A 7-year-old girl with Down Syndrome presents to her General Practitioner (GP) with complaints of getting tired easily while playing with her friends and experiencing shortness of breath. The mother informs the GP that the patient was born with an uncorrected cardiac defect. On examination, the GP observes clubbing and plethora.
What is the probable reason for the patient’s current symptoms?
A 35-year-old man comes to the clinic complaining of occasional palpitations and feeling lightheaded. He reports no chest pain, shortness of breath, or swelling in his legs. Upon examination, no abnormalities are found. An ECG reveals a shortened PR interval and the presence of delta waves. What is the underlying pathophysiology of the most likely diagnosis?
A 55-year-old man arrives at the emergency department complaining of central chest pain that started 15 minutes ago. An ECG is conducted and reveals ST elevation in leads I, aVL, and V6. Which coronary artery is the most probable cause of obstruction?
A 55-year-old man with a recent diagnosis of essential hypertension and prescribed ramipril has returned for a follow-up appointment after 6 weeks. He has a medical history of osteoarthritis and benign prostate hypertrophy. Despite being compliant with his medication, his blood pressure reading is 145/90 mmHg, which is higher than his previous readings at home. What could be the reason for his inadequate blood pressure control despite medical treatment?
As a junior doctor, you are taking the medical history of a patient who is scheduled for an elective knee replacement. During the physical examination, you hear a diastolic murmur and observe a collapsing pulse while checking the heart rate. Upon examining the hands, you notice pulsations of red coloration on the nail beds. Other than these findings, the examination appears normal.
What could be the probable reason behind these examination results if the patient is slightly older?
A 56-year-old woman comes to you complaining of severe body aches and pains that have been ongoing for the past 2 weeks. She has been taking atorvastatin for the last 5 years and is aware of its potential side effects, but insists that she has never experienced anything like this before.
Upon examination, her CK levels are found to be above 3000 U/L. Reviewing her medical records, it is noted that she had a medication review with her cardiologist just 2 weeks ago.
What could be the possible cause of her current symptoms?
A 23-year-old male university student presents to the emergency department with lightheadedness and a fall an hour earlier, associated with loss of consciousness. He admits to being short of breath on exertion with chest pain for several months. The patient denies vomiting or haemoptysis. The symptoms are not exacerbated or relieved by any positional changes or during phases of respiration.
He has no relevant past medical history, is not on any regular medications, and has no documented drug allergies. There is no relevant family history. He is a non-smoker and drinks nine unite of alcohol a week. He denies any recent travel or drug use.
On examination, the patient appears to be comfortable at rest. His heart rate is 68/min, blood pressure 112/84 mmHg, oxygen saturation 99% on air, respiratory rate of 16 breaths per minute, temperature 36.7ºC.
An ejection systolic murmur is audible throughout the praecordium, loudest over the sternum bilaterally. No heaves or thrills are palpable, and there are no radiations. The murmur gets louder when the patient is asked to perform the Valsalva manoeuvre. The murmur is noted as grade II. Lung fields are clear on auscultation. The abdomen is soft and non-tender, with bowel sounds present. His body mass index is 20 kg/m².
His ECG taken on admission reveals sinus rhythm, with generalised deep Q waves and widespread T waves. There is evidence of left ventricular hypertrophy.
What is the most likely diagnosis?
An 80-year-old patient comes in for a routine follow-up appointment and reports a decline in exercise tolerance. They mention having difficulty with stairs and experiencing occasional central chest pain that radiates to their back, which is relieved by rest. The pain is not present at rest.
During the examination, you observe a regular, slow-rising pulse and record a blood pressure of 110/95mmHg. Upon auscultation of the precordium, you detect an ejection systolic murmur.
To further assess cardiac function and valves, an echocardiogram is scheduled. Based on the likely diagnosis, what additional exam findings are you most likely to discover?
A 59-year-old man presents to the emergency department with pleuritic thoracic pain and fever. His medical history includes an inferior STEMI that occurred 3 weeks ago. During auscultation, a pericardial rub is detected, and his ECG shows diffuse ST segment elevation and PR segment depression. What is the complication of myocardial infarction that the patient is experiencing?
A 75-year-old man presents to the emergency department with chest pain and shortness of breath while gardening. He reports that the pain has subsided and is able to provide a detailed medical history. He mentions feeling breathless while gardening and walking in the park, and occasionally feeling like he might faint. He has a history of hypertension, is a retired construction worker, and a non-smoker. On examination, the doctor detects a crescendo-decrescendo systolic ejection murmur. The ECG shows no ST changes and the troponin test is negative. What is the underlying pathology responsible for this man’s condition?