Cardiac pathology: complications of infarction: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Cardiac pathology: complications of infarction

Sample item

A 62-year-old man is recovering from an anterior myocardial infarction. On day 5 he suddenly collapses with distended neck veins, muffled heart sounds and electromechanical dissociation. What is the likely pathology?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Free-wall rupture into the pericardium with tamponade at the time of maximal softening of necrotic myocardium

Free-wall rupture typically occurs 3 to 7 days after infarction, when inflammatory cells and enzymes have removed necrotic myocytes and granulation tissue has not yet provided strength. Blood enters the pericardium and causes tamponade. Septal and papillary muscle ruptures occur in the same period but present differently.

Option by option

  • A. Dressler syndrome with a pericardial effusion

    Dressler syndrome is an autoimmune pericarditis occurring weeks after infarction.

  • B. Papillary muscle rupture causing acute mitral regurgitation

    Papillary rupture gives sudden pulmonary oedema and a new loud mitral regurgitant murmur, not tamponade.

  • C. Free-wall rupture into the pericardium with tamponade at the time of maximal softening of necrotic myocardium (correct)

    Correct. The time window and picture of tamponade fit free-wall rupture.

  • D. Ventricular aneurysm formation with mural thrombus

    Aneurysm develops weeks later with fibrous scar and may cause thrombus or arrhythmias.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Free-wall rupture into the pericardium with tamponade at the time of maximal softening of necrotic myocardium. Free-wall rupture typically occurs 3 to 7 days after infarction, when inflammatory cells and enzymes have removed necrotic myocytes and granulation tissue has not yet provided strength.

Why is "Dressler syndrome with a pericardial effusion" not the answer?

Dressler syndrome is an autoimmune pericarditis occurring weeks after infarction.

Why is "Papillary muscle rupture causing acute mitral regurgitation" not the answer?

Papillary rupture gives sudden pulmonary oedema and a new loud mitral regurgitant murmur, not tamponade.

Why is "Ventricular aneurysm formation with mural thrombus" not the answer?

Aneurysm develops weeks later with fibrous scar and may cause thrombus or arrhythmias.

What concept does this question test?

It tests Cardiac pathology: complications of infarction in Pathology. Blood enters the pericardium and causes tamponade. Septal and papillary muscle ruptures occur in the same period but present differently.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiac pathology: complications of infarction?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.