Q:

Four days after a transmural MI, a 74-year-old man develops hypotension and congestive heart failure. The following is/are true:

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Four days after a transmural MI, a 74-year-old man develops hypotension and congestive heart failure. The following is/are true:


  1. An intra-aortic balloon pump should be used and cardiac catheterization performed
  2. If the infarct was posterior, this is most likely due to a ventricular septal defect
  3. Pulmonary wedge pressure tracing of prominent V waves without an O2 step-up suggests papillary muscle rupture
  4. Operative repair of a post MI VSD should be delayed to allow strengthening of the myocardium to hold sutures

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a. An intra-aortic balloon pump should be used and cardiac catheterization performed

c. Pulmonary wedge pressure tracing of prominent V waves without an O2 step-up suggests papillary muscle rupture

Both ventricular septal defect (VSD) and ruptured papillary muscle occur from 3–5 days post-MI and should be managed by intra-aortic balloon pump, decreasing afterload and cardiac catheterization for diagnosis. A VSD is most likely in an elderly hypertensive female who has sustained an anterior transmural MI; posterior MIs typically lead to papillary muscle rupture which is diagnosed by prominent V waves on pulmonary wedge pressure tracing. Survival rate for both of these complications is improved by early rather than late repair.

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