chest pain and NSAIDs are used for treatment. However, it does not cause
valvular abnormalities leading to a murmur and pulmonary infiltrates.
(d)Tuberculosis generally does not present with chest pain or cardiac mur-
mur.(e)In Lyme disease, patients frequently have a bull’s eye rash called
erythema migrans.Although Lyme disease does not lead to valvular abnor-
malities, patients may present with cardiac conduction abnormalities, the
most worrisome being complete heart block. Patients typically have risk fac-
tors for tick exposure, such as hiking in a wooded area.
10.The answer is d.(Rosen, p 1021.)The standard 12-lead ECG is the
single best test to identify patients with acute MI upon presentation in the
ED. It is important to identify the anatomic location of an acute MI to esti-
mate the amount of endangered myocardium. The right coronary artery
(RCA) supplies the AV node and inferior wall of the left ventricle in 90% of
patients.Inferior wall MIsare characterized by ST elevation in at least two
of the inferior leads (II, III, aVF).Reciprocal ST changes (eg, ST depres-
sion) in the anterior precordial leads (V 1 –V 4 ) in the setting of an inferior wall
acute MI predict a larger infarct distribution, an increased severity of underly-
ing coronary artery disease (CAD), more severe pump failure, and increased
mortality. In general, the more elevated the ST segments and the more ST seg-
ments that are elevated, the more extensive the injury.
Chest Pain and Cardiac Dysrhythmias Answers 29