Dyspnea in Medicine / Internal Medicine — 78yo Man | Cardiology | SMLE Q#11648
SMLE Question #11648
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 78-year-old man presents 1 hour after sudden severe central chest pain radiating to the left arm with dyspnea and diaphoresis. He appears pale and anxious with cool extremities. Examination shows elevated jugular venous pressure, bibasilar crackles, and a new loud blowing holosystolic murmur at the apex radiating to the left axilla. ECG shows 3-mm ST-segment elevation in II, III, and aVF with reciprocal ST depression in I and aVL. Hypotension persists despite a fluid bolus. What is the most likely cause of this patient’s hypotension?
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