WBR0431

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::A 63 year old male patient presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is discharged home. The patient returns 5 weeks later to the emergency department with complains of a new-onset low grade fever and chest pain that radiates to the back and is relieved when leaning forward. Cardiac auscultation shows friction rub. Which of the following pathologic processes is responsible for this patient’s new 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 symptoms and signs of the patient in the vignette 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. Symptoms 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 presentation would not be like that in the vignette.
Answer D	AnswerD::Autoimmune process that causes fibrinous disease
Answer D Explanation	AnswerDExp::Dressler’s syndrome is an autoimmune process that causes fibrinous pericarditis.
Answer E	AnswerE::Post-procedural stent thrombosis
Answer E Explanation	[[AnswerEExp::Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). Symptoms and signs would not be similar to the patient in the vignette that are strongly suggestive of a pericardial disease rather than a coronary disease.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Dressler’s syndrome is an autoimmune process that occurs 4-6 weeks after MI. It results in fibrinous pericarditis and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is classically described as radiating to the back and is relieved by leaning forward. Patients typically have signs of pericarditis on physical examination, such as pericardial friction rub. Educational Objective: Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks after MI. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Dressler's, WBRKeyword::syndrome, WBRKeyword::myocardial, WBRKeyword::infarction, WBRKeyword::pericarditis, WBRKeyword::fibrinous, WBRKeyword::chest, WBRKeyword::pain, WBRKeyword::autoimmune
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::