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This Q&A was obtained from the MKSAP® 18 edition of the Medical Knowledge Self-Assessment Program. Learn more about the new MKSAP® 19 edition and pre-order your copy today. You can expect customized learning plans, more content sections, a newly integrated Board Basics study guide, and multimedia enhancements.
MKSAP 18 Q & A
A 36-year-old woman is evaluated in the emergency department for progressive dyspnea. She gave birth 3 weeks ago. The pregnancy and delivery were uncomplicated. She has no history of cardiovascular disease.
On physical examination, temperature is normal, blood pressure is 100/72 mm Hg in both arms, pulse rate is 102/min and regular, and respiration rate is 26/min. The estimated central venous pressure is elevated. Cardiac palpation reveals a diffuse apical impulse. The S1 and S2 are soft. An S3 and S4 are present. A grade 2/6 holosystolic murmur is heard at the apex. Crackles are auscultated bilaterally.
An electrocardiogram demonstrates sinus tachycardia without ST-T–wave changes. Transthoracic echocardiogram reveals ventricular dilatation with global reduction in contractility; the left ventricular ejection fraction is 30%.
Which of the following is the most likely diagnosis?
A: Acute aortic dissection
B: Acute pulmonary embolism
C: Peripartum cardiomyopathy
D: Takotsubo cardiomyopathy