02-24-2008, 11:24 AM
A 38-year-old healthy Caucasian man is brought to the emergency department because of sudden onset of shortness of breath and diaphoresis. He denies fever, chills, cough or abdominal pain. He has no other medical problems. He had surgery for bilateral inguinal hernia when he was 16. He does not use tobacco, alcohol or illicit drugs. He takes no medication and has no known drug allergies. His blood pressure is 110/60 mm Hg, pulse is 116/min and respirations are 28/min. He is in marked respiratory distress. Pallor and diaphoresis are noted. His skin is velvety and has multiple scars. On auscultation of the heart, an early, decrescendo, systolic murmur at the cardiac apex is heard; the murmur decreases with Valsalva maneuver, and increases with the grip maneuver, radiating to the axilla. The first sound is barely audible; the second heart sound is normal. A fourth heart sound is also present. There are bilateral crackles in both lungs. Jugular venous distention and hepatojugular reflux are present. The abdomen is soft, non-tender and non-distended. The neurologic examination reveals no abnormalities. The initial EKG shows sinus tachycardia with occasional premature ventricular complexes. The chest x-ray reveals no cardiomegaly, but bilateral alveolar infiltrates and hilar prominence are present.
Item 1 of 2
Which of the following is the most likely cause of his condition?
A. Acute myocardial infarction
B. Rupture of chordae tendinea
C. Pulmonary embolism
D. Infective endocarditis
E. Papillary muscle rupture
Item 1 of 2
Which of the following is the most likely cause of his condition?
A. Acute myocardial infarction
B. Rupture of chordae tendinea
C. Pulmonary embolism
D. Infective endocarditis
E. Papillary muscle rupture
