A 64-year-old man presents to the emergency department with sudden onset of chest pain and an episode of vomiting. He also complains of ongoing nausea and heavy sweating (diaphoresis). He denies having experienced such symptoms before and is quite upset. Medical history is significant for hypertension and types 2 diabetes mellitus. He currently smokes and has smoked at least half a pack daily for the last 40 years. Vitals show a blood pressure of 80/50 mm Hg, pulse of 50/min, respirations of 20/min, temperature of 37.2°C (98.9°F), and oximetry is 99% before oxygen by facemask. Except for the patient being visibly distressed and diaphoretic, the examination is unremarkable. ECG findings are shown in the picture. Where is the most likely obstruction in this patient’s cardiac blood supply?
ALeft anterior descending artery
BThere is no obstruction
CLeft circumflex artery
DLeft main coronary artery
ERight coronary artery
A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 years. He appears uncomfortable. His pulse is 95/min. Serum studies show a normal troponin concentration. An ECG shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms?
AAtherosclerotic plaque thrombus with complete coronary artery occlusion
BStable atherosclerotic plaque with 85% coronary artery occlusion
CAortic valve thickening and calcification
DDisruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus
ECoronary artery occlusion due to transient increase in vascular tone
A 49-year-old man was brought to the emergency department by ambulance with complaints of sudden-onset chest pain that radiates into his neck and down his left arm. This substernal pain started 2 hours ago while he was having dinner. His past medical history is remarkable for hypercholesterolemia that is responsive to therapy with statins and coronary artery disease. His temperature is 37.0°C (98.6°F), blood pressure is 155/90 mm Hg, pulse is 112/min, and respiratory rate is 25/min. Troponin I levels are elevated. A 12-lead ECG was performed (see image). What is the most likely etiology of this patient’s presentation?
ACoronary vasospasm
BRight coronary artery occlusion
CLeft circumflex artery occlusion
DLeft anterior descending artery occlusion
ELeft main coronary artery occlusion
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