days ago and was treated with thrombolytics. His current vital signs reveal a heart rate of 130/min, blood pressure of 75/40 mm Hg, and respiratory rate of 32/min. Jugular venous distension is noted on physical examination, and heart sounds are distant. Which of the following is the most likely cause of his current condition?
(A) Ventricular aneurysm formation
(B) Rupture of the ventricular free wall
(C) Rupture of the interventricular septum
(D) Papillary muscle rupture
(E) Dressler syndrome
A 72-year-old woman with a history of hypertension and hyperlipidemia presents with sudden-onset dyspnea and orthopnea 3 days after suffering a myocardial infarction. She has bilateral pulmonary crackles and a new holosystolic murmur heard at the apex. Echocardiography reveals severe mitral regurgitation. Which of the following is the most likely underlying cause of her condition?
(A) Rupture of the ventricular free wall
(B) Rupture of the papillary muscle
(C) Rupture of the interventricular septum
(D) Formation of a ventricular aneurysm
(E) Acute pericarditis
A 60-year-old man presents with new-onset shortness of breath 5 days after an inferior wall myocardial infarction. On physical examination, a loud holosystolic murmur is heard at the left lower sternal border, and there are signs of biventricular heart failure. Echocardiography reveals a significant left-to-right shunt. Which of the following is the most likely cause of this patient’s presentation?
(A) Ventricular free wall rupture
(B) Ventricular aneurysm formation
(C) Papillary muscle rupture
(D) Interventricular septal rupture
(E) Acute pericarditis
A 58-year-old man presents to the clinic with low-grade fever, pleuritic chest pain, and fatigue 4 weeks after suffering a myocardial infarction. On physical examination, there is a pericardial friction rub. ECG reveals diffuse ST-segment elevations. Which of the following is the most likely diagnosis?
(A) Papillary muscle rupture
(B) Acute pericarditis
(C) Dressler syndrome
(D) Ventricular free wall rupture
(E) Ventricular aneurysm
