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A 55-year-old man with a past medical history of hypertension, hyperlipidemia, and insulin dependent diabetes mellitus presents to the ED with a sudden onset of substernal chest pain and pressure that radiated into his neck and down his left arm. The pain started a few hours ago while he was watching television. It was not relieved by rest. He was given aspirin by EMS en route to the hospital. His current medications are glargine insulin, hydrochlorothiazide, and atorvastatin. He has not had any similar episodes previously. His family history is significant for an uncle who had a heart attack at age 45. He drinks one drink every other day and has a 25-pack-year smoking history. His temperature is 99.0°F (37.2°C), blood pressure is 150/90 mmHg, pulse is 63/minute, respirations are 22/minute, and point-of-care glucose level is 110 mg/dl. Troponin level is elevated. EKG is shown in Figure A. What is the most likely etiology of this patient’s presentation?
Left main coronary artery occlusion
Right main coronary artery occlusion
Left circumflex artery occlusion
Left anterior descending artery occlusion
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A 24-year-old man presents to the emergency room with a stab wound to the left chest at the 4th intercostal space. The patient is hemodynamically unstable, and the trauma attending is concerned that there is penetrating trauma to the heart. Which cardiovascular structure is most likely to be affected by such a wound?
A 49-year-old male presents to the emergency room with dyspnea and pulmonary edema. He reports that he has been smoking 2 packs a day for the past 25 years and has difficulty breathing during any sustained physical activity. His blood pressure is normal, and he reports a history of COPD. An echocardiogram was ordered as part of a cardiac workup. Which of the following would be the most likely finding?
Mitral valve insufficiency
Left ventricular hypertrophy
Coronary sinus dilation
Tricuspid valve stenosis
A healthy 23-year-old male is undergoing an exercise stress test as part of his physiology class. If blood were to be sampled at different locations before and after the stress test, which area of the body would contain the lowest oxygen content at both time points?
Superior vena cava
Inferior vena cava
In the coronary steal phenomenon, vessel dilation is paradoxically harmful because blood is diverted from ischemic areas of the myocardium. Which of the following is responsible for the coronary steal phenomenon?
Dilation of the large coronary arteries
Volume loss of fluid in the periphery
A 62-year-old Caucasian male presents to the emergency room with severe substernal chest pain, diaphoresis, and nausea. Imaging reveals transmural myocardial infarction in the posterior 1/3 of the ventricular septum. Which of this patient's coronary arteries is most likely occluded?
Left anterior descending