You have requested a B-type natriuretic peptide (BNP) test for a patient with suspected heart failure who is in their 60s. The results have shown a slightly elevated BNP level. What could be a possible factor that may cause a falsely elevated BNP result?
A 59-year-old man comes to the hospital complaining of central chest pain that spreads to his left arm, accompanied by sweating and nausea. In the Emergency Department, an ECG reveals ST elevation in leads V1, V2, V3, and V4, and he is given 300mg of aspirin before undergoing primary percutaneous coronary intervention. After a successful procedure, he is admitted to the Coronary Care Unit and eventually discharged with secondary prevention medication and lifestyle modification advice, as well as a referral to a cardiac rehabilitation program.
During a check-up with his GP three weeks later, the patient reports feeling well but still experiences fatigue and shortness of breath during rehab activities. He has not had any further chest pain episodes. However, an ECG shows Q waves and convex ST elevation in leads V1, V2, V3, and V4.
What is the most likely diagnosis?
A 60-year-old man with no significant medical history presents to the Emergency Department with an ECG indicative of an anterior myocardial infarction. Tragically, he experiences cardiac arrest shortly after arrival. What is the leading cause of mortality in patients following a heart attack?
A 52-year-old man of African ethnicity visits the GP after receiving results from ambulatory home blood pressure monitoring. The average reading was 152/96 mmHg, and he has no medical history. During today’s visit, his heart rate is 78 bpm, blood pressure is 160/102 mmHg, and oxygen saturations are 97%. What should the GP do next?
You are requested to evaluate a 65-year-old woman who has been admitted to your ward with a lower respiratory tract infection. She has a medical history of hypertension and gout and is currently taking amlodipine 10mg once daily and allopurinol 100mg once daily. You observe that her blood pressure has been consistently high over the past three days, with readings of 149/76 mmHg, 158/88 mmHg, and 150/82 mmHg. Which antihypertensive medication would be the most suitable to initiate?
A 56-year-old man with difficult hypertension comes to the GP clinic for follow-up. His average blood pressure over the past two weeks has been 168/100 mmHg and today in the clinic it is 176/102 mmHg. He is currently taking a combination of telmisartan 80 mg and hydrochlorothiazide 25mg tablets, as well as amlodipine 10mg daily. The latest laboratory results are as follows:
Na+ 136 mmol/L (135 – 145)
K+ 3.8 mmol/L (3.5 – 5.0)
Bicarbonate 25 mmol/L (22 – 29)
Urea 5 mmol/L (2.0 – 7.0)
Creatinine 135 µmol/L (55 – 120)
What would be the most appropriate next step?
A 50-year-old man arrives at the emergency department complaining of severe chest pain that radiates to his left arm, accompanied by nausea and sweating. His ECG reveals widespread ST depression with T wave inversion, and his blood tests show a haemoglobin level of 75g/L. What is the appropriate treatment for his anaemia?
The medical emergency team is called to an 85-year-old man who has fainted in the cardiology ward whilst visiting a relative. He has been moved to a trolley, where he appears confused and is complaining of dizziness. An A-E examination is performed:
A: Is the airway patent?
B: Is there any respiratory distress? Sats are 98% on air.
C: Is the radial pulse regular? The patient has cool peripheries, blood pressure of 85/55 mmHg, and heart sounds of 1 + 2 + 0.
D: What is the Glasgow Coma Scale (GCS) score? Are the pupils equal and reactive to light?
E: Is the temperature normal? No other findings are noted.
An ECG shows sinus bradycardia with a rate of 42 beats per minute. What is the immediate treatment for his bradycardia?
A 70-year-old man comes to the clinic complaining of feeling tired and having palpitations for the last few days. Upon examination, his pulse is irregularly irregular and beats at a rate of 123 bpm. His blood pressure is 128/78 mmHg and his chest is clear. An ECG confirms that he has atrial fibrillation. What medication should be prescribed to manage his heart rate?
An 80-year-old woman is brought to the Emergency Department by her family. She has been experiencing increasing shortness of breath and low energy levels for the past 6 weeks. Upon arrival, an ECG reveals atrial fibrillation with a heart rate of 114 / min. Her blood pressure is 128/80 mmHg and a chest x-ray shows no abnormalities. What medication is recommended for controlling her heart rate?