American Board of Internal Medicine (ABIM) Certification Practice Exam

Following an MI, what symptom should indicate immediate evaluation for ventricular free wall rupture?

1. Chest pain

2. Syncope

3. New-onset heart failure symptoms

4. Acute shortness of breath

The correct answer is: New-onset heart failure symptoms

The symptom that should indicate immediate evaluation for ventricular free wall rupture following a myocardial infarction (MI) is new-onset heart failure symptoms. Ventricular free wall rupture is a serious complication that can occur after an MI, particularly within the first few days to weeks following the event. The rupture typically leads to a rapid accumulation of blood in the pericardial space, resulting in cardiac tamponade, which dramatically impairs cardiac output. New-onset heart failure symptoms, such as severe fatigue, dyspnea on exertion, or acute change in functional status, suggest that the heart is struggling to maintain adequate blood flow. This deterioration can serve as an early indicator of left ventricular dysfunction secondary to rupture. In these cases, prompt medical assessment is critical to manage the potential life-threatening event effectively. While chest pain, syncope, and acute shortness of breath can also be associated with cardiac complications following an MI, they do not necessarily indicate the same level of imminent danger as new-onset heart failure symptoms do. For instance, chest pain could derive from various causes, including ischemia or pericarditis, while syncope may result from other factors unrelated to immediate structural complications. Acute shortness of breath, too, can be a symptom