A 25-year-old man with a known harsh ejection systolic murmur on cardiac examination collapses and passes away during a sporting event. His father and uncle also died suddenly in their forties. The reason for death is identified as an obstruction of the ventricular outflow tract caused by an abnormality in the ventricular septum.
What is the accurate diagnosis for this condition?
A 60-year-old man comes to the hospital with sudden central chest pain. An ECG is done and shows ST elevation, indicating an infarct on the inferior surface of the heart. The patient undergoes primary PCI, during which a blockage is discovered in a vessel located within the coronary sulcus.
What is the most probable location of the occlusion?
A 65-year-old man arrives at the Emergency Department complaining of central crushing chest pain that spreads to his arm and jaw. Upon examination, his ECG reveals ST elevation in leads II, III, and aVF, with reciprocal changes in I and aVL. Based on this information, which of the following vessels is most likely obstructed?
A 65-year-old moderately obese man is brought to the Emergency Department with complaints of severe chest pain and shortness of breath. Upon physical examination, a pericardial tamponade is suspected and confirmed by an electrocardiogram (ECG) showing total electrical alternans and an echocardiogram revealing pericardial effusion. Which jugular vein is typically the most reliable indicator of central venous pressure (CVP)?
A 55-year-old man presents with sudden onset of severe chest pain and difficulty breathing. The pain started while he was eating and has been constant for the past three hours. It radiates to his back and interscapular region.
The patient has a history of hypertension for three years, alcohol abuse, and is a heavy smoker of 30 cigarettes per day. On examination, he is cold and clammy with a heart rate of 130/min and a blood pressure of 80/40 mm Hg. JVP is normal, but breath sounds are decreased at the left lung base and a chest x-ray reveals a left pleural effusion.
What is the most likely diagnosis?
A 55-year-old woman comes to you with complaints of worsening shortness of breath, weakness, lethargy, and a recent episode of syncope after running to catch a bus. She has a history of atrial flutter and takes bisoprolol regularly. During the physical examination, you notice a high-pitched, diastolic decrescendo murmur that intensifies during inspiration. She also has moderate peripheral edema. A chest X-ray shows no abnormalities. What is the best course of action for this patient?
A 50-year-old man with type II diabetes, is having his annual diabetes review. During this review it is noticed that the man has a heart rate between 38–48 beats/min. On questioning, he mentions that he has noticed occasional palpitations, but otherwise has been asymptomatic.
An ECG is performed, which shows that on every fourth beat there is a non-conducted P-wave (a P-wave without QRS complex). Otherwise there are no other abnormalities and the PR interval is constant.
What is the most likely diagnosis?
A 42-year-old man felt dizzy at work and later had a rhythm strip (lead II) performed in the Emergency Department. It reveals one P wave for every QRS complex and a PR interval of 240 ms.
What does this rhythm strip reveal?
A 72-year-old man is brought by ambulance to the Accident and Emergency department. He is visibly distressed but gives a history of sudden onset central compressive chest pain radiating to his left upper limb. He is also nauseous and very sweaty. He has had previous myocardial infarctions (MI) in the past and claims the pain is identical to those episodes. ECG reveals an anterior ST elevation MI.
Which of the following is an absolute contraindication to thrombolysis?
A 59-year-old woman was recently diagnosed with essential hypertension and prescribed medication to lower her blood pressure. However, she stopped taking the medication due to reported dizziness. Her blood pressure readings usually run at 150/100 mmHg. She denies any chest pain, shortness of breath, leg swelling, or visual problems. She has a history of occasional migraines but no other medical conditions. She has no known drug allergies. Her vital signs are within normal limits, other than high blood pressure. The S1 and S2 sounds are normal. There is no S3 or S4 sound, murmur, rub, or gallop. The peripheral pulses are normal and symmetric. The serum electrolytes (sodium, potassium, calcium, and chloride), creatinine, and urea nitrogen are within normal range.
What is the most appropriate antihypertensive medication for this patient?