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  #1  
Old 06-21-2011
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EKG cardio case with ECG

A 42-year-old woman with an acute onset of shortness of breath and left-sided pleuritic chest pain is evaluated in the emergency room. She experienced these symptoms, which she has never experienced before, early this morning while she was walking her dog. She describes herself as otherwise healthy. She smokes one pack/day of cigarettes, but she doesn’t drink. She had a laparoscopic cholecystectomy 2 weeks ago, and she had an appendectomy at age 10. She is on Prempro (estrogen 0.625mg/day) and a multivitamin. She denies any allergies. Her physical exam shows: T 38, P 107, RR 24, BP 123/89 mm Hg. The remainder of her physical exam is normal. A 12-lead electrocardiogram (ECG) is obtained and is shown in the figure.
What is the most likely diagnosis?

http://usmlesteps123.examweb.com/ass...4/Mmf037f1.jpg
Answer Choices
A. Acute myocardial infarction
B. Aortic dissection
C. Costochondritis
D. Pericarditis
E. Pulmonary embolus

Last edited by USMLE-Syndrome; 06-21-2011 at 01:02 PM.
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  #2  
Old 06-21-2011
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I don't see the EKG
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Old 06-21-2011
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Quote:
Originally Posted by aksyonez View Post
I don't see the EKG
sorry i added the ecg now

http://usmlesteps123.examweb.com/ass...4/Mmf037f1.jpg
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  #4  
Old 06-21-2011
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I wanna go with D. It looks like diffuse ST segment elevation
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Old 06-21-2011
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The ECG pic is soo tiny

Anyway i'll go with E. Pulmonary Embolus
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  #6  
Old 06-21-2011
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its e pe,e..tachycardia+tachypnea...
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Old 06-21-2011
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Most likely PE.

History and sinus tachycardia fit in!
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Old 06-22-2011
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Option E (Pulmonary embolus) is correct. The clinical scenario of acute shortness of breath, pleuritic chest pain, and risk factors for pulmonary embolus (smoking, recent surgery, and estrogen) with an ECG signifying sinus tachycardia makes pulmonary embolus the most likely diagnosis.

Option A (Acute myocardial infarction) is incorrect. The clinical scenario with an ECG without ischemia signs makes acute myocardial infarction less likely. The patient has multiple risk factors for venous thromboembolism.

Option B (Aortic dissection) is incorrect. The clinical scenario with an ECG signifying sinus tachycardia makes pulmonary embolus the most likely diagnosis. Patients with aortic dissection usually have hypertension as a risk factor and are older.

Option C (Costochondritis) is incorrect. The clinical scenario with an ECG signifying sinus tachycardia makes pulmonary embolus the most likely diagnosis; costochondritis often presents with pleuritic pain, but there is no evidence to suggest where the muscle strain occurred.

Option D (Pericarditis) is incorrect. The clinical scenario with an ECG signifying sinus tachycardia makes pulmonary embolus the most likely diagnosis. Pericarditis usually presents with pain relieved with sitting forward. Often, the ECG reveals diffuse ST segment elevation.

High-yield Hit 1
Table 1-12. Cause of Axis Deviation
RIGHT LEFT
Normal variation Normal variation
Mechanical shifts: inspiration, emphysema Mechanical shifts: expiration, high diaphragm (e.g., pregnancy)
Right bundle-branch block
Right ventricular hypertrophy Left anterior hemiblock
Left posterior hemiblock Left bundle-branch block
Dextrocardia Congenital lesions
Left ventricular ectopic rhythms Wolff-Parkinson-White syndrome, hyperkalemia, right ventricular ectopic beats
Some right ventricular ectopic rhythms
Pulmonary hypertension
Pulmonary embolus
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