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Cardiology MCQ

 Question:

A 58-year-old man presents with sudden severe retrosternal chest pain radiating to the jaw, associated with sweating and nausea. ECG shows ST-segment elevation in leads V1–V4. Which of the following is the most likely diagnosis?

Options:

A. Inferior wall myocardial infarction

B. Lateral wall myocardial infarction

C. Anterior wall myocardial infarction

D. Pericarditis

✅ Answer: C. Anterior wall myocardial infarction


Explanation:

Clinical features: Severe retrosternal chest pain radiating to jaw or left arm, sweating, nausea, and vomiting are classic ACS symptoms.

ECG interpretation:

ST-segment elevation in V1–V4 indicates anterior wall MI, usually due to occlusion of the left anterior descending (LAD) artery.

ST elevation in II, III, aVF → inferior MI (RCA occlusion).

ST elevation in I, aVL, V5–V6 → lateral MI (LCx or diagonal LAD branch).

Management:

Immediate reperfusion therapy: primary PCI (preferred) or thrombolysis if PCI not available.

Antiplatelet therapy (aspirin + P2Y12 inhibitor), anticoagulation, statins, beta-blockers (unless contraindicated), ACE inhibitors.

Complications: Arrhythmias, heart failure, cardiogenic shock, ventricular rupture, post-MI pericarditis.



References: 

Harrison’s Principles of Internal Medicine, 21st Edition, Ch. 222;

 Braunwald’s Heart Disease, 12th Edition, Ch. 42; 

UpToDate: Acute STEMI management.

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