September/2006

ANSWER 11=D

DISCUSSION:

The patient’s EKG is clearly abnormal demonstrating left ventricular hypertrophy and T wave inversions in the lateral precordial leads, V4- V6. The history is non-specific. Myocardial ischemia may present with abdominal pain particularly in the upper abdomen. The patient seems to be a smoker who is 74 years of age, again suggesting that you consider coronary artery pathology highly. It is not possible to care for a patient with myocardial ischemia in a psychiatric unit. Although you may want to consult a neurologist, you must handle the current findings yourself. A delay of 8 hours is inappropriate since one of the complications of myocardial ischemia is sudden death.