39.A 29-year-old man is brought to the ED by EMS for a syncopal episode
that occurred during a basketball game. A friend states that the patient just
dropped to the ground shortly after scoring a basket on a fast-break. On
examination, you note a prominent systolic ejection murmur along the left
sternal border and at the apex. An ECG reveals left ventricular hypertrophy,
left atrial enlargement, and septal Q waves. You suspect the diagnosis and
ask the patient to perform the Valsalva maneuver while you auscultate his
heart. Which of the following is most likely to occur to the intensity of the
murmur with this maneuver?
a. Decrease
b. Increase
c. Remain unchanged
d. Disappear
e. The intensity stays the same but the heart skips a beat
40.A 61-year-old woman with metastatic breast cancer presents to the ED
with chest pain, cough, and shortness of breath. She states these symptoms
began 1 week ago and progressively worsened. She denies fever or chills. On
examination, you notice jugular venous distension. Her BP is 105/70 mm Hg
and HR is 98 beats per minute. A chest radiograph is shown below. Which of
the following ECG finding is associated with this presentation?
Chest Pain and Cardiac Dysrhythmias 21a. Low-voltage complexes
b. High-voltage complexes
c. ST-segment depression
d. ST-segment elevation
e. T-wave inversion
(Reproduced, with permission, from Cheitlin MD., Sokolow M, McIlroy MB. Clinical Cardiology.
New York, NY: McGraw-Hill, 1996: 641)