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Self-Assessment Questions

Cardiology

Mechanical Complications of Acute Myocardial Infarction: Review Questions

Mehdi H. Shishehbor, DO, MPH, and Deepak L. Bhatt, MD

Dr. Shishehbor is a fellow in cardiology, and Dr. Bhatt is director of the interventional cardiology fellowship, associate director of the cardiovascular fellowship, and staff physician of the cardiac, peripheral, and carotid intervention; both are at the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH.



Choose the single best answer for each question.

A 19-year-old college student presents with chest pain. One week previously, she had a self-limited upper respiratory infection. The chest pain is central in location, with radiation to the neck and trapezius ridge. The discomfort intensifies with recumbency and inspiration and improves with sitting upright.

1. All of the following findings are commonly associated with hemodynamically significant severe right ventricular (RV) myocardial infarction (MI) EXCEPT
  1. Elevated jugular venous pressure
  2. Hypotension
  3. Kussmaul’s sign
  4. Pulmonary edema
  5. Pulsus paradoxus
Click here to compare your answer.


2. A 64-year-old woman presents to the emergency department with crushing substernal chest pain that lasted for 90 minutes. Physical examination reveals heart rate of 110 bpm, blood pressure of 75/40 mm Hg, respiratory rate of 22 breaths/min, and jugular venous pressure of 12 cm above the right atrium. Lungs are clear to auscultation. Cardiac examination reveals normal S1 and S2 and a right-sided S3 with no evidence of mitral or aortic murmur. A 3-mm ST elevation in leads II, III, and aVF are noted as well as a 1-mm ST elevation in leads V1 and V2. What is the most appropriate first step in this patient’s management?

  1. Intravenous (IV) nitroglycerin
  2. IV dopamine
  3. Intra-aortic balloon pump (IABP)
  4. Furosemide
  5. IV fluid administration
Click here to compare your answer.
Questions 3 and 4 refer to the following case study.

A patient presents to the cardiology clinic with a new onset pansystolic murmur after a recent ST elevation anterior MI. Physical examination reveals a woman in no apparent distress with a heart rate of 110 bpm, blood pressure of 95/50 mm Hg, jugular venous pressure of 10 cm above right atrium, and bibasilar rales. Extremities are cool with 1+ edema.


3. Which of the following is the best first test to use to evaluate this patient?
  1. Cardiac computed tomography
  2. Chest radiograph
  3. Right heart catheterization
  4. Right heart catheterization
  5. Two-dimensional (2-D) echocardiography with Doppler
Click here to compare your answer.


4. The echocardiogram reveals a ventricular septal rupture with left-to-right shunting and no valvular or paravalvular leak. Which of the following interventions has been associated with decreased mortality rates in stable patients with post-MI ventricular septal rupture?

  1. Early surgical closure
  2. IABP
  3. IV dopamine
  4. IV fluid administration
  5. IV nitroprusside
Click here to compare your answer.


5. The presence of giant V waves on pulmonary capillary wedge (PCW) tracing in a patient with a new pansystolic murmur after an acute MI is indicative of which of the following diagnoses?

  1. Atrial septal defect
  2. Cardiac tamponade
  3. Severe mitral regurgitation
  4. Ventricular free wall rupture
  5. Ventricular septal rupture
Click here to compare your answer.



 

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