A 47-year-old male presents with "crushing chest pain." He is a diabetic and smoker, with a history of hyperlipidemia and angina. Which of the following physical findings is most suggestive of acute myocardial ischemia?
- physiologic split second heart sound (split S2)
- crackles in both lungs that do not change with coughing
- chest tenderness with palpation of the costosternal junctions
- an S4 gallop that is not present when the patient is asymptomatic
- sinus bradycardia
Answer: D
An S4 gallop that is not present when the patient is asymptomatic
S4 is almost always present in an acute MI
Know Your Content Blueprint
Acute myocardial infarction is covered as part of the PANCE Cardiology Blueprint
Review Topic: Acute myocardial infarction (PEARLS)