A 72-year-old man is seen in the emergency department due to chest pain. He reports 2 days of mid-sternal chest pain, left shoulder pain, fatigue, and occasional sweating. He sleeps on his right side because sleeping on his back "hurts too much." He has a known history of coronary artery disease and underwent coronary artery bypass grafting (CABG) 4 weeks ago. The post-operative course was complicated by new-onset temporary atrial fibrillation and several days of post-operative fever.
His temperature is 38.2 C (100.8 F), blood pressure is 120/75 mmHg, pulse is 89/min, and pulse oximetry is 96% on room air. His cardiac and pulmonary examinations are within normal limits. His chest examination reveals a well-healing sternotomy site with mild erythema, but no tenderness to palpation.
ECG shows sinus rhythm with left bundle branch block, which was present on his ECG three weeks ago. Chest x-ray reveals cardiomegaly with sternotomy wires present and a small left-sided pleural effusion.
Which of the following best explains this patient's current complaints?

Question

A 72-year-old man is seen in the emergency department due to chest pain.  He reports 2 days of mid-sternal chest pain, left shoulder pain, fatigue, and occasional sweating.  He sleeps on his right side because sleeping on his back "hurts too much."  He has a known history of coronary artery disease and underwent coronary artery bypass grafting (CABG) 4 weeks ago.  The post-operative course was complicated by new-onset temporary atrial fibrillation and several days of post-operative fever.
His temperature is 38.2 C (100.8 F), blood pressure is 120/75 mmHg, pulse is 89/min, and pulse oximetry is 96% on room air.  His cardiac and pulmonary examinations are within normal limits.  His chest examination reveals a well-healing sternotomy site with mild erythema, but no tenderness to palpation.
ECG shows sinus rhythm with left bundle branch block, which was present on his ECG three weeks ago.  Chest x-ray reveals cardiomegaly with sternotomy wires present and a small left-sided pleural effusion.
Which of the following best explains this patient's current complaints?

Quizplus · Accepted Answer

The Answer is B

A 72-Year-Old Man Is Seen in the Emergency Department Due