Ischaemic Heart Dx Short Cases Flashcards
A 60-year-old male presents with retrosternal chest pain radiating to the left arm, occurring on exertion and relieved by rest. What is the most likely diagnosis?
Stable angina.
A 55-year-old female with diabetes presents with nausea, diaphoresis, and epigastric discomfort but no chest pain. What should be suspected?
Atypical presentation of myocardial infarction (MI), commonly seen in diabetics and elderly patients.
A patient with ST-elevation MI (STEMI) arrives at a hospital without PCI facilities. What is the next best step?
Administer fibrinolytic therapy within 30 minutes if PCI is unavailable within 90 minutes.
A 70-year-old male with a history of hypertension presents with acute chest pain and ECG showing ST elevation in leads II, III, and aVF. What is the diagnosis?
Inferior wall myocardial infarction.
A 45-year-old smoker complains of chest pain occurring at rest and relieved by nitrates. ECG shows transient ST elevation. What is the likely diagnosis?
Prinzmetal’s (variant) angina due to coronary artery spasm.
A patient presents with sudden onset chest pain and ECG shows ST elevation in leads V1-V6. What is the diagnosis?
Anterior wall myocardial infarction.
A 65-year-old male with a history of diabetes and hypertension presents with new-onset heart failure symptoms. ECG shows Q waves in leads V1-V3. What does this suggest?
Old anterior myocardial infarction with left ventricular dysfunction.
A patient with chest pain is found to have ST depression in leads V4-V6. What is the likely diagnosis?
Non-ST-elevation myocardial infarction (NSTEMI).
A 50-year-old male presents with exertional chest pain and shortness of breath. ECG shows downsloping ST depression during a stress test. What does this indicate?
Positive stress test suggesting ischemic heart disease.
A patient with MI develops a new systolic murmur at the left lower sternal border. What is the likely cause?
Ventricular septal rupture.
A 58-year-old female with known ischemic heart disease presents with recurrent angina despite optimal medical therapy. What is the next step?
Consider coronary angiography to assess for revascularization options (PCI or CABG).
A patient with STEMI receives thrombolysis but continues to have persistent ST elevation. What is the next step?
Rescue percutaneous coronary intervention (PCI).
A 72-year-old male with a history of ischemic heart disease presents with worsening exertional dyspnea and orthopnea. What complication should be considered?
Heart failure due to ischemic cardiomyopathy.
A patient presents with acute chest pain and ECG shows ST elevation in leads I and aVL. Which coronary artery is likely affected?
Left circumflex artery (LCx).
A patient presents with chest pain, but ECG is non-diagnostic. What is the next best test to rule out MI?
High-sensitivity troponin measurement.
A patient with NSTEMI is found to have multi-vessel coronary artery disease on angiography. What is the preferred treatment?
Coronary artery bypass grafting (CABG).
A 65-year-old male with prior MI presents with progressive shortness of breath. Echocardiography shows a left ventricular ejection fraction (LVEF) of 30%. What is the likely diagnosis?
Heart failure with reduced ejection fraction (HFrEF) secondary to ischemic heart disease.
A patient with acute MI suddenly develops hypotension, jugular venous distension, and clear lung fields. What is the most likely complication?
Right ventricular infarction.
A 40-year-old male presents with chest pain, diaphoresis, and nausea. ECG shows hyperacute T waves. What does this indicate?
Early myocardial infarction.
A 60-year-old male presents with recurrent episodes of chest pain at night. ECG shows transient ST elevations. What is the likely diagnosis?
Prinzmetal’s angina (coronary vasospasm).
A 55-year-old female with ischemic heart disease presents with exertional dyspnea. What non-invasive test can assess myocardial ischemia?
Stress echocardiography or myocardial perfusion imaging.
A patient with a history of MI presents with syncope. ECG shows polymorphic ventricular tachycardia. What is the likely cause?
Ventricular arrhythmia secondary to previous infarction.
A patient with MI presents with fever, pleuritic chest pain, and pericardial rub weeks after the event. What is the diagnosis?
Dressler’s syndrome (post-MI pericarditis).
A patient presents with exertional chest pain and has a history of percutaneous coronary intervention (PCI) 2 years ago. What is the likely cause?
In-stent restenosis or progression of coronary artery disease.
A patient with suspected IHD has a coronary CT angiogram showing significant stenosis of the left main coronary artery. What is the preferred management?
Coronary artery bypass grafting (CABG).
A 65-year-old male presents with acute chest pain and hypotension. ECG shows ST elevation in leads V3-V4. What is the likely infarct location?
Anterior wall infarction due to left anterior descending (LAD) artery occlusion.
A patient with MI presents with severe mitral regurgitation and pulmonary edema. What is the likely cause?
Papillary muscle rupture.
A patient with NSTEMI is started on dual antiplatelet therapy (DAPT). How long should this be continued?
For at least 12 months.
A 70-year-old male presents with chest pain and confusion. His BP is 80/50 mmHg, and he has cold extremities. What is the likely diagnosis?
Cardiogenic shock due to MI.
A 58-year-old female presents with chest pain and ECG shows ST depression. Troponins are negative. What is the next step?
Repeat troponin levels in 3-6 hours to rule out MI.
A patient with known CAD develops worsening exertional chest pain despite medical therapy. What is the next step?
Perform coronary angiography to assess for possible revascularization.
A patient presents with chest pain and a systolic murmur at the apex. Echocardiography shows severe mitral regurgitation. What is the likely cause?
Ischemic mitral regurgitation due to papillary muscle dysfunction.
