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  #1  
Old 10-28-2012
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Arrow Billy Step 1 Questions # 52

A 70-year-old woman with a history of type 2 diabetes mellitus, a body mass index of 30 kg/ m2, and an MI 10 years prior presents to the
emergency department with crushing substernal chest pain radiating to her neck and jaw. Emergency cardiac catheterization with percutaneous coronary intervention (PCI) shows a 99% occlusion of her left anterior descending artery, and an ECG reveals an anterior wall ST
segment elevation MI. The patient remains stable after PCI, and echocardiography shows a mildly impaired ejection fraction (EF) of
45%. Three days later, the patient becomes acutely hypotensive and dyspneic, and physical examination reveals a high-pitched holosystolic murmur, loudest at the apex and radiating to the axilla, that had not been heard on previous exams. An emergency echocardiogram shows an EF of 25%. This patient has developed which of the following?


(A) Aortic stenosis
(B) Dressler’s syndrome
(C) Ruptured interventricular septum
(D) Ruptured left ventricular free wall
(E) Ruptured papillary muscle
(F) Ventricular aneurysm
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  #2  
Old 10-28-2012
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i think case presented abt...mitral regurgitation... but not sure abt answer

will go with E) papillary muscle rupture

thanks.

so finally completed half a century...gr8 doing with your questions...thanks
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  #3  
Old 10-28-2012
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Agree with Venky.
Papillary muscle rupture ---> Mitral Regurg.(Holosystolic murmur at apex radiating to axilla.)
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Old 10-28-2012
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E seems the best choice to me for this option
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  #5  
Old 10-28-2012
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Default my answer :)

(E) Ruptured papillary muscle
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  #6  
Old 10-28-2012
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Default Good question

Hmm good question. Ant papillary muscles receive dual blood supply so they are unlikely to rupture. The murmur does sound like a mitral regurg I want to go with (C) Ruptured interventricular septum
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papillary muscle rupture
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  #8  
Old 10-28-2012
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I go with papillary muscle rupture>>>>>mr
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Old 10-28-2012
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My answer E) Ruptured papillary muscle.
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  #10  
Old 10-29-2012
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Correct Answer E is correct

This patient has suffered rupture of one of the two left ventricular papillary muscles, a complication that may occur 3–10 days after an acute MI, when the infarcted area of myocardium is replaced with granulation tissue and thus is the most weak. Without the anchor of the papillary muscle, there is severe acute mitral valve regurgitation, diagnosed by a new holosystolic “blowing murmur” that is loudest at the apex and radiates to the axilla, a severely reduced stroke volume (hypotension with EF of 25%), and evidence of pulmonary edema (dyspnea).
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  #11  
Old 10-29-2012
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Quote:
Originally Posted by billy View Post
A 70-year-old woman with a history of type 2 diabetes mellitus, a body mass index of 30 kg/ m2, and an MI 10 years prior presents to the
emergency department with crushing substernal chest pain radiating to her neck and jaw. Emergency cardiac catheterization with percutaneous coronary intervention (PCI) shows a 99% occlusion of her left anterior descending artery, and an ECG reveals an anterior wall ST
segment elevation MI. The patient remains stable after PCI, and echocardiography shows a mildly impaired ejection fraction (EF) of
45%. Three days later, the patient becomes acutely hypotensive and dyspneic, and physical examination reveals a high-pitched holosystolic murmur, loudest at the apex and radiating to the axilla, that had not been heard on previous exams. An emergency echocardiogram shows an EF of 25%. This patient has developed which of the following?


(A) Aortic stenosis
(B) Dressler’s syndrome
(C) Ruptured interventricular septum
(D) Ruptured left ventricular free wall
(E) Ruptured papillary muscle
(F) Ventricular aneurysm
(E) Ruptured papillary muscle
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  #12  
Old 10-29-2012
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Quote:
Originally Posted by koolkiller88 View Post
(E) Ruptured papillary muscle
guessing answer just below answered post.
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