A 56-year-old man complains of fatigue. During the physical examination, a soft diastolic murmur is detected, which is most audible in the second intercostal space on the right. His blood pressure is measured at 162/65 mmHg. What is the probable reason for the murmur?
A 75 year old woman comes to the Emergency Department with gradual onset of difficulty breathing. During the examination, the patient displays an S3 gallop rhythm, bibasal crepitations, and pitting edema up to both knees. An ECG reveals indications of left ventricular hypertrophy, and a chest X-ray shows small bilateral pleural effusions, cardiomegaly, and upper lobe diversion.
Considering the probable diagnosis, which of the following medications has been proven to enhance long-term survival?
An 80-year-old male presents to the low-risk chest pain clinic with intermittent substernal chest pains. The pain typically comes on with exertion and improves with rest. A trial of GTN has been given by his GP which helps with his pain. He is a known ex-smoker of 35 pack-years. He has no diabetes, hyperlipidaemia, hypertension, and no family history of coronary artery disease.
During examination, his observations are stable. On auscultations of his chest, his first and second heart sounds are audible with no added sounds and his lungs are clear.
What investigation should be prioritized given his risk for coronary artery disease?
A 58-year-old man presents for follow-up. He has experienced two episodes of fainting in the past month. The first occurred while he was climbing stairs, and the second occurred last week as he was exiting a swimming pool. There were no warning signs before either episode. Witnesses to the most recent episode reported that he was unconscious for approximately 15 seconds. He reports feeling disoriented for only a few seconds after regaining consciousness. On physical examination, his pulse is 90 beats per minute, blood pressure is 110/86 mmHg, his lungs are clear, and there is a systolic murmur that radiates to the carotid area. Which of the following tests should be ordered first?
What is the primary mode of operation of simvastatin in elderly patients?
An 81-year-old woman presents to the cardiology clinic for a routine follow-up appointment. She has a history of ischaemic heart disease after experiencing a myocardial infarction 3 years ago. Although she denies chest pain, she reports an increase in shortness of breath during physical activity. Upon examination, her vital signs are normal, but there is mild pitting edema up to the knees bilaterally. An echocardiogram reveals mild left ventricular impairment with an estimated ejection fraction of 45%. What is the initial treatment plan for this patient?
A 63-year-old woman presents for follow-up. She completed a 6 month course of warfarin a year ago after being diagnosed with an unprovoked, proximal deep vein thrombosis. Over the past few weeks, she has been experiencing a sensation of heaviness and aching in the same leg, accompanied by itching and some swelling that subsides each night. Her medical history includes osteoarthritis and type 2 diabetes mellitus. On examination, there are prominent varicose veins on the affected leg, and the skin above the medial malleolus is discolored. The calves have no difference in circumference. Her vital signs are as follows: temperature 36.9ºC, pulse 78/min, and blood pressure 108/82 mmHg. What is the most probable diagnosis?
A 55-year-old man with NYHA class III heart failure is currently on furosemide and ramipril. Which beta-blocker would be the most appropriate to add for improving his long-term prognosis?
You assess a 65-year-old man who has recently been discharged from hospital in France following a heart attack. He presents with an echocardiogram report indicating his left ventricular ejection fraction is 38%. Upon examination, his pulse is regular at 76 beats per minute, blood pressure is 126/74 mmHg, and his chest is clear. He is currently taking aspirin, simvastatin, and lisinopril. What is the most appropriate course of action regarding his medication?
A 40-year-old female patient comes to you at the cardiology department complaining of a sharp, stabbing chest pain behind her breastbone. The pain is not spreading to any other part of her body, and she denies feeling sweaty or experiencing nausea and vomiting. She reports that the pain worsens at night when she lies flat in bed and improves slightly when she sits up. She reveals that she has been diagnosed with systemic lupus and is taking regular medication for it. During auscultation, you hear scratchy, rubbing sounds that are most audible during systole. You decide to order an ECG to confirm the diagnosis. What ECG findings are you most likely to observe?