Question

A 76-year-old man is seen in the emergency room for chest and left shoulder pain, sweating and nausea for the last 8 hours. He says he took a few aspirins at home but that did not relieve his pain. An EKG shows signs of anterior myocardial infarction (heart attack). Myocardial infarctions are caused by occlusion of blood supply to a portion of the heart potentially leading to oxygen shortage and tissue death. This is most commonly caused by blockage of vessels in the coronary circulation by slow-growing plaques that become unstable and rupture. The patient is treated appropriately with revascularization by dilating the stenotic artery with a balloon pump (coronary angioplasty) and placement of a stent. He is kept in the coronary care unit (CCU) for observation. On day 4 of hospital admission, he becomes dizzy and nauseous. He also complains of chest pain. His blood pressure is low and his heart sounds are difficult to hear on auscultation. The physician suspects myocardial rupture causing cardiac tamponade, a rare complication of myocardial infarction. Cardiac tamponade is a life-threatening condition where rapid fluid collection in the pericardial space will prevent normal pumping of the heart.The patient is quickly treated with fluid resuscitation and cardiac surgery. He eventually recovers and is sent to a long-term care facility. When he is seen months later by the cardiologist, a murmur is heard loudest at the fifth left intercostal space in the midclavicular line.

1. Which valve is likely dysfunctional in this patient?

Answer 1

Mitral valve is the most likely dysfunctional valve..

Left 5th intercostal space, mid clavicular line is the most important clue here