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?
A 63-year-old man arrives at the emergency department with sudden and severe chest pain that began an hour ago. He experiences nausea and sweating, and the pain spreads to his left jaw and arm. The patient has a medical history of essential hypertension and type 2 diabetes mellitus. He is a current smoker with a 30 pack years history and drinks about 30 units of alcohol per week. He used to work as a lorry driver but is now retired. An electrocardiogram in the emergency department reveals ST segment elevations in leads II, III, and aVF, and a blood test shows elevated cardiac enzymes. The man undergoes a percutaneous coronary intervention and is admitted to the coronary care unit. After two weeks, he is discharged. What is the complication that this man is most likely to develop on day 7 after his arrival at the emergency department?
Sarah, a 68-year-old woman, visits her doctor complaining of shortness of breath and swollen ankles that have been worsening for the past four months. During the consultation, the doctor observes that Sarah is using more pillows than usual. She has a medical history of hypertension, hypercholesterolemia, type 2 diabetes mellitus, and a previous myocardial infarction. The doctor also notices a raised jugular venous pressure (JVP) and suspects congestive heart failure. What would indicate a normal JVP?
A 65-year-old male with chronic cardiac failure visits his doctor and reports experiencing dyspnoea even with minimal physical exertion, and only feeling comfortable when at rest. What class of the New York Heart Association scale does he fall under?
An 80-year-old woman comes to the hospital complaining of chest pain, vomiting, and sweating for the past two hours. She has a medical history of hypertension and peripheral arterial disease. Despite using sublingual nitrate spray at home, the pain has not subsided. Upon admission, she is found to be tachycardic and tachypneic, but no other respiratory or cardiac abnormalities are detected. An ECG reveals ST segment elevation in leads II, III, and aVF, as well as ST segment depression in leads I and aVL. Which coronary artery is most likely affected?