Cardiology

A 60-year-old man has known CAD for many years and has had multiple cardiac catheterizations and two stents. His last cath was six months back after a borderline positive stress test. The cath revealed that his stents were widely patent and that his other proximal coronaries had non-obstructive disease; he has diffuse disease distally- but these were non-revascularisable by intervention or CABG and needed to be medically managed. His Ejection fraction is normal.

He gets angina on moderate to severe exertion but it gets relieved by resting. He uses 2-3 sublingual Nitroglcerine pills per...

A 35-year-old Caucasian female presents to the ER with Chest Pain of six hours duration. The pain is a tight and heavy sensation in the retrosternum and neck. She also is mildly short of breath and has to take sighing breaths to help her breathing. She describes some tingling and numbness in both her hands. No radiation of pain to the jaw or back.

Patient is a nurse with two children ages ten and five-years-old. She is very active but does not exercise daily. She has been unrestricted in her activities till now. The pain started while working at the hospital. She has been unwilling to...

A 47-year-old old Caucasian man presents with three hours of severe unrelenting retrosternal chest tightness. This is associated with shortness of breath and sweating. The discomfort started when he was chopping wood (usual activity) but would not get relieved with rest, water and Tums. He has never had chest Pain before and has not seen a doctor for over 10 years. He smokes two packs of cigarettes a day and has been doing so for over 30 years. He denies HTN and Diabetes. His brother (age 51) had a 3 vessel CABG 2 years ago and is doing well.

1.What is the likely diagnosis?
2.What...

A 42-year-old African American Female develops chest pain while driving. Pain is 8/10 in intensity over left breast and makes her hold her breath. There is no radiation of the pain and no other associated features. Her sister has SLE.

On Examination:
No signs of lupus.
BP 120/70 P 78/m
CVS: JVP not elevated
PMI not displaced
Heart sounds normal
Sharp triphasic scratchy sound over the area of Chest pain
Chest: Clear
Abdomen: No organomegaly
CXR: Normal
EKG: Diffuse ST segment elevation.

A 32 year-old white femaile has a heart murmur since childhood and takes regular endocarditis prophylaxis. She is admitted after a motor vehicle accident.

On Examination:
BP=126/76
P=88/m
Bruising over chest wall from steering wheel injury
No cyanosis or clubbing
CVS: JVP not elevated, Apex is displaced down and out
S1 soft, narrowly split S2, soft LVS3, no S4
5/6 pansystolic murmur over precordium. soft mid-diastolic murmur at
apex
Chest: Clear
Abdomen: Soft nontender, no organomegaly

Two worried parents came to your office to discuss a big problem for their child. You examine their 6 month old boy and tell them that he is very well. Then, they told you,they are very worried because their child may suffer from myocardial infarction. This because one of their cousin die from this diagnosis.

What will you recommend to this parents?

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A patient 80-year-old female has had several episodes of syncope, all of which have occurred while she was returning to her room after breakfast. She complains of headache and she feels cold and weak. She takes nitroglycerin in the morning for a history of chest pain, but denies recent chest pain or shortness of breath.

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