Discussions By Condition: Cardiovascular disease

please help to answer

Posted In: Cardiovascular disease 0 Replies
  • Posted By: kancha
  • December 26, 2008
  • 00:22 PM

1. A 52 –year-old woman presented with exercise-induced chest pain. Examination was normal except for mild epigastric tenderness. Her only significant past medical was chronic pancreatitis. She was a non-smoker and did not drink alcohol. ECG revealed ischemic features and serum troponin I was positive at 1.8. Her plasma sodium was low at 125.
a. What is the probable cause of her chest pain?
b. What risk factor could explain the low sodium?
c. What is the immediate treatment?
d. Does her family require further screening?

2. A 65-year-old man was treated for a myocardial infarction. 24 hours later, he became increasing hypotensive and oliguric. His chest was clear to auscultation. A central venous catheter was inserted and CVP was measured at 25cm H2O. The ECG reveals St Segment elevation in the inferior leads, with a dominant R wave in V1.
a. Which artery is likely to be responsible?
b. How do you explain the absence of pulmonary edema despite an elevated CVP?
c. What is the immediate treatment?

3. A 78-year –old man was admitted following a collapse at home. He had suffered a myocardial infarction the previous year, which was complicated by complete heart block, ventricular fibrillation and left ventricular failure. An implantable cardioverter defibrillator was inserted at the time. Shortly after admission he suffered a further collapse and a defibrillator shock was delivered. The telemetry print-out is ventricular tachycardia.
a. What is cause of the collapse?
b. How should this patient be managed?
c. What is the prognosis?

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