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36. A previously healthy 65-year-old man is brought to the emergency department because of severe chest pain for 1 hour. His pulse is 95/min, and blood pressure is 160/110 mm Hg. The lungs are clear to auscultation. An S4 gallop and a grade 2/6 systolic murmur are heard at the apex. An ECG shows 3 mm of ST-segment elevation in leads V2 through V5. The most appropriate treatment includes immediate administration of which of the following?
A. Captopril
B. Digoxin
C. Furosemide
D. Magnesium
E. Tissue plasminogen activator
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what's wrong with that one?? an MI, pt arrived 1 hour after his CP began, previously healthy... so the most appropriate treatment is tpA to break down the thrombus!! the point here is the timing and the ''healthy'' pt...
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THese are all signs of acute coronary syndrome.. the new s4 gallop and murmer are due to papillary muscle disfunction that control the mitral valve due to low oxygen from occlusion. Therefore, trying to lyse the clot or obstruction is indicated in this patient.
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thanks xahdum... i was stupidly thinking where did the murmur come from!!?? i knew it does appear sometimes in MI, but i just forgot the pathological reason!!!!! apparently, stress is really affecting me!!!
GL to all....
