A 55-year-old woman visits her GP and mentions her diagnosis of heart failure. She expresses interest in learning about medications that can potentially decrease mortality in heart failure. Which drug has been proven to have this effect?
An 82-year-old man has been experiencing increasing shortness of breath, tiredness, intermittent chest pain and leg swelling for the past 6 months. He recently underwent an echocardiogram as an outpatient which revealed evidence of heart failure. As the FY1 on the Medical Assessment Unit, you have been tasked with taking the patient’s medical history. He has a history of hypertension and gout and is currently taking diltiazem (calcium-channel blocker) 60 mg po bd, furosemide (diuretic) 20 mg po od, Spironolactone 25mg od, allopurinol 100 mg po od, paracetamol 1 g po qds prn, and lisinopril 20 mg po od. Considering his likely diagnosis of heart failure, which medication should be discontinued?
An 82-year-old man presents with increasing shortness of breath, tiredness, intermittent chest pain and leg swelling for the last 6 months. His past medical history includes hypertension, gout and a previous myocardial infarction 5 years ago. His current medications are as follows:
diltiazem 60 mg orally (po) twice daily (bd)
spironolactone 100 mg po once daily (od)
allopurinol 100 mg po od
paracetamol 1 g po four times daily (qds) as required (prn)
lisinopril 20 mg po od.
Given this man’s likely diagnosis, which of the above medications should be stopped?
A 45-year-old man visits his GP for a routine check-up. He reports feeling well today but has a history of chronic respiratory tract infections and lung issues. He is immunocompetent.
During the examination, his temperature and blood pressure are normal. His heart rate is regular and his breathing is effortless. The GP detects a diastolic murmur with a snap that is most audible at the right fifth intercostal space in the mid-clavicular line.
What is the most probable diagnosis?
A 56-year-old patient presents for an annual review. He has no significant past medical history. He is a smoker and has a family history of ischaemic heart disease: body mass index (BMI) 27.4, blood pressure (BP) 178/62 mmHg, fasting serum cholesterol 7.9 mmol/l (normal value < 5.17 mmol/l), triglycerides 2.2 mmol/l (normal value < 1.7 mmol/l), fasting glucose 5.8 mmol/l (normal value 3.9–5.6 mmol/l).
Which of the following would be the most appropriate treatment for his cholesterol?
A 65-year-old retiree visits his GP as he is becoming increasingly breathless and tired whilst walking. He has always enjoyed walking and usually walks 3 times a week. Over the past year he has noted that he can no longer manage the same distance that he used to be able to without getting breathless and needing to stop. He wonders if this is a normal part of ageing or if there could be an underlying medical problem.
Which of the following are consistent with normal ageing with respect to the cardiovascular system?
A 49-year-old man presents to the Emergency Department with complaints of chest pain and pain in his left shoulder. He had spent the previous 2 h shoveling snow, but had to stop because of the pain. He admits to several prior episodes of chest pain under similar circumstances. No ST segment changes are seen on the electrocardiogram (ECG). The patient is given sublingual nitroglycerin, which relieves his pain, and is admitted for an overnight stay. The following morning, serum cardiac enzymes are within normal limits and no ECG changes are seen.
Which one of the following is the most likely diagnosis?
A 57-year-old man comes to the Emergency Department with severe crushing pain in his chest and left shoulder that has been ongoing for 2 hours. Despite taking sublingual nitroglycerin, the pain persists, and his electrocardiogram shows ST elevation in multiple leads. Due to preexisting renal impairment, primary percutaneous intervention (PCI) is not an option, and he is started on medical management in the Coronary Care Unit. The following day, his serum cardiac enzymes are found to be four times higher than the upper limit of normal, and his electrocardiographic changes remain.
What is the most probable diagnosis?
A final-year medical student is taking a history from a 63-year-old patient as a part of their general practice attachment. The patient informs her that she has a longstanding heart condition, the name of which she cannot remember. The student decides to review an old electrocardiogram (ECG) in her notes, and from it she is able to see that the patient has atrial fibrillation (AF).
Which of the following ECG findings is typically found in AF?
A 25-year-old man presents to the Emergency Department with severe vomiting and diarrhoea that has lasted for four days. He has been unable to keep down any fluids and is dehydrated, so he is started on an intravenous infusion. Upon investigation, his potassium level is found to be 2.6 mmol/L (3.5-4.9). What ECG abnormality would you anticipate?