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?
A 55-year-old man is admitted to Resus with a suspected anterior myocardial infarction. An ECG on arrival confirms the diagnosis and thrombolysis is prepared. The patient is stable and his pain is well controlled with intravenous morphine. Clinical examination shows a blood pressure of 140/84 mmHg, pulse 90 bpm and oxygen saturations on room air of 97%. What is the most appropriate management with regards to oxygen therapy?
A 70-year-old man presents with central chest pain that has been ongoing for 2 hours. The pain is radiating to his left arm. He has a medical history of hypertension and hypercholesterolemia.
Upon examination, the patient appears uncomfortable and sweaty. His vital signs are as follows:
– Heart rate: 90 bpm
– Respiratory rate: 20 breaths/min
– Peripheral oxygen saturation: 95% on room air
– Blood pressure: 136/78 mmHg
– Temperature: 37.0ºC
An ECG performed by the paramedics shows ST depression in leads II, III, and aVF, as well as T-wave inversion.
What is the immediate treatment that should be given?
A 57-year-old man of Indian descent presents for a hypertension follow-up. He presents a log of blood pressure readings he has taken at home, consistently showing values above 150/90 mmHg. He is currently taking amlodipine and atorvastatin, with optimal dosing for the past year. What would be the best course of action at this point?
A 63-year-old man presents to the emergency department with sudden-onset chest pain and nausea. He is not taking any regular medications. An ECG reveals ST depression and T wave inversion in leads V2-V4, and troponin levels are elevated. The patient receives a STAT 300mg aspirin, and there are no immediate plans for primary PCI. According to the GRACE score, the 6-month mortality risk is 8.0%. The patient is stable. What is the best course of treatment going forward?
A 28-year-old female presents to the hospital with palpitations. On ECG, a shortened PR interval and wide QRS complexes are observed, along with a slurred upstroke in lead II. What is the definitive treatment for this condition?
A 38-year-old male presents with left-sided dull chest pain that has been present for five days. He reports no associated shortness of breath, cough, collapse, or pleuritic nature of the chest pain. The patient had a recent sore throat and headache last week, which has since resolved. There is no family history of sudden cardiac death in a first-degree relative, and the patient has never smoked.
Upon examination, the patient’s blood pressure is 125/89 mmHg, heart rate is 95/min, temperature is 37.3ºC, and oxygen saturations are 97% on room air. Pulsus paradoxus is not present. Blood results reveal Hb of 154 g/L, platelets of 425 * 109/L, WBC of 11.5 * 109/L, Na+ of 137 mmol/L, K+ of 4.6 mmol/L, urea of 6.4 mmol/L, creatinine of 100 µmol/L, CRP of 40 mg/L, and Troponin T of 13 ng/L. The ECG shows ST-segment elevation in lead I, II, III, aVL, V5, and V6, and PR segment elevation in aVR.
What is the most likely diagnosis for this patient?
An 83-year-old man who resides in a nursing home arrives at the Emergency Department with symptoms of diarrhoea and vomiting. He has been experiencing 8 watery bowel movements per day for the past 3 days and seems disoriented and dehydrated. The patient has a medical history of atrial fibrillation, type II diabetes, and dementia. His heart rate is elevated at 110/min, and his electrocardiogram displays noticeable U waves. What is the probable reason for his ECG alterations?
A 62-year-old female presents to the Emergency Department complaining of central chest pain that has been radiating to her left arm for the past 30 minutes. Upon examination, an ECG reveals ST elevation in leads II, III, and aVF. Which coronary artery is the most probable culprit?