Coronary Artery Disease USMLE Step 1 Practice Question
A 52-year-old woman with hypertension presents to the emergency department with a 6-week history of progressive dyspnea, orthopnea, and fatigue. She denies chest pain, has no smoking history, and takes only lisinopril. Vital signs: BP 138/86 mmHg, HR 108 bpm, RR 22/min, SpO2 93% on room air. Physical examination reveals elevated jugular venous pressure, bilateral crackles, and a displaced point of maximal impulse. Laboratory studies show troponin I 0.08 ng/mL (normal <0.04) and BNP 850 pg/mL. Echocardiography demonstrates global left ventricular hypokinesis with ejection fraction of 26%. Coronary angiography shows normal epicardial coronaries with normal TIMI flow. Cardiac MRI reveals patchy subendocardial fibrosis in a non-ischemic distribution. Which of the following is the most likely diagnosis?
Answer choices
- AAcute coronary syndrome with unobstructed coronary arteries (MINOCA)
- BAcute myocarditisCorrect answer
- CDilated cardiomyopathy from infiltrative disease
- DTakotsubo cardiomyopathy with apical ballooning
- ESpontaneous coronary artery dissection with recanalization
- FCoronary vasospasm with demand ischemia
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.