Case Challenges
Quiz
184Cardiology
A 61-year-old man presents to the emergency department with chest pain that began 3 days ago. He has a history of coronary stent implantation 20 years ago, but discontinued his medications 8 months ago. Three days ago, he was evaluated at another hospital for chest pain and advised to undergo treatment, but he left against medical advice. On arrival today, ECG demonstrates ST-elevation myocardial infarction (STEMI). He undergoes coronary angiography (Video A) followed by stent implantation. On the following day, transthoracic echocardiography demonstrates the findings shown in Video B. Which of the following medications should be added to this patient’s regimen?
160Cardiology
A 45-year-old man presents to the emergency department with severe palpitations and chest discomfort. On arrival, his vital signs are: blood pressure 137/101 mmHg, heart rate 230/min, respiratory rate 18/min, temperature 36.5°C, and oxygen saturation 99%. His initial ECG is shown in Figure A. After administration of adenosine 12 mg IV, the ECG shown in Figure B is obtained. The patient’s heart rate transiently slows but then immediately resumes tachycardia at 150-200/min. He has no significant past medical history and is not taking any medications. Which of the following is the most likely diagnosis, underlying mechanism, and appropriate treatment for the wide QRS tachycardia seen on the initial ECG (Figure A)?
153Cardiology
A 75-year-old woman is hospitalized for recurrent syncopal episodes. She has a history of breast cancer and is currently undergoing chemotherapy. Since starting chemotherapy, she has developed severe nausea and vomiting and has been taking the antiemetic ondansetron. On admission, her initial 12-lead ECG is shown in Figure A. During hospitalization, she again experiences a brief loss of consciousness lasting about 10 seconds. At that time, the bedside monitor demonstrates the rhythm shown in Figure B. Which of the following is the most likely diagnosis and the appropriate management?
133Cardiology
An 84-year-old woman with a history of hypertension, diabetes mellitus, and atrial fibrillation presents after a syncopal episode. Serial ECGs demonstrate variable findings (Figures A and B). A 24-hour Holter monitor subsequently reveals a 7-second episode of asystole (Figure C). For treatment, the procedure shown in Figure D was performed. Which of the following statements is correct?
85Cardiology
A 47-year-old man presents with chest pain that began 30 minutes prior to arrival. He is diagnosed with acute myocardial infarction due to left anterior descending (LAD) artery occlusion (Figures A, B), and undergoes stent implantation (Figure C). Three hours after the procedure, he again develops chest pain. Sublingual nitroglycerin was administered, but there was no relief. The symptoms persisted for more than 1 hour. ECG and repeat coronary angiography are performed, with findings shown in Figures D and E. Which of the following statements is correct?
71Cardiology
A 74-year-old woman is admitted to the intensive care unit for management of septic shock secondary to pneumonia. An emergency call is triggered due to the ECG findings shown in Figure A. The on-call resident attempts defibrillation with biphasic 150 J, but an abnormal ECG tracing persists as shown in Figure B.
What is the most appropriate diagnosis and next step in management?
What is the most appropriate diagnosis and next step in management?
48Cardiology
A 34-year-old woman presents with exertional dyspnea that has developed over the past month. She had been previously healthy, with no significant past medical history. Her blood pressure is 120/60 mmHg, heart rate is 77 beats per minute, and body temperature is 36.7°C. On physical examination, a continuous murmur with an associated palpable thrill was auscultated along the left sternal border. Transthoracic echocardiography demonstrates the following findings (Figures A, B, C).
What is the most likely diagnosis?
What is the most likely diagnosis?