The Daily PANCE and PANRE Extended Edition: Question 46

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?

  1. physiologic split second heart sound (split S2)
  2. crackles in both lungs that do not change with coughing
  3. chest tenderness with palpation of the costosternal junctions
  4. an S4 gallop that is not present when the patient is asymptomatic
  5. 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

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