Q:

Following repair of an abdominal aortic aneurysm, a 66-year-old man develops severe chest pain, diaphoresis, bradycardia and hypotension. The following is/are true:

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Following repair of an abdominal aortic aneurysm, a 66-year-old man develops severe chest pain, diaphoresis, bradycardia and hypotension. The following is/are true:


  1. The electrocardiogram is most likely to show a prominent Q in lead 3 if this is an MI
  2. If Q wave is present, the infarct is subendocardial rather than transmural
  3. Creatine kinase measurement alone is diagnostic of MI
  4. Since bradycardia rarely occurs with MI, another diagnosis should be considered

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a. The electrocardiogram is most likely to show a prominent Q in lead 3 if this is an MI

Pain is the most common complaint in patients with myocardial infarction although 20%–25% are asymptomatic. Inferior MIs involving the right coronary frequently have parasympathetic activity with bradycardia, hypotension and a prominent Q wave in lead 3. The presence of a Q wave indicates a transmural MI which can be confirmed by measurement of the specific isoenzyme for cardiac tissue (CK-MB) since creatine kinase can be elevated non-specifically after stroke or operation.

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