A 50-year-old man with a lengthy history of diabetes mellitus and hypertension has had pain in...

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A 50-year-old man with a lengthy history of diabetes mellitus and hypertension has had pain in the left shoulder andarm for the past 12 hours. He attributes the pain to arthritis and takes acetaminophen. Over the next 6 hours, he develops shortness of breath, which persists for 2 days. On day 3, he visits the physician. On physical examination, his temperature is 37.1°C, pulse is 82/min, respirations are 18/min, and blood pressure is 160/100 mm Hg. Laboratory studies show that the total creatine kinase (CK) activity is within reference range, but the troponin I level is elevated. The patient is admitted to the hospital and continues to experience dyspnea for the next 3 days. On day 7 after the onset of shoulder pain, he has a cardiac arrest. Resuscitative measures are unsuccessful. Postmortem examination shows a large trans mural infarction of the left anterior free wall with rupture and hemopericardium. Which of the following statements is best supported by these clinical and autopsy data? □ (A) Infarction did not develop until day 5 or day 6 after the episode of chest pain (B) The normal CK level obtained on day 3 excludes the possibility of infarction within the preceding 72 hours □ (C) He had an acute infarction occurring on the day he developed shoulder pain U (D) A CK-MB fraction determination would have detected acute infarction on day 3 □ (E) A second acute infarction on day 6 or day 7 caused myocardial rupture within several hours A 50-year-old man with a lengthy history of diabetes mellitus and hypertension has had pain in the left shoulder andarm for the past 12 hours. He attributes the pain to arthritis and takes acetaminophen. Over the next 6 hours, he develops shortness of breath, which persists for 2 days. On day 3, he visits the physician. On physical examination, his temperature is 37.1°C, pulse is 82/min, respirations are 18/min, and blood pressure is 160/100 mm Hg. Laboratory studies show that the total creatine kinase (CK) activity is within reference range, but the troponin I level is elevated. The patient is admitted to the hospital and continues to experience dyspnea for the next 3 days. On day 7 after the onset of shoulder pain, he has a cardiac arrest. Resuscitative measures are unsuccessful. Postmortem examination shows a large trans mural infarction of the left anterior free wall with rupture and hemopericardium. Which of the following statements is best supported by these clinical and autopsy data? □ (A) Infarction did not develop until day 5 or day 6 after the episode of chest pain (B) The normal CK level obtained on day 3 excludes the possibility of infarction within the preceding 72 hours □ (C) He had an acute infarction occurring on the day he developed shoulder pain U (D) A CK-MB fraction determination would have detected acute infarction on day 3 □ (E) A second acute infarction on day 6 or day 7 caused myocardial rupture within several hours

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