An 80-year-old man is hospitalized with acute coronary syndrome and is diagnosed with a heart attack. After four days, he experiences another episode of chest pain with non-specific ST-T wave changes on the ECG. Which cardiac enzyme would be the most suitable for determining if this second episode was another heart attack?
A 30-year-old woman patient presents with a subacute history of lethargy and low-grade fever. Among other findings, full clinical examination reveals retinal haemorrhages with pale centres, painful red raised lesions on the hands and feet and subcentimetre, non-tender, raised papules on the palms and soles of the feet.
What is the underlying condition?
You are fast-bleeped to the ward where you find a 46-year-old woman in ventricular tachycardia. She had a witnessed syncopal episode while walking to the toilet with nursing staff and currently has a blood pressure of 85/56 mmHg. She is orientated to time, place and person but is complaining of feeling light-headed.
How would you manage this patient’s ventricular tachycardia?
A 27-year-old woman is brought to the Emergency Department by ambulance from a music festival. It is a hot day and she had been standing in the crowd when she suddenly collapsed and lost consciousness. She is now fully alert and gives a history of feeling dizzy and nauseated before the collapse. She tells you that she is healthy, plays tennis for her local club and is a keen runner. She has had no previous episodes of losing consciousness. Her father has recently had a heart attack aged 60 years. Her resting electrocardiogram (ECG) shows a corrected QT interval of 400 ms and a slightly prolonged PR interval but is otherwise normal.
What is the most likely diagnosis?
What are the components of Virchow’s triad?
What do T waves represent on an ECG?
A 65-year-old woman presents with a 4-month history of dyspnoea on exertion. She denies a history of cough, wheeze and weight loss but admits to a brief episode of syncope two weeks ago. Her past medical history includes, chronic kidney disease stage IV and stage 2 hypertension. She is currently taking lisinopril, amlodipine and atorvastatin. She is an ex-smoker with a 15-pack year history.
On examination it is noted that she has a low-volume pulse and an ejection systolic murmur heard loudest at the right upper sternal edge. The murmur is noted to radiate to both carotids. Moreover, she has good bilateral air entry, vesicular breath sounds and no added breath sounds on auscultation of the respiratory fields. The patient’s temperature is recorded as 37.2°C, blood pressure is 110/90 mmHg, and a pulse of 68 beats per minute. A chest X-ray is taken which is reported as the following:
Investigation Result
Chest radiograph Technically adequate film. Normal cardiothoracic ratio. Prominent right ascending aorta, normal descending aorta. No pleural disease. No bony abnormality.
Which of the following most likely explains her dyspnoea?
An adolescent with Down’s syndrome is being seen at the cardiology clinic due to a heart murmur detected during a routine check-up. It is known that approximately half of infants with Down’s syndrome have congenital heart defects, and the prevalence remains high throughout their lifespan. What are the five most frequent types of congenital heart disease observed in individuals with Down’s syndrome? Please list them in order of decreasing incidence, starting with the most common cause and ending with the least common cause.
A 65-year-old woman with ischaemic heart disease presents with sudden onset palpitations. She has no other complaints. On examination, a regular tachycardia is present. Her blood pressure is 150/90 mmHg. Chest is clear. ECG reveals a regular tachycardia with a QRS width of 80 ms and a rate of 149 beats per min in a sawtooth pattern.
What is the diagnosis?
A fourth year medical student on a ward round with your team is inquiring about pacemakers.
Which of the following WOULD BE an indication for permanent pacemaker implantation?