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A 68-year-old male with a history of type 2 diabetes, hypertension, and COPD presents to the emergency department with severe substernal chest pain. On exam, he is diaphoretic and in obvious distress. An EKG is obtained which is demonstrated in Figure F. He immediately receives treatment for his condition and is subsequently admitted to the cardiac intensive care unit (CICU). In the CICU, he does well until day 5 of hospitalization when he begins to complain of severe shortness of breath and chest pain. Vitals are noted to be T: 36 deg C, HR: 130 bpm, BP: 65/40 mmHg, RR: 12, SaO2: 98%. He is clearly in distress and has elevated JVP. Which of the following histologic images would you expect to see if a biopsy of the myocardium was performed on this patient?
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A 53-year-old man with a past medical history significant for hyperlipidemia, hypertension, and hyperhomocysteinemia presents to the emergency department complaining of 10/10 crushing, left-sided chest pain radiating down his left arm and up his neck into the left side of his jaw. His ECG shows ST-segment elevation in leads V2-V4. He is taken to the cardiac catheterization laboratory for successful balloon angioplasty and stenting of a complete blockage in his left anterior descending coronary artery. Echocardiogram the following day shows decreased left ventricular function and regional wall motion abnormalities. A follow-up echocardiogram 14 days later shows a normal ejection fraction and no regional wall motion abnormalities. This post-infarct course illustrates which of the following concepts?
Coronary collateral circulation
A 62-year-old male collapses while mowing the lawn, and it is determined that he experienced sudden cardiac death. The patient's medical history is significant for a preceding myocardial infarction that was managed conservatively. Posthumous histologic evaluation of the patient's heart reveals extensive granulation tissue replacing dead myocardium as well as early evidence of neovascularization, which is shown in Figure A. How long prior to death did this patient most likely experience his myocardial infarction?
A 64-year-old male with a past medical history of obesity, diabetes, hypertension, and hyperlipidemia presents with an acute onset of nausea, vomiting, diaphoresis, and crushing substernal chest pain. Vital signs are temperature 37° C, HR 110, BP 149/87, and RR of 22 with an oxygen saturation of 99% on room air. Physical exam reveals a fourth heart sound (S4), and labs are remarkable for an elevated troponin. EKG is shown below. The pathogenesis of the condition resulting in this patient’s presentation involves:
Genetic inheritance of a mutation in ß-myosin or troponin expressed in cardiac myocytes
A fully obstructive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque
A partially occlusive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque
Destruction of the vasa vasorum caused by vasculitic phenomena
A stable atheromatous lesion without overlying thrombus
A 60-year-old woman with history of type I diabetes currently on hormone replacement therapy is seen in your ED complaining of "bad indigestion", dizziness and nausea for the past several hours. Vitals are T98.9, HR 102, BP 130/100, RR 25 and she is mildly diaphoretic. An EKG is shown in Figure A. At what time point does the injury to her affected cells become irreversible?
An autopsy is being performed on an elderly man who died from a myocardial infarction. Biopsy of the heart is likely to reveal necrosis most similar to necrosis seen in which of the following scenarios?
The central nervous system following a stroke
The lung following a tuberculosis infection
Acute pancreatitis resulting from release of enzymatically active enzymes into the pancreas
A region of kidney where blood flow is obstructed
Pfeffer MA, Braunwald E, MoyÃ© LA, Basta L, Brown EJ, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC
N. Engl. J. Med.. 1992 Sep;327(10):669-77. PMID: 1386652 (Link to Abstract)