A 69-year-old woman complains of some atypical chest pain 2 days prior to presentation. On examination, the JVP is at 8 cm, positive Kussmaul sign, and normal heart sounds. The lungs are clear. The ECG is abnormal, and the CXR shows a normal cardiac silhouette.For the above patient with shortness of breath and peripheral edema, select the most likely diagnosis.
High-Yield Explanation
RVMI is characterized by high neck veins, ECG abnormalities, and often a right-sided S3. The low cardiac output associated with RVMI can often be treated by volume expansion. Although a third of patients with inferoposterior infarctions have some degree of right ventricular necrosis, extensive RVMI is uncommon.