WBR0431

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::A 63-year-old male presents to the emergency room with complaints of severe chest pain and shortness of breath. Upon work-up, you diagnose him with myocardial infarction (MI) following appropriate management he is discharged. The patient returns 5 weeks later with complaints of a new-onset low grade fever and chest pain that radiates to the back and is relieved when he leans forward. Cardiac auscultation demonstrates a friction rub. Which of the following pathologic processes is most likely responsible for this patient’s condition?]]
Answer A	AnswerA::Increased left ventricular (LV) preload due to left ventricular failure post-MI
Answer A Explanation	AnswerAExp::LV failure is a complication of MI, but the patient's symptoms and manifestations do not suggest LV failure.
Answer B	AnswerB::Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac
Answer B Explanation	[[AnswerBExp::Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Frequent manifestations of cardiac tamponade are chest pain, hypotension, jugular venous distension, and pulsus paradoxus.]]
Answer C	AnswerC::New onset cardiac arrhythmia that abolishes the atrial kick
Answer C Explanation	AnswerCExp::Cardiac arrhythmias could result post-MI but their manifestation would likely not resemble what is described in the vignette.
Answer D	AnswerD::Autoimmune process that causes fibrinous disease
Answer D Explanation	[[AnswerDExp::Dressler syndrome is an autoimmune process that frequently results in fibrinous pericarditis.]]
Answer E	AnswerE::Post-procedural stent thrombosis
Answer E Explanation	[[AnswerEExp::Post-procedural stent thrombosis is frequently a complication of percutaneous interventions (PCI). The manifestations in the patient in the vignette are suggestive of a pericardial disease rather than a coronary disease.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Dressler syndrome, an autoimmune process that occurs 4-6 weeks proceeding MI, results in fibrinous pericarditis and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is frequently described as radiating to the back and relieved by leaning forward. Patients typically demonstrate signs of pericarditis, such as pericardial friction rub. Educational Objective: Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically manifests 4-6 weeks following MI. References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Dressler syndrome, WBRKeyword::myocardial infarction, WBRKeyword::MI, WBRKeyword::pericarditis fibrinous, WBRKeyword::chest pain, WBRKeyword::autoimmune
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::