A 61-Year-Old Man Comes to the Office for Follow-Up for Coronary

question 1285

Multiple Choice

A 61-year-old man comes to the office for follow-up for coronary artery disease.  He says that he feels "fine."  The patient has had no chest pain, syncope, or lower extremity swelling.  He has had some shortness of breath on moderate exertion.  Medical follow-up has been inconsistent, and he has missed multiple medical appointments.  Medical history includes a myocardial infarction 2 years ago.  The patient is an ex-smoker with a 20-pack-year smoking history.  Blood pressure is 122/70 mm Hg, and pulse is 70/min and regular.  Echocardiogram reveals left ventricular dilation, apical left ventricular aneurysm, and ejection fraction of 23%.  There are no significant valvular abnormalities.  Appropriate pharmacotherapy is prescribed, medical compliance is reinforced, and a follow-up appointment is scheduled.  Several days later, the patient suddenly dies at home.  Which of the following is the most likely cause of death in this patient?

• A)Myocardial free wall rupture
• B)Papillary muscle rupture
• C)Pulmonary embolism
• D)Sinus arrest
• E)Ventricular arrhythmia

---

Definitions:

Self-confidence

The belief in one's own abilities, qualities, and judgment, contributing to a person's self-esteem and overall sense of value.

Self-confidence

The belief in one's own abilities and judgement.

Peak Performance

Achieving the highest level of performance capability in any activity, often characterized by optimal functioning and exceptional achievement.

Codependent

A psychological condition or a relationship in which a person is excessively emotionally or psychologically reliant on another, especially in cases of addiction.