cardiology

A 60-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. His blood pressure is 180/100 mmHg in the right arm and 160/90 mmHg in the left arm. On examination, there is a new diastolic murmur. What is the most appropriate initial investigation?

A 65-year-old man with hypertension is started on a medication that blocks the angiotensin-converting enzyme (ACE). What is the most common side effect of this class of drugs?

A 67-year-old man with a history of hypertension and type 2 diabetes is scheduled for elective cholecystectomy due to symptomatic gallstones. During the preoperative assessment, he mentions experiencing mild chest discomfort during exertion over the past few weeks. What is the most appropriate next step in his preoperative management?

A 58-year-old man presents to the emergency department with chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate immediate management?

A 68-year-old man presents to the emergency department with 90 minutes of crushing chest pain radiating to his left arm. He is diaphoretic and anxious. ECG shows 3mm ST elevation in leads V2-V4. His blood pressure is 130/80 mmHg, heart rate 75 bpm. What is the most appropriate immediate next step in management?

A 72-year-old man with fatigue and a past myocardial infarction at 55 is breathless on stairs, has a 3 kg weight gain, and ankle marks. What is his likely NYHA functional class for chronic heart failure?

A 25-year-old Aboriginal man presents to a remote clinic with increasing shortness of breath on exertion and palpitations over the past month. He recalls having a sore throat as a child but no specific diagnosis. On examination, his pulse is 95 bpm, blood pressure 110/70 mmHg, respiratory rate 20 breaths/min. Auscultation reveals a pansystolic murmur loudest at the apex, radiating to the axilla. There are no signs of heart failure currently. Considering the likely diagnosis and the patient's background, which of the following is the most appropriate initial investigation?

A 68-year-old male with a history of hypertension and stable angina is prescribed amlodipine. He returns after two weeks complaining of significant ankle edema. What is the most appropriate initial management step?

A 58-year-old man with a history of hypertension and left ventricular systolic dysfunction (LVSD) is being treated with an ACE inhibitor. His blood pressure is well-controlled, but he develops a persistent, dry cough that is affecting his sleep and quality of life. What is the most appropriate next step in management?

A 72-year-old man with a history of type 2 diabetes mellitus, hypertension, and chronic kidney disease (stage 3) presents with a 2-week history of exertional dyspnea and fatigue. He reports no chest pain but has noticed occasional palpitations. On examination, his blood pressure is 150/90 mmHg, heart rate is 110 bpm (irregularly irregular), respiratory rate is 20 breaths per minute, and oxygen saturation is 94% on room air. Cardiovascular examination reveals a variable intensity S1, no S3 or S4, and a soft systolic murmur at the apex. Lung fields are clear. An ECG shows absent P waves and irregularly irregular QRS complexes. Which of the following is the most appropriate next step in management?

A 68-year-old male presents for routine follow-up. He is asymptomatic. Review the image. What is the most appropriate next step in management?

A 68-year-old woman with a history of hypertension and heart failure is admitted to the hospital with increasing shortness of breath and peripheral edema. She is currently taking furosemide 40mg daily. Her blood tests reveal the following: Na+ 130 mmol/L (135-145 mmol/L), K+ 3.1 mmol/L (3.5-5.0 mmol/L), Cl- 95 mmol/L (98-107 mmol/L), HCO3- 32 mmol/L (22-29 mmol/L). What is the most appropriate initial management?

A 45-year-old male with a history of hypertension presents with recurrent episodes of palpitations and near-syncope. His ECG during an episode shows a wide QRS complex tachycardia with a rate of 220 bpm. There is no evidence of structural heart disease on echocardiography. Which of the following is the most likely underlying mechanism of his arrhythmia?

A 68-year-old woman with a history of heart failure presents to the emergency department with increasing shortness of breath and lower extremity edema. She has been taking furosemide 40mg daily for the past year. Her blood pressure is 110/70 mmHg, heart rate is 90 bpm, and respiratory rate is 24 breaths/min. An ECG shows flattened T waves and prominent U waves. Which of the following is the most likely electrolyte abnormality contributing to her presentation?

What is the most common cardiac anomaly associated with Noonan syndrome?

An 82-year-old female presents with a 3-month history of intermittent retrosternal burning pain, worse after meals, and occasional shortness of breath on exertion. Vital signs are stable. Physical exam unremarkable. A chest X-ray is performed. Considering the findings on the image, what is the most appropriate initial management step?

Which zoonotic infection is a leading cause of culture-negative endocarditis?

Reciprocal ST-depression with ST-elevation in leads II, III, aVF is most likely seen in which leads?

A 78-year-old female on warfarin for chronic atrial fibrillation presents to the emergency department with a 24-hour history of increasing pain and discolouration in her right lower leg. She reports the pain is severe and worsening rapidly. She denies trauma or recent falls. Her INR this morning was 2.5 (target 2.0-3.0). Vital signs are stable: BP 130/80, HR 75, RR 16, Temp 36.8°C. Examination reveals the findings shown in the image. Considering the patient's history, current medication, and the clinical appearance depicted, the underlying mechanism involves a transient deficiency of which of the following?

A 68-year-old man with atrial fibrillation is scheduled for elective hip replacement surgery. He is currently on warfarin with a target INR of 2.0-3.0. His INR is 2.5 at the preoperative assessment. What is the most appropriate management of his anticoagulation therapy in preparation for surgery?

A 68-year-old male on warfarin presents with pleuritic chest pain and mild dyspnea. INR is 4.5. The image was obtained. What is the MOST appropriate initial intervention?

A farmer successfully treated for acute Q fever presents 6 months later with unexplained weight loss and night sweats. Physical exam reveals a new murmur. What is the most likely diagnosis?

A 72-year-old man with a history of heart failure and hypertension is admitted to the hospital with pneumonia. His medications include furosemide, ramipril, and digoxin. On day 3 of admission, he develops new-onset polymorphic ventricular tachycardia (Torsades de Pointes). An ECG shows a QTc interval of 580 ms. Which of the following is the MOST likely contributing factor to his arrhythmia?

A 62-year-old man presents to the emergency department with acute onset chest pain radiating to his left arm and jaw, accompanied by diaphoresis and nausea. He has a history of hypertension, type 2 diabetes mellitus, and hyperlipidemia. On examination, his blood pressure is 160/95 mmHg, heart rate is 95 bpm, respiratory rate is 20 breaths per minute, and oxygen saturation is 96% on room air. An ECG shows ST-segment elevation in leads II, III, and aVF. Initial troponin levels are elevated. He is given aspirin and clopidogrel in the emergency department. Which of the following is the most appropriate next step in management?

A 70-year-old man with known atrial fibrillation presents with sudden onset of severe pain, pallor, and coldness in his left leg. Pulses are absent below the femoral artery. What is the most likely source of the embolus causing this presentation?

A 72-year-old male presents with increasing shortness of breath and epigastric discomfort, particularly after meals. He has a history of well-controlled hypertension. An X-ray is performed. What is the MOST appropriate next step in management?

A 65-year-old man with a history of hypertension and ischemic heart disease presents to the emergency department with worsening shortness of breath, orthopnea, and peripheral edema. On examination, he has elevated jugular venous pressure, bilateral basal crackles, and pitting edema in the lower limbs. An echocardiogram shows an ejection fraction of 35%. What is the most appropriate initial management step for this patient?

A 65-year-old man with a history of type 2 diabetes mellitus and hypertension presents with exertional dyspnea and fatigue. His physical examination reveals a blood pressure of 150/90 mmHg, a heart rate of 88 bpm, and a soft S4 gallop. There is no peripheral edema. An electrocardiogram shows left ventricular hypertrophy with repolarization abnormalities. Which of the following diagnostic tests would be most appropriate to evaluate for underlying coronary artery disease in this patient?

A 68-year-old man with a history of hypertension, type 2 diabetes, and stable angina is scheduled for elective hernia repair surgery. He is currently on aspirin, metformin, lisinopril, and atorvastatin. His last angina episode was over a year ago, and he has no history of myocardial infarction. What is the most appropriate preoperative management step to minimize his cardiovascular risk during surgery?

A 72-year-old woman is admitted to the cardiology ward following an episode of syncope. Her past medical history includes hypertension, for which she takes hydrochlorothiazide, and osteoarthritis, managed with regular ibuprofen. An ECG reveals a prolonged QTc interval of 520 ms. She denies any family history of sudden cardiac death or prolonged QT syndrome. Her electrolytes are within normal limits except for a potassium level of 3.4 mmol/L (normal range 3.5-5.0 mmol/L). Which of the following is the MOST appropriate initial step in managing this patient?

A 68-year-old man with a history of hypertension and coronary artery disease presents to the emergency department with worsening shortness of breath and fatigue over the past week. On examination, he has elevated jugular venous pressure, bilateral lung crackles, and peripheral edema. An echocardiogram reveals reduced ejection fraction and dilated ventricles. Which of the following best explains the pathophysiological mechanism leading to his symptoms?

A 45-year-old man with a history of hypertension presents to the emergency department with palpitations and lightheadedness. His ECG shows a regular narrow-complex tachycardia at a rate of 180 bpm. There are no visible P waves, and the QRS duration is 0.08 seconds. He is hemodynamically stable. Which of the following is the most appropriate initial management?

A 72-year-old man with a history of hypertension and atrial fibrillation presents to the emergency department with worsening shortness of breath and fatigue over the past two weeks. He reports occasional palpitations but denies chest pain or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 130 bpm (irregularly irregular), respiratory rate is 22 breaths per minute, and oxygen saturation is 94% on room air. Jugular venous pressure is elevated, and there are bilateral lung crackles. An ECG shows atrial fibrillation with a rapid ventricular response. An echocardiogram reveals moderate mitral regurgitation and left atrial enlargement. Which of the following is the most appropriate initial management step?

A 16-year-old Aboriginal boy from a remote community presents to the local clinic with a two-week history of increasing fatigue, occasional shortness of breath on exertion, and migratory joint pains affecting his knees and ankles. He had a documented episode of acute rheumatic fever (ARF) three years ago, complicated by mild mitral regurgitation, and was commenced on monthly benzathine penicillin G injections for secondary prophylaxis. However, his adherence has been inconsistent over the past year due to difficulties accessing the clinic. On examination, he is afebrile. His pulse is 95 bpm, blood pressure 110/70 mmHg, and respiratory rate 18 breaths/min. Cardiac auscultation reveals a soft apical pansystolic murmur, unchanged from his last review six months ago. There is mild swelling and tenderness in his left ankle joint, but no erythema or warmth. His throat swab for *Streptococcus pyogenes* is negative. Laboratory tests show a CRP of 45 mg/L (normal <5), ESR 60 mm/hr (normal <15), and a normal full blood count. An ECG shows sinus rhythm with no PR interval prolongation. A point-of-care ultrasound shows mild mitral regurgitation. Considering the clinical presentation, history, and the significant burden of rheumatic heart disease in this population, which of the following is the most appropriate immediate management step regarding his secondary prophylaxis?

A 70-year-old woman with a history of hypertension presents with fatigue, shortness of breath, and bilateral leg swelling. Echocardiography shows an ejection fraction of 30%. What is the most appropriate first-line treatment?

A 55-year-old man with a history of hypertension and smoking presents for a routine check-up. He is concerned about his risk of cardiovascular disease and asks for advice on lifestyle modifications. Which of the following lifestyle changes would most significantly reduce his risk of cardiovascular events?

A 55-year-old male with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 150/95 mmHg despite lifestyle modifications. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A 72-year-old man with fatigue, a past myocardial infarction at age 55, breathlessness on stairs, and ankle marks has an LVEF < 40% on echocardiogram. Which of the following medications is known to improve outcomes in Heart Failure with Reduced Ejection Fraction (HFrEF)?

An 82-year-old patient presents to their GP with a 3-month history of intermittent retrosternal chest discomfort, often described as a burning sensation, worse after meals and when lying flat. They also report mild shortness of breath on exertion and occasional regurgitation, but deny significant dysphagia or weight loss. Past medical history includes hypertension and osteoarthritis. Medications are perindopril and paracetamol. On examination, vital signs are stable (BP 130/80, HR 75, RR 16, SpO2 97% on air), and lung sounds are clear. A chest X-ray is performed as part of the workup. Based on the clinical context and the findings demonstrated in the image, what is the most appropriate next step in investigation?

An electrocardiogram (ECG) shows a supraventricular tachycardia (SVT). What is the first-line treatment?

A 62-year-old man presents to the emergency department with a history of palpitations and dizziness that started suddenly 2 hours ago. He has a history of hypertension and is on lisinopril. He denies chest pain, shortness of breath, or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 150 bpm (irregular), respiratory rate is 18 breaths per minute, and temperature is 36.7°C. An ECG is performed, showing an irregularly irregular rhythm with no distinct P waves and a narrow QRS complex. Which of the following is the most appropriate initial management step?

A 55-year-old man presents to the emergency department with crushing chest pain radiating to his left arm and jaw. He is diaphoretic and appears anxious. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate immediate management?

A 72-year-old man with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presents to the emergency department complaining of exertional chest pain that has been increasing in frequency and severity over the past month. He describes the pain as a pressure-like sensation in the center of his chest, radiating to his left arm, and associated with shortness of breath. The pain typically occurs after walking two blocks and resolves with rest. He denies any recent changes in his medications or lifestyle. On examination, his blood pressure is 150/90 mmHg, heart rate is 78 bpm, and oxygen saturation is 96% on room air. An ECG shows normal sinus rhythm with no acute ST-segment changes. Troponin levels are within normal limits. Which of the following is the MOST appropriate next step in the management of this patient?

A 65-year-old patient with a history of DVT presents with sudden onset dyspnoea and pleuritic chest pain. Examination is unremarkable except for mild tachypnoea. Wells score is 4. Which initial investigation is most appropriate in the diagnostic pathway?

A 72-year-old male presents with increasing shortness of breath and epigastric discomfort, particularly after meals. He has a history of well-controlled hypertension and takes aspirin daily. An X-ray is performed. What is the most appropriate next step in management?

A 35-year-old patient with schizophrenia is on risperidone and develops QT prolongation on ECG. What is the next step?

A 67-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. His blood pressure is 180/100 mmHg in the right arm and 160/90 mmHg in the left arm. He has a history of hypertension and is a smoker. An ECG shows no acute ischemic changes. What is the most appropriate next step in the management of this patient?

A 55-year-old male presents with chest pain that radiates to his left arm and jaw, accompanied by diaphoresis and nausea. ECG shows ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?

A 68-year-old female presents with right leg pain and skin changes after starting warfarin for atrial fibrillation 5 days ago. Her INR is currently 3.5. Examination reveals the findings in the image. What is the MOST appropriate next step in management?

A 62-year-old man presents to the emergency department with sudden onset chest pain and shortness of breath that started 2 hours ago while he was gardening. He describes the pain as a tightness across his chest, radiating to his left arm. He has a history of hypertension and hyperlipidemia, and he is a current smoker. On examination, his blood pressure is 150/90 mmHg, heart rate is 110 bpm, respiratory rate is 22 breaths per minute, and oxygen saturation is 94% on room air. He appears anxious and diaphoretic. An ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following is the most appropriate immediate management step?