A 51-year-old woman with a history of hypothyroidism experiences a collapse during her yoga class. She has been reporting occasional chest pains and difficulty breathing during exercise in the past few weeks. During her physical examination, an ejection systolic murmur is detected at the right upper sternal edge, and her second heart sound is faint. Additionally, she has a slow-rising pulse. What is the most probable cause of her symptoms?
What term describes a lack of pulses but regular coordinated electrical activity on an ECG?
A young marine biologist was snorkelling among giant stingrays when the tail (barb) of one of the stingrays suddenly pierced his chest. The tip of the barb pierced the right ventricle and the man instinctively removed it in the water. When he was brought onto the boat, there was absence of heart sounds, reduced cardiac output and engorged jugular veins.
What was the most likely diagnosis for the young marine biologist who was snorkelling among giant stingrays and had the tail (barb) of one of the stingrays pierce his chest, causing the tip of the barb to pierce the right ventricle? Upon being brought onto the boat, the young man exhibited absence of heart sounds, reduced cardiac output and engorged jugular veins.
A man in his early 60s is undergoing treatment for high blood pressure. During a dental check-up, his dentist informs him that he has gingival hyperplasia. Which medication is the most probable culprit for this condition?
A 65-year-old man presents to the Emergency Department with sudden onset epigastric discomfort. He has a significant past medical history of hypercholesterolaemia and type II diabetes mellitus, and he is a heavy smoker. On examination, his pulse is 30 bpm; he is hypotensive and has distended neck veins. The chest is clear to auscultation. Initial blood tests reveal an elevated troponin level, and an electrocardiogram (ECG) shows hyperacute T-waves in leads II, III and aVF.
What is the most likely diagnosis?
A typically healthy and fit 35-year-old man presents to Accident and Emergency with palpitations that have been ongoing for 4 hours. He reports no chest pain and has a National Early Warning Score (NEWS) of 0. Upon examination, the only notable finding is an irregularly irregular pulse. An electrocardiogram (ECG) confirms that the patient is experiencing atrial fibrillation (AF). The patient has no significant medical history and is not taking any regular medications. Blood tests (thyroid function tests (TFTs), full blood count (FBC), urea and electrolytes (U&Es), liver function tests (LFTs), and coagulation screen) are normal, and a chest X-ray (CXR) is unremarkable.
What is the most appropriate course of action for this patient?
A typically healthy and fit 35-year-old man presents to the Emergency Department (ED) with palpitations that have been ongoing for 4 hours. He reports no chest pain, has a National Early Warning Score (NEWS) of 0, and the only physical finding is an irregularly irregular pulse. An electrocardiogram (ECG) confirms that the patient is experiencing atrial fibrillation. The patient has no notable medical history.
What is the most suitable course of action?
A 38-year-old man presents to the Emergency Department with a 2-day history of flu-like symptoms. He reports experiencing sharp central chest pain that worsens with coughing and improves when he sits forwards. Upon examination, he is found to be tachycardic and has a temperature of 39 °C. A third heart sound is heard upon auscultation. What is the most probable cause of this patient’s chest pain?
A 70-year-old obese woman is admitted with episodic retrosternal chest pain not relieved by rest, for the past 3 weeks. The pain is described as squeezing in nature, and is not affected by meals or breathing. The episodic pain is of fixed pattern and is of same intensity. She has a background of diabetes mellitus, hyperlipidaemia and hypertension. Her family history is remarkable for a paternal myocardial infarction at the age of 63. She is currently haemodynamically stable.
What is the most likely diagnosis in this patient?
A 27-year-old Asian woman complains of palpitations, shortness of breath on moderate exertion and a painful and tender knee. During auscultation, a mid-diastolic murmur with a loud S1 is heard. Echocardiography reveals valvular heart disease with a normal left ventricular ejection fraction.
What is the most probable valvular disease?