A radiologist examined a coronary angiogram of a 75-year-old man with long-standing heart disease and identified stenosis of the right coronary artery resulting in reduced perfusion of the myocardium of the right atrium. Which structure related to the right atrium is most likely to have been impacted by the decreased blood flow?
A 29-year-old woman presents with sudden-onset palpitation and chest pain that began 1 hour ago. The palpitation is constant and is not alleviated or aggravated by anything. She is worried that something serious is happening to her. She recently experienced conflict at home with her husband and left home the previous day to stay with her sister. She denies any medication or recreational drug use. Past medical history is unremarkable. Vital signs are within normal limits, except for a heart rate of 180 bpm. Electrocardiography shows narrow QRS complexes that are regularly spaced. There are no visible P waves preceding the QRS complexes. Carotid sinus massage results in recovery of normal sinus rhythm.
What is the most likely diagnosis?
A 25-year-old female with Down’s syndrome presents with a systolic murmur on clinical examination. What is the most prevalent cardiac anomaly observed in individuals with Down’s syndrome that could account for this murmur?
A 65-year-old man presents with a 1-hour history of chest pain and is found to have an acute ST elevation inferior myocardial infarct. His blood pressure is 126/78 mmHg and has a pulse of 58 bpm. He is loaded with anti-platelets, and the cardiac monitor shows second-degree heart block (Wenckebach’s phenomenon).
What would you consider next for this patient?
Various cardiac diseases necessitate the use of pacemakers to maintain regular heartbeats and sustain the patient’s life. The following are three types of pacemakers, labeled 1-3: AAI, VVI, and DDD. Can you correctly match each pacemaker to the condition it is typically used to treat?
A 65-year-old male with a nine year history of type 2 diabetes is currently taking metformin 1 g twice daily and gliclazide 160 mg twice daily. He has gained weight over the past year and his HbA1c has worsened from 59 to 64 mmol/mol (20-42). The doctor is considering treating him with either insulin or pioglitazone. The patient is curious about the potential side effects of pioglitazone.
What is a common side effect of pioglitazone therapy?
A 38-year-old man presents to his GP for a routine health check. Upon physical examination, no abnormalities are found. However, laboratory test results reveal the following:
– Serum glucose: 4.5 mmol/L
– Haemoglobin A1c: 4.2% (22 mmol/mol)
– Total cholesterol: 5.8 mmol/L
– LDL cholesterol: 4.2 mmol/L
– HDL cholesterol: 0.6 mmol/L
Based on these results, what is the most likely mechanism for injury to the vascular endothelium in this patient?
A 70-year-old man experiences an acute myocardial infarction and subsequently develops a bundle branch block. Which coronary artery is the most probable culprit?
A 70-year-old man with a history of chronic cardiac failure with reduced ventricular systolic function presents with recent onset of increasing breathlessness, and worsening peripheral oedema and lethargy. He is currently taking ramipril and bisoprolol alongside occasional paracetamol.
What is the most appropriate long-term management?
You are urgently requested to assess a 23-year-old male who has presented to the Emergency department after confessing to consuming 14 units of alcohol and taking 2 ecstasy tablets tonight. He is alert and oriented but is experiencing palpitations. He denies any chest pain or difficulty breathing.
The patient’s vital signs are as follows: heart rate of 180 beats per minute, regular rhythm, blood pressure of 115/80 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 99% on room air. An electrocardiogram (ECG) is performed and reveals an atrioventricular nodal re-entry tachycardia (SVT).
What would be your first course of action in terms of treatment?