Thursday, April 24, 2014

Cardiology Case Scenario - Mitral Stenosis

30 years old male came to the ER with c/o palpitations and sweating since last 30 minutes.
Heart Rate – 220/min
B.P 120/80 mmHg
ECG shows AVNRT

2D Echo reveals that Patient is a case of Isolated Mitral Stenosis 
















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Thursday, November 8, 2012

Cardiology Case Scenario- Make your Diagnosis

A 60 year old gentleman with  history of hypertension and diabetes mellitus presents to the emergency room with retrosternal chest pain . He is afebrile, blood pressure is 110/70 mmHg, heart rate 70/min, and respiratory rate 18/min. Physical examination reveals normal lung sounds, normal jugular venous pressure, and an S4 heart sound. Laboratory studuies are initially normal. His ECG is below. What complication is most commonly associated with this patient's diagnosis?
















 A) Acute mitral regurgitation
 B) Left ventricular thrombus
 C) Left ventricular aneurysm
 D) Left ventricular Free Wall rupture




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Sunday, November 4, 2012

19 year old boy Passes out while running- Next Step in Management ?

A 19 year old boy with no past medical history passes out while running at a school evnt. He states that he was feeling a little dizzy prior to the event, but does not complains of chest pain or palpitations. His blood pressure is 120/85, heart rate 85/min, Respiratory Rate 12/min, and he is afebrile. His physical examination reveals normal lung sounds, a II/VI mid-sytolic creshendo-decreshndo murmur is heard at the right upper sternal border which increases in intensity with Valsalva, an S4 heart sound is also present. Laboratory studies are normal. What is the most appropriate treatment at this time?


 A) Start a Diuretic
 B) Permanent Pacemaker Implantation
 C) AICD Implantation
 D) Observation
 
 E) Start  Beta Blocker


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Monday, October 29, 2012

89 year old gentleman with history of Syncope - What should be the next step in management ?

A 89 years old gentleman with a history of hypertension and osteoarthritis presents to the ED with an episode of syncope while listening to music. He has felt generally lethargic for the past one week. He denies  chest pain, shortness of breath, or fever. His medications include Metoprolol and celecoxib. The blood pressure is 120/60 mmHg, H/R 42/min, R/R 15/min, and he is afebrile. His physical examination reveals normal lung sounds, a regular, bradycardic rhythm with varying intensities of the S1 heart sound on auscultation, and intermittent large cannon A waves in the jugular venous pulsation. His laboratory studies are normal. The ECG of the patient is depicted below. What is the next step in management of this patient?













 A) Observation

 B) Stop Metoprolol
 C) Permanent pacemaker implantation
 D) AICD Implantation

Answer-
Diagnosis -2nd degree AV block - high grade - Mobitz II 
Next Step in Management - Stop Metprolol and be ready for PPI 
Thanks to all for contribution

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