AssessmentsCoronary artery disease: Pathology review
USMLE® Step 1 style questions USMLE
A 60-year-old man comes to the emergency department due to 20 minutes of crushing chest pain and diaphoresis that began suddenly while watching television. According to the patient’s partner, lately he has had occasional chest pain occurring during rest that resolved after a few minutes. Medical history is significant for hyperlipidemia, hypertension, and diabetes mellitus. The patient has not been compliant with the medications. The patient’s temperature is 37.0°C (98.6° F), pulse is 80/min, respirations are 20/min, and blood pressure is 135/85 mm Hg. The patient appears to be in acute distress and in pain. Cardiac examination shows an additional sound just prior to S1 on auscultation. ECG demonstrates ST segment elevation in leads V1-V5. While being prepared for percutaneous coronary intervention, the patient suddenly dies. Following this patient’s death, an autopsy is performed to better understand the underlying pathology. At the time of this patient's death, which of the following sets of findings is most likely to be seen in the anterior wall of the myocardium?
Content Reviewers:Yifan Xiao, MD
Contributors:Kaylee Neff, Jake Ryan, Antonia Syrnioti, MD, Ahmad El-Gammal, MBBS, Robyn Hughes, MScBMC, Samantha McBundy, MFA, CMI
In an urban emergency department, 3 people came in for chest pain. The first is Anish, a 54 year old man with a known history of hypertension, hyperlipidemia, and 25-pack year smoking. He’s complaining of shortness of breath, and squeezing, retrosternal chest pain that radiates to his neck, jaw and left arm. He’s been having these episodes but they only come after riding his bicycle for at least 20 minutes, and is relieved once he rests. Investigations reveal a normal ECG and normal troponin levels. Next, is Erica, a 66-year old woman with a history of