Cardiovascular III Flashcards
What is the initial treatment of choice for a patient with ventricular fibrillation or pulseless ventricular tachycardia?
Immediate defibrillation (unsynchronized)
What is the likely cause of bradycardia, AV block, and diffuse wheezing in a CAD patient that has attempted suicide?
Beta blocker overdose
other symptoms include hypotension, hypoglycemia, delirium, seizures, and cardiogenic shock
What is the likely cause of LAD artery occlusion in a patient with recent stent placement in the LAD artery?
Stent thrombosis (likely due to medication non-compliance)
premature discontinuation of antiplatelet therapy is the strongest predictor of stent thrombosis after intracoronary stent implantation
What is the likely cause of syncope in a young patient with occasional chest pain, dyspnea, and a crescendo-decrescendo systolic murmur along the left sternal border without carotid radiation?
Hypertrophic obstructive cardiomyopathy (HOCM)
syncope in HOCM is multifactorial and can be due to outflow obstruction (interventricular septal hypertrophy), arrhythmia, ischemia, or a ventricular baroreceptor response that inappropriately causes vasodilation
What is the likely cause of the imaging findings below in an IV drug user with a history of fever, cough, and tricuspid regurgitation?
Septic pulmonary emboli
What is the likely diagnosis in a chronic atrial fibrillation patient taking furosemide, metoprolol, digoxin, and warfarin who presents with diarrhea, nausea, decreased appetite, and arrhythmias?
Digoxin toxicity
may also present with vision changes
What is the likely diagnosis in a chronic renal failure patient that presents with pleuritic chest pain that improves when leaning forward?
Uremic pericarditis
the classic ECG finding of diffuse ST elevation is typically absent due to lack of myocardial inflammation
What is the likely diagnosis in a COPD patient with JVD, hepatomegaly, and pitting edema?
Cor pulmonale
What is the likely diagnosis in a hemodynamically unstable patient that presents following a motor vehicle accident with an elevated PCWP that worsens after administration of IV fluids?
Myocardial contusion
an elevated PCWP at baseline should raise suspicion of myocardial contusion (hypovolemic shock would have a low PCWP); urgent echocardigram is required for further evaluation
What is the likely diagnosis in a hypertensive patient with symptoms of CHF with LV hypertrophy and an ejection fraction of 55% on echocardiography?
Diastolic heart failure (HFpEF)
caused by impaired myocardial relaxation or increased LV wall stiffness (leads to increased LV end-diastolic pressure)
What is the likely diagnosis in a hypotensive patient requiring IV fluids/pressors to maintain BP that develops cool extremities and the skin findings below?
Pressor-induced vasospasm (e.g. norepinephrine)
diagnosis is suggested by symmetric duskiness and coolness of all finger tips
What is the likely diagnosis in a male smoker with chest discomfort and the CXR findings below?
Thoracic aortic aneurysm
What is the likely diagnosis in a male with a history of SLE that presents with epigastric burning provoked by exertion and relieved by rest?
Atypical angina
What is the likely diagnosis in a patient 2 months post-MI that presents with CHF and persistent ST elevations/deep Q waves on ECG?
Ventricular aneurysm
may be complicated by a mural thrombus which can lead to systemic embolization
What is the likely diagnosis in a patient being treated with furosemide and nitroprusside for hypertensive emergency that develops confusion, agitation, and seizures?
Cyanide toxicity
due to nitroprusside; most common in patients with renal insufficiency
What is the likely diagnosis in a patient on post-MI day 3 that presents with pleuritic chest pain that improves when leaning forward with clear lungs on auscultation?
Peri-infarction pericarditis
ECG typically reveals diffuse ST-segment elevation
What is the likely diagnosis in a patient on post-MI day 3 that presents with sudden-onset pulmonary edema, hypotension, and a systolic murmur (cardiac apex)?
Papillary muscle rupture
What is the likely diagnosis in a patient on post-MI day 5 that presents with acute onset chest pain and profound shock without signs of congestive heart failure?
Ventricular free wall rupture
What is the likely diagnosis in a patient on post-MI day 5 that presents with sudden-onset cardiogenic shock and a harsh holosystolic murmur at the left sternal border?
Interventricular septal rupture
left-to-right shunting may manifest as an increase in O2 saturation from the right atrium to the right ventricle
What is the likely diagnosis in a patient on post-op day 1 status-post CABG that presents with hypotension, tachycardia, and the findings below:
Right atrium: 20 mmHg
Right ventricle: 35/20 mmHg
PCWP: 20 mmHg
Cardiac tamponade
equilibrated intracardiac diastolic pressures suggests cardiac tamponade
What is the likely diagnosis in a patient status-post coronary angiogram that presents with abdominal pain, AKI, eosinophilia, and purple mottling of both feet?
Cholesterol embolism
common complications include renal failure, skin manifestations, cerebral/intestinal ischemia, and Hollenhorst plaques (ocular involvement); treatment is supportive and involves statin therapy to prevent recurrent cholesterol embolism
What is the likely diagnosis in a patient status-post lung biopsy that presents with severe shortness of breath and chest pain with a decreased cardiac output and increased PCWP?
Cardiogenic shock (secondary to MI)
elevated PCWP is indicative of cardiac etiology (helps rule out pulmonary etiologies, such as pneumothorax and pulmonary embolus)
What is the likely diagnosis in a patient that experienced a syncopal episode while urinating with normal cardiac exam?
Situational syncope
specific triggers (e.g. micturition, defecation, cough) precipitate an alteration in the autonomic response and can cause a cardioinhibitory, vasodepressor, or mixed response
What is the likely diagnosis in a patient that experiences syncopal episodes provoked by strong emotion with prodromal symptoms (e.g. nausea, diaphoresis)?
Vasovagal (neurocardiogenic) syncope
can be caused by emotional or painful stimuli
What is the likely diagnosis in a patient with a history of a stab wound that develops progressive weakness and exertional dyspnea with widened pulse pressure, tachycardia, and brisk carotid upstroke?
High-output heart failure (secondary to AV fistula formation)
results in increased preload, decreased afterload, and increased cardiac output; doppler US is the preferred test for diagnosis and surgical therapy may be warranted
What is the likely diagnosis in a patient with a history of peripheral arterial disease that presents with pain, pallor, paresthesias, and pulselessness in one limb?
Acute limb ischemia
e.g. due to arterial thrombosis
What is the likely diagnosis in a patient with a history of recent MI that presents with pain, pallor, paresthesias, and pulselessness in one limb?
Acute limb ischemia
e.g. due to arterial embolus
What is the likely diagnosis in a patient with a recent URI that presents with CHF and dilated ventricles with diffuse hypokinesia on echocardiogram?
Dilated cardiomyopathy
often seen following viral myocarditis, particularly after a Coxsackievirus B infection; treatment is supportive
What is the likely diagnosis in a patient with a recent URI that presents with JVD, hypotension, non-palpable PMI, and clear lungs (CXR below)?
Pericardial effusion
What is the likely diagnosis in a patient with a recent URI that presents with syncope, dyspnea, and the ECG findings below?
Pericardial effusion
What is the likely diagnosis in a patient with a short systolic murmur (cardiac apex) that disappears with squatting?
Mitral valve prolapse
squatting increases preload and LV volume, decreasing the intensity of the murmur
What is the likely diagnosis in a patient with a wide pulse pressure and “pounding heart” sensation, especially in the left lateral decubitus position?
Aortic regurgitation
the left lateral decubitus position brings the enlarged LV closer to the chest wall, increasing awareness of the heartbeat
What is the likely diagnosis in a patient with an aortic dissection that develops hypotension, JVD, and pulsus paradoxus?
Cardiac tamponade
What is the likely diagnosis in a patient with an implantable pacemaker that presents with peripheral edema, JVD, and a holosystolic murmur (left lower sternal border) with clear lungs on auscultation?
Tricuspid regurgitation
the right ventricular lead of an implantable pace maker passes through the tricuspid valve to enter the RV and may damage the leaflets
What is the likely diagnosis in a patient with dizziness, weakness, and the ECG findings below?
Complete heart block
What is the likely diagnosis in a patient with fever, weight loss, an early diastolic murmur, and a left atrial mass on echocardiography?
Cardiac myxoma
may also have complications of systemic embolization (e.g. TIA, stroke) or cardiovascular symptoms simulating mitral valve disease (e.g. dyspnea, pulmonary edema, orthopnea); treatment involves prompt surgical resection
What is the likely diagnosis in a patient with hypotension, distended neck veins, and muffled heart sounds?
Cardiac tamponade
this is classically known as “Beck’s triad”; symptoms are due to an exaggerated shift of the interventricular septum toward the left ventricular cavity (decreases LV preload, SV, and CO)
What is the likely diagnosis in a patient with Marfan syndrome that presents with sudden-onset tearing chest pain?
Aortic dissection
What is the likely diagnosis in a patient with peripheral edema, ascites, JVD without inspiratory decline, and pericardial calcifications on CXR?
Constrictive pericarditis
increased JVP without inspiratory decline is known as Kussmaul’s sign; may also have prominent x & y descents on jugular venous pulse tracings and a pericardial knock (mid-diastolic sound) on PE
What is the likely diagnosis in a patient with pitting edema and leg pain that is worse in the evening accompanied by varicose veins and skin ulceration?
Chronic venous insufficiency (CVI)
skin ulceration is classically on the medial aspect of the lower leg; some risk factors for CVI include advancing age, obesity, family history, and sedentary lifestyle
What is the likely diagnosis in a patient with previous Hodgkin lymphoma status-post chemoradiation therapy that presents with dyspnea, JVD, ascites, and hepatomegaly?
Constrictive pericarditis
other common findings include Kussmaul’s sign, a pericardial knock (mid-diastolic sound), and pericardial calcifications
What is the likely diagnosis in a patient with sharp, localized chest pain that is worsened with inspiration and tender to palpation?
Costochondritis
most common cause of musculoskeletal chest pain
What is the likely diagnosis in a patient with ST elevations in leads II, III, and aVF with JVD, hypotension and clear lungs on auscultation?
Right ventricular MI
What is the likely diagnosis in a patient with unexplained CHF accompanied by proteinuria and concentric LV hypertrophy with normal ventricular chamber dimensions?
Amyloidosis
cardiac symptoms due to restrictive cardiomyopathy (may progress to dilated cardiomyopathy); other commonly involved organ systems include the liver, kidneys (proteinuria), skin, and nervous system
What is the likely diagnosis in a patient with upper extremity hypertension, brachial-femoral pulse delay, and a continuous interscapular murmur?
Coarctation of the aorta
What is the likely diagnosis in a post-MI patient that presents a few weeks later with chest pain that improves while leaning forward and diffuse ST elevation on EKG?
Dressler’s syndrome (a type of pericarditis)
believed to be due to immunologic phenomena; malaise, fever, and elevated ESR may also be present
What is the likely diagnosis in a systemic sclerosis patient that presents with renal failure and malignant hypertension?
Scleroderma renal crisis
What is the likely diagnosis in a young adult with a month history of fever and malaise that develops symptoms of CHF with cardiomegaly on imaging?
Viral myocarditis
What is the likely diagnosis in a young patient from a developing country that presents with dyspnea, hemoptysis, and occasional palpitations?
Mitral stenosis (from rheumatic heart disease)
left atrial enlargement due to MS predisposes to atrial fibrillation and thromboembolic complications (e.g. stroke)
What is the likely diagnosis in a young patient with a smoking history that presents with episodic chest pain that resolves spontaneously and is associated with transient ST-segment elevation during the episodes?
Vasospastic angina
formerly known as Prinzmetal angina; typically occurs in young (age < 50) smokers with minimal risk factors for CAD
