A 62-year-old man presents with shortness of breath during physical activity. His heart rate is 102 and irregularly irregular. He has a loud first heart sound with an opening snap in early diastole. He also has a mid/late diastolic murmur.
What is the most probable cause of his heart condition from the options given below?
You review a 54-year-old man who has recently been discharged from the hospital after receiving thrombolysis for an acute inferior myocardial infarction (MI). He was relatively well post-infarct, and he is here to review his post- discharge medication.
Other past medical history of note includes type 2 diabetes. Current treatment includes metformin 1g BD, aspirin 75 mg, atorvastatin 10 mg daily and ramipril 10 mg. On examination his BP is 155/92 mmHg, pulse is 75 and regular. His BMI is 29 kg/m2. There are bibasal crackles on auscultation of the chest.
Investigations reveal:
Hb 125 g/dL (135-180)
WCC 5.2 ×109/L (4-10)
PLT 231 ×109/L (150-400)
Na 139 mmol/L (134-143)
K 4.5 mmol/L (3.5-5.0)
Cr 145 µmol/L (60-120)
HbA1c 55 mmol/mol (20-46)
7.2% (<5.5) Which of the following is true with respect to the management of his post-MI medication?
You see a 70-year-old male smoker in clinic who describes symptoms of pain in his left leg which is exacerbated by exercise and relieved by rest.
On examination his pulses are weak in the left leg compared to the right. Suspecting intermittent claudication you arrange leg Dopplers. These show an ABPI (ankle brachial pressure Index) of 0.84.
What is the appropriate diagnosis for this man based on these findings?
You are reviewing a 75-year-old woman.
You saw her several weeks ago with a clinical diagnosis of heart failure and a high brain natriuretic peptide level. You referred her for echocardiography and cardiology assessment. Following the referral she now has a diagnosis of ‘Heart failure with reduced ejection fraction’.
Providing there are no contraindications, which of the following combinations of medication should be used as first line treatment in this patient?
A 68-year-old woman presents to the GP clinic for a follow-up on her heart failure management. She is currently on lisinopril 20 mg and carvedilol 25 mg BD. Her main symptoms include shortness of breath on minimal exercise and occasional episodes of paroxysmal nocturnal dyspnoea. During the examination, her BP is 136/74, her pulse is 80 and regular. There are bibasal crackles but no other significant findings. The test results show a haemoglobin level of 128 g/L (115-165), white cells count of 7.9 ×109/L (4-11), platelets count of 201 ×109/L (150-400), sodium level of 139 mmol/L (135-146), potassium level of 4.2 mmol/L (3.5-5), creatinine level of 149 μmol/L (79-118), and an ejection fraction of 38% on echocardiogram. What is the most appropriate next step?
A 78-year-old man presents at the clinic for follow-up of his heart failure. He was referred by his GP through the rapid assessment pathway and has received the results of his recent Echocardiogram. The patient has a history of hypertension and an inferior myocardial infarction and is currently taking amlodipine and ramipril 5 mg. On examination, his BP is 150/82, his pulse is regular at 84 beats per minute, and there are bibasal crackles on chest auscultation, but no significant pitting edema is observed. Laboratory investigations reveal a haemoglobin level of 132 g/L (135-177), white cell count of 9.3 ×109/L (4-11), platelet count of 179 ×109/L (150-400), sodium level of 139 mmol/L (135-146), potassium level of 4.3 mmol/L (3.5-5), and creatinine level of 124 μmol/L (79-118). The Echocardiogram shows no significant valvular disease, with an ejection fraction of 31%. What is the most appropriate initial treatment for his heart failure?
A 70-year-old man with heart failure complains of increasing shortness of breath. During examination, his peripheral oedema has worsened since his last visit (pitting to mid shins, previously to ankles). He has bibasal crackles on auscultation of his lungs; his blood pressure is 160/90 mmHg but his heart rate and oxygen saturations are within normal limits. His current medication includes an angiotensin-converting enzyme (ACE) inhibitor, loop diuretic and beta-blocker.
What is the most appropriate management to alleviate symptoms and decrease mortality?
A 65-year-old man with known congestive cardiac failure presents to his General Practitioner for his annual review. He reports that his heart failure symptoms have been stable in recent months. On examination his heart rate is 68 bpm but is noted to be irregularly irregular, blood pressure is 136/84 mmHg, respiratory rate 18 breaths per minute and oxygen saturations 95% in air. An electrocardiogram (ECG) confirms atrial fibrillation (AF) with a stable ventricular rate of 72 bpm.
Which single medication from the following list would be most beneficial from the point of view of this patient’s atrial fibrillation?
A 48-year-old man presents to an out-of-hours community hospital walk-in centre feeling light-headed and short of breath. Shortly after he arrives, he loses consciousness. He continues to breathe spontaneously, and a nurse is able to maintain his airway and administer oxygen. Observations show a heart rate of 38 bpm and blood pressure of 88/44 mmHg. An electrocardiogram shows complete heart block.
What is the most appropriate initial step in management?
A 72-year-old man who rarely visits the clinic is brought in by his daughter with complaints of orthopnoea, paroxysmal nocturnal dyspnoea and swollen ankles that have been present for a few weeks. On examination, he has bilateral basal crepitations and a resting heart rate of 110 beats per minute. An ECG shows sinus rhythm and an echocardiogram reveals a reduced ejection fraction. He responds well to treatment with optimal doses of an ACE inhibitor and furosemide. What is the most accurate statement regarding his future management?