All right. Welcome. My name is Devine. This is episode 454 of the Devine Intervention

Podcast. In this podcast we're going to be continued on our rapid review series

for the USMI- Step 2 seek, his step 3 exams. This is going to be Series 3.

Now, what if they give you a question about a 45 year old male, they tell you that he presented for these a goal with ST segment elevations.

And then now he's profoundly short of breath, he's gasping for air, he's not doing well, and they tell you that he has, that his neck is bulging

bilaterally and they're also given a blood pressure and he's like precipitously low.

They tell you that he's popable, that is, uh,

real pulses are 3D barely popable. And then, you notice that there are crackles

when you also take the lungs and they tell you that a discernible

signal is hard to obtain with an E-K-J-G. When you see something like this, I really hope you're probably thinking about one of these

complications of an M. I remember M. M. M. M. M. M. M. M. M. M. M. M. M.

complications, they are very regularly tested on exams, but the big one I want to focus on here is a free wall rupture. A ventricular free wall rupture.

So how does this stuff usually present? Well, the way we typically present is you see a

person will be a few days after they've had an MRI and then they will have signs and

symptoms of cardiac tamponat, signs and symptoms of cardiac tamponat because again when the

free war ruptures that blood is going to find its way to the pericardium

it's going to cause tamponat physiology and remember cardiac tamponat has a classic triad

They'll have givid d'll have more food heart sounds, they would have

hypotension. But the thing is the USML is again, they love to use surrogates. The basic stuff you know, they just try to take things a step

further to see if you truly understand what you're talking about. So like for example,

JVD, they could, again instead of saying that a person has GVD,

you can see the person has a bilateral neck bulge, right, a bilateral neck bulge,

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