Final Exam: Cardiology 101

L.T., a 68-year-old male, presents to the emergency department with a 4-hour history of chest pain. His ECG reveals ST-segment elevation in the inferior leads. Upon further history, you discover that he had an ischemic stroke 2 months ago. A CT scan of the head at that time did not show any hemorrhage.

Question: Given L.T.’s history of a recent ischemic stroke, is he a candidate for fibrinolytic therapy?

FM is a 42-year-old male (87 kg) who presents to the ED with severe headache and hypertension (212/122 mmHg). He has been diagnosed with high blood pressure in the past but is not currently on any medication. A stat head CT shows no sign of intracranial pathology. Labs are drawn and his BMP is normal, except for a SCr of 2.1. His baseline SCr was 0.8 a year ago, and he denies any history of renal dysfunction. Based on his current situation, which of the following represents the best initial goals for reducing FM’s blood pressure?

A 55-year-old male presents to the clinic with a blood pressure of 160/100 mmHg. He has a history of hypertension for the past 10 years and has been taking lisinopril 20 mg daily for the past 5 years. He denies any symptoms, is allergic to chlorthalidone, and his physical exam is unremarkable. His laboratory values are within normal limits. What is the most appropriate next step in the management of this patient’s hypertension?

A 65-year-old male with a history of hypertension, diabetes, and coronary artery disease presents to the emergency department with shortness of breath, fatigue, and ankle swelling. Physical examination reveals elevated jugular venous pressure, bibasilar crackles, and peripheral edema. Chest X-ray shows cardiomegaly and pulmonary congestion. Labs reveal elevated BNP levels and renal dysfunction. The patient is diagnosed with acute decompensated heart failure and admitted to the hospital.

A 65-year-old male with a history of hypertension, diabetes, and coronary artery disease presents to the clinic with complaints of shortness of breath and fatigue. On physical examination, he has bilateral lower extremity edema and jugular venous distension. His labs show an elevated BNP level and an ejection fraction of 30%. An echocardiogram reveals left ventricular dilation and dysfunction. What is the recommended target dose and titration schedule for carvedilol in the management of chronic heart failure?

BL is a 78-year-old female (67kg) who arrives at the Emergency Department (ED) experiencing difficulty breathing and coughing up pink foam. She has a history of high blood pressure but hasn’t taken her prescribed medications (lisinopril and hydrochlorothiazide) for several days. BL believes her blood pressure escalated due to stress from her family and an unusual diet filled with rich foods, but her difficulty breathing worsened rapidly within the last couple of hours. Upon examination, her blood pressure is 220/146, RR 34, O2 saturation 86% on room air, and her work of breathing is visibly increased. The physician believes that BL has Sympathetic Crashing Acute Pulmonary Edema (SCAPE). The respiratory therapist places BL on BiPAP, and the physician asks for your recommendation regarding medication therapies. Which of the following is the most appropriate recommendation for BL?

A 63-year-old female with a history of hypertension and diabetes presents to the emergency room with sudden onset of dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On examination, she has rales in both lung fields, elevated jugular venous pressure (JVP), and an S3 heart sound. Based on her presentation and findings, what is the most likely diagnosis?

A 65-year-old male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril 20mg daily, metformin 1000mg twice daily, and furosemide 40mg daily. His blood pressure is 130/80 mmHg, heart rate is 80 beats per minute, and respiratory rate is 20 breaths per minute. His physical exam is significant for bilateral crackles in the lung bases and peripheral edema. Which of the following is the most appropriate pharmacologic therapy for the management of chronic heart failure in this patient?

A 60-year-old female presents to her primary care physician with a history of hypertension. She reports that she has been taking lisinopril 10mg daily for the past year, but her blood pressure has not been well controlled. Her current blood pressure is 150/90 mm Hg. She has a past medical history of hyperlipidemia and is currently taking atorvastatin 20mg daily. She denies any history of cardiovascular disease or diabetes. Her family history is significant for hypertension in both parents. What is the appropriate initial treatment for this patient’s uncontrolled hypertension?

A 55-year-old male patient with a history of hypertension, type 2 diabetes, and high cardiovascular risk presents to your clinic. His current blood pressure is 145/85 mm Hg. Based on the 2017 ACC/AHA guideline and other evidence, what should be the target blood pressure goal for this patient?

V.L., a 59-year-old male with a BMI of 32, is diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). He is started on clopidogrel, an antiplatelet agent. On review of his medication list, you note that he is also taking omeprazole for gastroesophageal reflux disease (GERD) and atorvastatin for hyperlipidemia. His liver function tests are within normal limits.

Question: Given V.L.’s current medications, what major drug interaction should be considered regarding clopidogrel?

Mr. S is a 52-year-old male with a history of hypertension, type 2 diabetes mellitus, and a 30-pack-year smoking history. He comes to the clinic complaining of increasing fatigue and shortness of breath on exertion. Based on his medical history, which condition confers the greatest risk for developing heart failure in Mr. S?

A 55-year-old patient with chest pain is admitted to the emergency department. His ECG results are consistent with an acute myocardial infarction. As part of the treatment plan, the medical team has decided to initiate nitroglycerin therapy. Before this, which of the following medications should be checked in the patient’s medication history to avoid potentially lethal interactions?

Mrs. L, a 65-year-old female, presents with complaints of exertional dyspnea. She has a history of hypertension and atrial fibrillation. Her ECG reveals left ventricular hypertrophy, and her echocardiogram shows an ejection fraction of 58%. Based on her findings, which feature is consistent with heart failure with preserved ejection fraction (HFpEF)?

A 67-year-old woman with a known history of heart failure is admitted with severe fatigue, worsening dyspnea, and decreased urine output. Despite optimizing her fluid status and medications, her symptoms persist, and she exhibits signs of poor perfusion. Which clinical finding suggests the need for positive inotropic therapy in her ADHF?

A 45-year-old male presents to the clinic with a blood pressure reading of 150/90 mmHg. He has no significant past medical history and is not taking any medications. He denies any symptoms such as headache, chest pain, shortness of breath, or visual changes. Physical examination is unremarkable except for elevated blood pressure.

According to the 2017  ACC/AHA Hypertension guideline, what is the definition of a hypertensive emergency?

In the DOSE trial, what was the comparison made in the study regarding the strategies for diuretic administration in acute decompensated heart failure?

According to the “2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction,” what is the recommended time frame for primary PCI in patients with STEMI at a PCI-capable hospital?

According to the LIFE study published in The Lancet, which medication was found to prevent more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure?

In the 2017  ACC/AHA Hypertension guideline, what is the recommended initial goal for BP reduction in patients with a hypertensive emergency?

In the article “Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure,” what was the primary objective of the study?

According to the findings in the article “Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure,” which group showed a significant reduction in the risk of death from cardiovascular causes?

Based on the “2013 ACCF/AHA Guideline,” what is the recommended approach for risk stratification in patients with STEMI?

What was the primary outcome of the INTERACT3 trial?

A 58-year-old female with a previous medical history of hyperlipidemia, type 2 diabetes mellitus, and myocardial infarction, presents to the emergency department reporting chest pain. She appears anxious with a respiratory rate of 26 breaths per minute, and her blood oxygen saturation reads 89% on room air. Her vital signs are a blood pressure of 110/80 mmHg and a pulse rate of 94 beats per minute. An ECG reveals ST-segment elevation. Due to the lack of facilities for coronary stenting, the managing physician has decided to administer tissue plasminogen activator (t-PA). Considering that the patient’s weight is 73 kg, what is the generally recommended total dose of alteplase for infusion in this case?

According to the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended initial treatment for patients with acute decompensated heart failure (ADHF) and volume overload?

In the ACCOMPLISH trial, how were the patients categorized based on their BMI?

According to the CLUE trial, what was the primary outcome and how was it defined?

According to the PLATO trial, how did the rates of overall major bleeding in patients treated with Ticagrelor compare to those treated with Clopidogrel?