A 60-year-old male presents with palpitations. He reports drinking many glasses of wine over several hours at a family wedding the previous evening. An EKG reveals absent P waves and irregularly irregular rhythm. He does not take any medications. Which is most likely responsible for the patient’s symptoms?
ATransmural myocardial infarction
BUntreated hypertension
CVentricular hypertrophy
DTorsades de pointes
EAtrial fibrillation
A 36-year-old woman presents to the emergency department with chest discomfort and fatigue. She reports that her symptoms began approximately 1 week ago and are associated with shortness of breath, swelling of her legs, and worsening weakness. She’s been having transitory fevers for about 1 month and denies having similar symptoms in the past. Medical history is significant for systemic lupus erythematosus (SLE) treated with hydroxychloroquine. She had a SLE flare approximately 2 weeks prior to presentation, requiring a short course of prednisone. Physical exam was significant for a pericardial friction rub. An electrocardiogram showed widespread ST-segment elevation and PR depression. After extensive work-up, she was admitted for further evaluation, treatment, and observation. Approximately 2 days after admission she became unresponsive. Her temperature is 100°F (37.8°C), blood pressure is 75/52 mmHg, pulse is 120/min, and respirations are 22/min. Heart sounds are muffled. Which of the following is a clinical finding that will most likely be found in this patient?
AWarm extremities
BPericardial knock
CDecreased systolic blood pressure by 8 mmHg with inspiration
DJugular venous distension
EUnequal blood pressure measurements between both arms
A 64-year-old woman is brought to the emergency department 1 hour after the onset of acute shortness of breath and chest pain. The chest pain is retrosternal in nature and does not radiate. She feels nauseated but has not vomited. She has type 2 diabetes mellitus, hypertension, and chronic kidney disease. Current medications include insulin, aspirin, metoprolol, and hydrochlorothiazide. She is pale and diaphoretic. Her temperature is 37°C (98°F), pulse is 136/min, and blood pressure is 80/60 mm Hg. Examination shows jugular venous distention and absence of a radial pulse during inspiration. Crackles are heard at the lung bases bilaterally. Cardiac examination shows distant heart sounds. Laboratory studies show: Hemoglobin 8.3 g/dL Serum Glucose 313 mg/dL Urea nitrogen 130 mg/dL Creatinine 6.0 mg/dL Which of the following is the most appropriate next step in management?
AFurosemide therapy
BPericardiocentesis
CAspirin therapy
DHemodialysis
ENorepinephrine infusion
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