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USLME Step 2 Review
Question #11 A 82 year old male with a history of recent aortic valve replacement, hypertension, and diabetes presents to the emergency department with fevers for 5 days. No chest pains or shortness of breath. His medications include lisinopril, hydrochlorothiazide, aspirin, and coumadin. His temperature is 38.4 C, blood pressure is 160/60, heart rate 100, respirations 20, and oxygen saturation 99% on room air. Physical examination reveals normal lung sounds, a II/IV early diastolic decrescendo murmur, and a very soft 1st heart sound. Laboratory studies reveal a white blood cell count of 15 thousand and an ESR of 110. A portion of his ECG is below. Which of the following is causing his abnormal finding on his ECG?  1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9
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