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  #1  
Old 02-23-2011
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Arrow Anterior myocardial infarction

A 65 y/o man on the 5th day of hospitalization for an acute anterior myocardial infarction has recurrent of chest pain and an increase in both CK-MB and Troponin-1. The patient MOST likely has?

A. papillary muscle dysfunction
B. a right ventricular infarct
C. a ventricular aneurysm
D. a myocardial rupture
E. reinfarction
F. Dressler's syndrome

very easy one. lol
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Old 02-23-2011
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You say easy one, but all of those are complications of an MI.

A. Papillary muscle dysfunction. Nope.
B. RV Infarct, could be.
C. Ventricular Aneurysm, I dont think so.
D. Myocardial Rupture, could be.
E. Reinfarction, less possible since he's probably already on anticoagulants, or has undergone a bypass.
F. No signs of fevers, or symptoms of pneumonia, so nope.

I would have to guess Myocardial Rupture.
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Quote:
Originally Posted by patelMD View Post
You say easy one, but all of those (or atleast most) are complications of an MI.

A. Papillary muscle dysfunction. Nope.
B. RV Infarct, could be.
C. Ventricular Aneurysm, I dont think so.
D. Myocardial Rupture, could be.
E. Reinfarction, less possible since he's probably already on anticoagulants, or has undergone a bypass.
F. No signs of fevers, or symptoms of pneumonia, so nope.

I would have to guess Myocardial Rupture.
Do not worry if you get it wrong. I want you to know these facts and concepts for your exam. Most of my qns are already tested on the RRRR Exam.. you know what I mean.....! Try your best.
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@patelMD - Dressler's syndrome is not a pneumonia, its a complication of MI
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Quote:
Originally Posted by aktorque View Post
@patelMD - Dressler's syndrome is not a pneumonia, its a complication of MI
Yes, you are right, but symptoms mimic it, that's what I remember from learning Medicine. Symptoms consisted of a persistent low-grade fever, chest pain etc. And in this case because its at the 5th day, it can't be it since Dressler's was to begin after 2 - 3 weeks.

Seems that I have made a fatal mistake of reading the question improperly. It said recurrent chest pain haha, that would obviously be an acute state, so a reinfarction would be the best choice.
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Old 02-23-2011
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reinfarction
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Default E

I would guess E because of the elevated CK-MB. Normally, CK-MB levels are only elevated for up to 3 days post-MI (from my understanding) so if they are elevated on day 5, I would suspect reinfarction. CK-MB is commonly used as a marker for re-infarction.

On the other hand, Troponin is elevated and stays elevated for about a week. Therefore this is not a great marker for reinfarction.

There is not much evidence to point to any of the other answer choices.

Papillary muscle dysfunction would cause holosystolic murmer
Dresslers would cause pericardial friction rub (autoimmune pericarditis). plus this occurs 2-10 weeks post-MI
Rupture could be possible, especially in this time frame but is not common
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Old 02-23-2011
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Hey pakbrain---- (I like your name)... tell me more about it
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hey
it was given to my by my friends back in the days when i was into coding and computers and i created my first virus with this name :P
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hey
it was given to my by my friends back in the days when i was into coding and computers and i created my first virus with this name :P
Wow...so you are a software Geek. Now I want you to crack the USMLE code... lol
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i was then i chose this profession and now i m fully dedicated to it and yea i m workin on cracking this usmle step by step
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Old 02-23-2011
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Arrow E) reinfarction

Quote:
Originally Posted by patelMD View Post
Seems that I have made a fatal mistake of reading the question improperly. It said recurrent chest pain haha, that would obviously be an acute state, so a reinfarction would be the best choice.
Quote:
Originally Posted by pakbrain View Post
reinfarction
Quote:
Originally Posted by apx85 View Post
I would guess E because of the elevated CK-MB. Normally, CK-MB levels are only elevated for up to 3 days post-MI (from my understanding) so if they are elevated on day 5, I would suspect reinfarction. CK-MB is commonly used as a marker for re-infarction.

On the other hand, Troponin is elevated and stays elevated for about a week. Therefore this is not a great marker for reinfarction.

There is not much evidence to point to any of the other answer choices.

Papillary muscle dysfunction would cause holosystolic murmer
Dresslers would cause pericardial friction rub (autoimmune pericarditis). plus this occurs 2-10 weeks post-MI
Rupture could be possible, especially in this time frame but is not common
Guyz, you all correct. I'm impressed.

Correct ans is E) reinfarction

B/c reappearance of CK-MB after 3 days is the definition of reinfarction.
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Got lucky, I read the Cardio chapter in USMLE Secrets today
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I remember this from the Goljan Audio....

Reinfarction is very common after the 3-4th day post-MI

Nice question.
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Old 03-28-2012
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Quote:
Originally Posted by apx85 View Post
I would guess E because of the elevated CK-MB. Normally, CK-MB levels are only elevated for up to 3 days post-MI (from my understanding) so if they are elevated on day 5, I would suspect reinfarction. CK-MB is commonly used as a marker for re-infarction.

On the other hand, Troponin is elevated and stays elevated for about a week. Therefore this is not a great marker for reinfarction.

There is not much evidence to point to any of the other answer choices.

Papillary muscle dysfunction would cause holosystolic murmer
Dresslers would cause pericardial friction rub (autoimmune pericarditis). plus this occurs 2-10 weeks post-MI
Rupture could be possible, especially in this time frame but is not common
Thank you for explaining why the other answers are wrong. I jumped the gun and chose A as the answer b/c i saw 5 days & i recognized in FA 5-10 days has increased Papillary muscle rupture . However, i skimmed over lab results. Grr.
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Old 03-28-2012
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Reinfarction.

Goljan, increase of CKMB on the 5th day.
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