A woman with coronary artery disease is starting to go for a walk. As she begins, her heart rate accelerates from a resting pulse of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her chest. She stops walking to rest and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement?
AThis patient's chest pain is indicative of transmural ischemia
BPerfusion of the myocardium takes place equally throughout the cardiac cycle
CIncreasing the heart rate increases the amount of time spent during each cardiac cycle
DIncreasing the heart rate decreases the relative amount of time spent during diastole
EPerfusion of the myocardium takes place primarily during systole
A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an inferior wall myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully done that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion. Which of the following is the most reliable test for rapidly establishing the diagnosis in this patient?
ACreatine kinase MB
BLactate dehydrogenase
CCopeptin
DAspartate aminotransferase
ECardiac troponin T
A 32-year-old man comes to the emergency department because of sharp chest pain for 3 days. The pain is retrosternal, 8 out of 10 in intensity, increases with respiration, and decreases while sitting upright and leaning forward. He has nausea and myalgia. He has not had fever or a cough. He has asthma and was treated for bronchitis 6 months ago with azithromycin. His mother has hypertension. He uses an over-the-counter inhaler. His temperature is 37.3°C (99.1°F), pulse is 110/min, and blood pressure is 130/84 mm Hg. Breath sounds are normal. Cardiac examination shows a high-pitched grating sound between S1 and S2. The remainder of the examination shows no abnormalities. Serum studies show: Urea nitrogen 16 mg/dl Glucose 103 mg/dL Creatinine 0.7 mg/dL Troponin I 0.230 ng/mL (N < 0.1 ng/mL) An ECG shows diffuse ST elevations in all leads. The patient is at increased risk for which of the following conditions?
ACardiac tamponade
BPapillary muscle rupture
CPulmonary infarction
DVentricular aneurysm
EMediastinitis
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