A 56-year-old man presents to the Emergency Department with chest pain. He has a medical history of angina, hypertension, high cholesterol, and is a current smoker. Upon arrival, a 12-lead electrocardiogram (ECG) is conducted, revealing ST elevation in leads II, III, and aVF. Which coronary artery is most likely responsible for this presentation?
The cardiologist is examining a 48-year-old man with chest pain and is using his stethoscope to listen to the heart. Which part of the chest is most likely to correspond to the location of the heart’s apex?
A 62-year-old salesman is found to have a blood pressure (BP) of 141/91 mmHg on a routine medical check. Two months later, his BP was 137/89 mmHg. He leads a physically active life, despite being a heavy smoker. He is not diabetic and his cholesterol levels are low. There is no past medical history of note.
What is the most suitable course of action for managing this patient?
A 38-year-old man comes for his 6-week post-myocardial infarction (MI) follow-up. He was discharged without medication. His total cholesterol is 9 mmol/l, with triglycerides of 1.2 mmol/l. He is a non-smoker with a blood pressure of 145/75. His father passed away from an MI at the age of 43.
What is the most suitable initial treatment for this patient?
A 55-year-old woman has been suffering from significant pain in her lower limbs when walking more than 200 meters for the past six months. During physical examination, her legs appear pale and cool without signs of swelling or redness. The palpation of dorsalis pedis or posterior tibial pulses is not possible. The patient has a body mass index of 33 kg/m2 and has been smoking for 25 pack years. What is the most probable vascular abnormality responsible for these symptoms?
A 60-year-old man presents to cardiology outpatients after being lost to follow-up for 2 years. He has a significant cardiac history, including two previous myocardial infarctions, peripheral vascular disease, and three transient ischemic attacks. He is also a non-insulin-dependent diabetic. Upon examination, his JVP is raised by 2 cm, he has peripheral pitting edema to the mid-calf bilaterally, and bilateral basal fine inspiratory crepitations. His last ECHO, which was conducted 3 years ago, showed moderately impaired LV function and mitral regurgitation. He is currently taking bisoprolol, aspirin, simvastatin, furosemide, ramipril, and gliclazide. What medication could be added to improve his prognosis?
A 65-year-old man presents with shortness of breath and is noted to have an irregular pulse. He reports intermittent palpitations over the past two months, which come on around four to five times weekly and are troublesome. He has diet-controlled type II diabetes mellitus and hypertension, for which he takes amlodipine. An electrocardiogram (ECG) confirms atrial fibrillation (AF) with a rate of 82 bpm. He has no chest pain and is not in overt cardiac failure. He is otherwise well and enjoys hill walking.
What is the appropriate new pharmacological therapy for the patient’s condition?
A 23-year-old woman with a history of two episodes of pneumothorax over the last 12 months was found to have ectopia lentis, during a recent examination by an ophthalmologist. It is noted that she has pectus excavatum, pes planus, a high arched palate and a positive wrist and thumb sign.
What is the likely finding from her echocardiogram?
A 56-year-old man presents to the Emergency Department with crushing substernal chest pain that radiates to the jaw. He has a history of poorly controlled hypertension and uncontrolled type II diabetes mellitus for the past 12 years. An electrocardiogram (ECG) reveals ST elevation, and he is diagnosed with acute myocardial infarction. The patient undergoes percutaneous coronary intervention (PCI) and stenting and is discharged from the hospital. Eight weeks later, he experiences fever, leukocytosis, and chest pain that is relieved by leaning forwards. There is diffuse ST elevation in multiple ECG leads, and a pericardial friction rub is heard on auscultation. What is the most likely cause of the patient’s current symptoms?
A 68-year-old man presents to the Emergency Department (ED) with chest tightness. The tightness started about a day ago, however today it is worse and associated with shortness of breath and dizziness.
Upon examination, there is a slow rising carotid pulse and systolic murmur which radiates to carotids 3/6. Examination is otherwise unremarkable without calf tenderness. The patient does not have any significant past medical history apart from type II diabetes mellitus and hypertension which are both well controlled.
What is the best diagnostic investigation?