A 62-Year-Old Man Comes to the Emergency Department Due to 2

question 131

Multiple Choice

A 62-year-old man comes to the emergency department due to 2 hours of chest discomfort.  He was eating a light dinner when he developed rapidly worsening mid-chest discomfort associated with nausea and weakness.  For the last few days, the patient has also experienced "stomach flu" symptoms with episodic nausea and vomiting and decreased oral intake.  Two weeks ago, he was diagnosed with an acute inferior wall myocardial infarction and received a bare metal stent to the right coronary artery.  His hospital course was uncomplicated.  Pre-discharge echocardiogram showed inferior and posterior wall hypokinesis and a left ventricular ejection fraction of 50%.
Temperature is 37.2 C (99 F) , blood pressure is 98/64 mm Hg, and pulse is 55/min.  Oxygen saturation is 99% on room air.  BMI is 23 kg/m².  The patient appears uncomfortable.  There is no jugular venous distention and the lungs are clear.  A grade 2/6 holosystolic murmur is heard at the apex.  The abdomen is nontender with no hepatomegaly.  Peripheral pulses are symmetric.
ECG shows sinus bradycardia with 2-mm ST-segment elevation in leads II, III, and aVF.
Which of the following is the most likely diagnosis?

• A)Left ventricular aneurysm
• B)Noncardiac chest pain
• C)Papillary muscle rupture
• D)Peri-infarction pericarditis
• E)Stent thrombosis

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