A 65-Year-Old Man Comes to the Emergency Department Due to Substernal

question 251

Multiple Choice

A 65-year-old man comes to the emergency department due to substernal chest discomfort and intermittent palpitations that began this morning.  The patient has a history of coronary artery disease and stable angina that is managed medically.  He takes high-dose metoprolol, atorvastatin, and low-dose aspirin.  The patient reports that he has been traveling for the past week and ran out of his medications 2 days ago.  Temperature is 37 C (98.6 F) , blood pressure is 148/82 mm Hg, and pulse is 112/min.  ECG reveals sinus tachycardia with a 1-mm ST segment depression in the lateral leads.  Which of the following is most likely responsible for this patient's presentation?

• A)Increased levels of circulating catecholamines
• B)Predominant activation of alpha-adrenergic receptors
• C)Reduced activity of cyclic AMP-mediated messaging
• D)Reduced cellular sensitivity to circulating catecholamines
• E)Upregulation of beta-adrenergic receptors

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