A 26-year-old male with a history of 'A' type Wolff-Parkinson-White (WPW) syndrome presents with palpitations for 2 hours. Blood pressure (BP) is 16/9.5 kPa (120/70 mmHg), and electrocardiogram (ECG) shows WPW syndrome with atrial fibrillation and a ventricular rate of 170 beats/min. Which of the following drugs is contraindicated in this patient?
A 60-year-old male patient with aortic regurgitation and left ventricular enlargement has a left ventricular ejection fraction of 40% but experiences no symptoms during daily activities. The most accurate diagnosis of this patient's cardiac function is:
A 65-year-old male with 10-year history of coronary artery disease (CAD) developed severe retrosternal pain 6 hours ago, described as crushing and radiating to the left arm. Took nitroglycerin 4 times with partial relief. Presents with restlessness, sweating. Examination: acute distress, temperature 36.5°C, BP 100/70 mmHg, pulse rate 110 bpm; normal cardiac size, regular rhythm, diminished heart sounds, no gallop or murmurs heard; few bilateral wet rales; liver/spleen not palpable. Most likely diagnosis is:
The QRS-T complex disappears and is replaced by waveforms of varying morphology, size, and extreme irregularity
acute myocardial infarction (AMI)
A patient with rheumatic heart disease (RHD) and heart failure (HF) is treated with digitalis and diuretics, presenting with anorexia, headache, and ventricular bigeminy on electrocardiogram (ECG). What should be considered first?
A 30-year-old female with aortic regurgitation presents with left ventricular enlargement and palpitations/shortness of breath when walking quickly or climbing stairs. Echocardiogram shows left ventricular ejection fraction of 40%. What is her NYHA functional class?
A 54-year-old male with a 10-year history of hypertension presents due to uncontrolled blood pressure. To assess for early left-sided heart failure (HF), which symptom should be inquired about?
A 40-year-old male with rheumatic heart disease and heart failure (HF) is on digoxin therapy. Electrocardiogram (ECG) shows paroxysmal supraventricular tachycardia with 2:1 atrioventricular block and a ventricular rate of 100/min. The diagnosis is digitalis toxicity. Besides discontinuing digitalis, which drug should be administered?
A patient with acute myocarditis repeatedly experiences Adams-Stokes syndrome, and the electrocardiogram (ECG) shows third-degree atrioventricular block (AV block). The most appropriate management is:
A 75-year-old male with coronary artery disease (CAD) experiences occasional palpitations and chest tightness. The electrocardiogram (ECG) shows absence of P waves, replaced by f waves at an average rate of 380/min, with irregular QRS intervals. The ECG diagnosis is:
A 35-year-old female patient with rheumatic heart disease (RHD) and severe mitral stenosis (MS) presents with sudden palpitations, dyspnea, and coughing up pink frothy sputum. Examination reveals BP 90/70 mmHg, orthopnea, bilateral rales, heart rate 155 bpm, irregular rhythm with variable intensity of first heart sound. Intravenous digoxin 0.4mg is administered. The primary purpose is to:
A 56-year-old male with no prior medical history presents to the clinic with palpitations for 3 weeks. Physical examination reveals normal cardiac size, heart rate 180 beats per minute (bpm), irregular rhythm, and variable intensity of the first heart sound at the apex. The most likely diagnosis is:
A 32-year-old female presents with palpitations and chest tightness 1 week after a cold. Electrocardiogram (ECG) shows second-degree Wenckebach atrioventricular block. What is its characteristic ECG finding?
A 26-year-old male college student was found to have a heart rate of 58 beats/min during a physical examination. Later, he frequently palpated his pulse at night, often measuring 45 beats/min, prompting a clinic visit. The atropine test was negative. The diagnosis should be considered as:
A 40-year-old female patient presents with palpitations and chest tightness for 6 months, and 2 episodes of syncope in the past month. Current heart rate is 50 bpm with no improvement after atropine therapy. ECG shows third-degree AV block with junctional escape rhythm. What is the best treatment option?
A 35-year-old male has experienced episodic headaches, palpitations, and sweating over the past year, with symptoms resolving within 30-60 minutes. During this episode, examination revealed: heart rate 85 bpm, BP 195/120 mmHg, no significant cardiopulmonary abnormalities, positive urine glucose, and positive urine catecholamines. After 1 hour of observation, BP and heart rate normalized. The most likely diagnosis is:
A 40-year-old male presents with dizziness and headache for 5 months, generalized edema and oliguria for over 1 month. BP: 190/135 mmHg, generalized edema, urinary protein (++++), RBC (+++) in urine, BUN: 20 mmol/L. The diagnosis is:
A hypertensive patient suddenly develops dyspnea, cannot lie flat, and has bilateral rales. Blood pressure is 240/120 mmHg. Which drug should be used?
A hypertensive patient develops epileptiform convulsions, vomiting, and confusion after anger-induced blood pressure elevation to 250/120 mmHg. Brain CT shows no abnormalities. The most likely diagnosis is:
A 50-year-old male patient presents with dizziness and nocturia. Two separate measurements on different days show BP of 155/90 mmHg in both upper limbs and 170/100 mmHg in lower limbs. Both parents have hypertension. According to WHO criteria, the most likely diagnosis is:
A 60-year-old male with hypertensive heart disease experiences dyspnea at rest. Electrocardiogram (ECG) shows second-degree AV block, and bilateral basal rales are heard. Which of the following drugs should NOT be used in this case?
A 30-year-old male is diagnosed with coronary artery disease (CAD) and angina pectoris due to episodes of retrosternal pressure. He has a history of hypertension (HTN), diabetes mellitus (DM), and 10 years of smoking. His father has CAD. Which of the following is NOT a risk factor for CAD in this patient?
A 56-year-old male presents with episodic oppressive precordial pain for over 1 year, always occurring during activity. In the past month, episodes occur 3-4 times daily with limited mobility, and also occur at rest, lasting 20 minutes before relief. The most likely diagnosis is:
A 70-year-old male was admitted for heart failure (HF) with symptoms of palpitations, shortness of breath, and lower extremity edema for 2 weeks, and inability to lie flat at night for the past 3 days. Past coronary angiography showed triple-vessel disease when asymptomatic. The most likely diagnosis is:
A 60-year-old male presents with sudden severe retrosternal pain and 3 episodes of syncope. Heart rate is 40/min, regular. ECG shows P waves unrelated to QRS complexes, more P waves than QRS complexes, and QRS duration of 0.14 seconds. The best management is:
A 67-year-old male patient was admitted with acute myocardial infarction (AMI). On day 3, a 3/6 systolic murmur appeared at the apex, accompanied by progressively worsening heart failure (HF). Despite maximal medical therapy for HF, the patient died. The most likely complication of AMI in this case is:
A 52-year-old male with a history of exertional angina pectoris has experienced episodes occurring at 5 AM daily for the past 2 weeks, with prolonged pain duration. During hospitalization, the episodes were associated with a heart rate of 50 bpm, 4-5 premature beats/min, blood pressure of 95/60 mmHg (12.5/8 kPa), and ST-segment elevation in leads II, III, and aVF on ECG. Nifedipine was added, and no further episodes occurred. The mechanism of nifedipine's action in this case is:
A 28-year-old female with rheumatic heart disease (RHD) and mitral stenosis (MS) frequently experiences dyspnea, cough, and hemoptysis. After medical treatment, these symptoms gradually improve, but she develops anorexia, right upper quadrant pain, and edema. This suggests:
A 70-year-old male with a 10-year history of diabetes mellitus (DM), previously no history of palpitations or chest pain. One hour after breakfast today, he suddenly developed significant chest tightness, pallor, restlessness, sweating, and a sense of fear. Symptoms persisted for 2 hours before he presented to the emergency department. Physical examination: heart rate 100 bpm, blood pressure 86/70 mmHg. The most likely diagnosis is:
A 56-year-old male presents to the emergency department with chest pain for 10 hours. Electrocardiogram (ECG) confirms acute anterior wall myocardial infarction. The most common arrhythmia in this patient is:
A patient has experienced retrosternal crushing chest pain radiating to the left shoulder induced by physical activity over the past two months. The pain resolves within 3-5 minutes after stopping activity, responds well to nitroglycerin, and shows no change in character or location with each episode. The most likely diagnosis is:
A 68-year-old male patient presents with a diastolic blowing murmur loudest at the second right intercostal space. BP is 170/90 mmHg. CXR shows widened, tortuous aorta and a boot-shaped heart. The most likely diagnosis is:
A 52-year-old male with a 2-year history of angina pectoris presents with 1 hour of unrelieved angina despite nitroglycerin. Electrocardiogram (ECG) shows pathological Q waves with ST-segment elevation in leads V1-V4, leading to a diagnosis of acute myocardial infarction (AMI). The underlying mechanism is:
A 60-year-old male presents to the emergency department with precordial pain for 2 hours. The electrocardiogram (ECG) shows acute anterior wall myocardial infarction with occasional ventricular premature beats (3 times). The appropriate management at this time is:
A 62-year-old male presents to the emergency department with severe chest pain for 2 hours. Electrocardiogram (ECG) shows abnormal Q waves in V1-V3 with ST-segment elevation, diagnosed as acute myocardial infarction (AMI). Which vessel occlusion is responsible for this condition?
A 56-year-old male presents with chest pain, fever (38°C), and cough for 3 days. He had a history of acute myocardial infarction (AMI) 1 month ago. Physical exam reveals pleural friction rub in the left lower chest and pericardial friction rub at the left sternal border (3rd-4th intercostal space). Chest X-ray (CXR) and echocardiogram (ECHO) show small pleural and pericardial effusions, with a small shadow in the left lower lung. What is the most likely diagnosis?
A 76-year-old woman presented with persistent retrosternal pain for 1 hour. Examination: BP 90/60 mmHg, bilateral pulmonary rales. ECG showed widespread ST elevation in precordial leads with ventricular premature beats. During transfer to the ward, she suddenly developed convulsions and died despite resuscitation. The most likely cause of death is:
A 78-year-old man wakes up at night with wheezing and inability to lie flat, shows apathy, and has cold extremities. Emergency ECG reveals acute extensive anterior wall myocardial infarction (MI). Physical exam: BP 70/40 mmHg, heart rate 120/min, with audible ventricular gallop rhythm. The most likely cause of hypotension is:
A 56-year-old male with a 6-year history of precordial dull pain after exertion. For the past week, he has frequently been awakened by nocturnal chest pain. During episodes, the electrocardiogram (ECG) shows unidirectional curve-type ST-segment elevation of 0.2 mV in leads II, III, and aVF, which resolves after relief. Which medication is MOST contraindicated during an attack?
A 40-year-old woman with a history of rheumatic heart disease presents with palpitations and shortness of breath during activity for the past 1-2 years, along with minor hemoptysis. Echocardiogram shows mitral valve area <1.5cm², with an opening snap audible at the apex. No clinical or laboratory evidence of active rheumatic fever is present. The optimal treatment for this patient is:
A 35-year-old woman with a 10-year history of rheumatic mitral stenosis (MS) presents to the emergency department with sudden-onset dyspnea and palpitations for 1 hour after an argument. Examination reveals: sitting upright, cyanosis of the lips, restlessness, respiratory rate 40/min, heart rate 150/min with regular rhythm. Acute pulmonary edema is suspected. Which clinical manifestation is most specific for the diagnosis?
A 34-year-old male is found to have a diastolic rumbling murmur at the apex, heart rate 76 bpm with regular rhythm, no hepatosplenomegaly, and no lower limb edema. Echocardiogram reveals rheumatic mitral stenosis (MS) with a valve area of 1.7 cm². The patient reports no activity limitations. Which management is most appropriate?
A 25-year-old male presents with palpitations and shortness of breath for 3 years and fever for 1 month. Examination: temperature 37.6°C, petechiae on conjunctiva, clubbing, heart rate 100 bpm, biphasic murmur at the apex, diastolic murmur at the aortic valve area, splenomegaly 1 cm below the costal margin, hemoglobin 80 g/L, urinary protein (+). The most likely diagnosis is:
A 35-year-old male presents with lower extremity edema, oliguria, and shortness of breath for 2 months. Physical examination reveals jugular vein distension, few basal crackles in the lungs, cardiomegaly, heart rate 100 bpm with regular rhythm, audible S2, and a 2/6 systolic blowing murmur at the apex. The liver is palpable 3 cm below the costal margin, and lower extremity edema is present. Echocardiogram shows cardiac enlargement with diffuse hypokinesis of the ventricular walls, and urinary protein is positive. The most likely diagnosis is:
A 24-year-old male presents with shortness of breath on exertion. Physical examination reveals a systolic ejection murmur at the left sternal border (3rd-4th intercostal space). Echocardiogram shows thickened interventricular septum and left ventricular posterior wall with a ratio >1.3. The most likely diagnosis is:
A 24-year-old woman had fever (38°C) with sore throat, runny nose, and headache 2 weeks ago, which improved with treatment. For the past 2 days, she has experienced chest tightness and shortness of breath. Examination reveals: heart rate 100 bpm, regular rhythm, grade 2/6 systolic blowing murmur at the apex. ECG shows ST-T changes in all leads. Lab results: WBC 7.2×10⁹/L, ESR 25mm/h, elevated CPK and CPK-MB. The most likely diagnosis is:
A 28-year-old male presents with palpitations and shortness of breath for 3 months. Physical exam reveals cardiomegaly, ventricular gallop rhythm, grade III/VI systolic blowing murmur at the apex, few crackles in both lungs, hepatomegaly, and lower limb edema. Echocardiography shows significant left atrial and left ventricular enlargement. The diagnosis is dilated cardiomyopathy. The most common cause of death in this condition is:
A 36-year-old male presents with palpitations, chest pain, and exertional dyspnea for 3 months. Physical exam reveals a systolic ejection murmur at the left 3rd-4th intercostal space, normal cardiac size. Echocardiogram shows a diastolic ventricular septal thickness to posterior wall ratio of 1.35. The most likely diagnosis is:
Echocardiographic diagnostic criteria for hypertrophic obstructive cardiomyopathy (HOCM)
A 30-year-old male presents with palpitations and chest tightness for 3 weeks. ECG shows frequent premature ventricular contractions (PVCs), and chest X-ray reveals left ventricular enlargement. Suspecting cardiomyopathy, which test is most valuable to differentiate between primary cardiomyopathy and viral myocarditis?
A 44-year-old male presents with dyspnea and abdominal distension for 6 months, worsening over the past week. Examination reveals dyspnea in semi-recumbent position, jugular venous distension, normal cardiac size, and indistinct apical impulse. Heart rate is 100 bpm with regular rhythm. Heart sounds are diminished, and no murmurs are heard. Few rales are noted at lung bases. Abdomen is distended with liver palpable 4 fingerbreadths below the costal margin and tender; hepatojugular reflux is positive. Ascites sign (+), no lower limb edema. BP 95/80 mmHg. ECG shows low voltage and flattened T waves in precordial leads. The most likely diagnosis is:
A 30-year-old male presents with fever and fatigue for half a month, without chest pain or arthralgia. Examination reveals jugular vein distension, cardiomegaly, distant heart sounds, heart rate of 103/min, and hepatomegaly. Laboratory tests show WBC count 10×10<sup>9</sup>/L, ESR 25mm/h. Echocardiography confirms pericardial effusion. Pericardiocentesis yields 800ml of pale straw-colored fluid with WBC 0.4×10<sup>9</sup>/L (400/mm<sup>3</sup>), neutrophils 40%, lymphocytes 60%. No tubercle bacilli or other bacteria on smear. Which etiology is most likely?
A 22-year-old male presents with chest pain, accompanied by fever and dyspnea. Physical examination reveals significant cardiac enlargement, with the apical impulse located approximately 2cm medial to the left border of cardiac dullness. The liver is palpable 5cm below the costal margin. Electrocardiogram (ECG) shows sinus tachycardia and low voltage. The most likely diagnosis is:
A 27-year-old male with a history of ventricular septal defect (VSD) presents with fever, chest tightness, palpitations, and shortness of breath for 3 weeks, along with petechiae on the skin and conjunctiva. Subacute infective endocarditis is highly suspected. Which of the following tests is most helpful for definitive diagnosis?
A 46-year-old male with a 10-year history of hypertension presents to the emergency department with severe retrosternal pain radiating to the back for 5 hours. Physical examination: BP 200/105 mmHg, pallor, profuse sweating, cold clammy skin. Heart rate 120 bpm with regular rhythm. A grade III diastolic blowing murmur and grade II systolic blowing murmur are heard at the aortic valve area. ECG shows left ventricular hypertrophy with strain. The most likely diagnosis is:
A 32-year-old woman presents with palpitations and shortness of breath after activity for over 3 years, inability to lie flat at night, and coughing up pink frothy sputum for 1 hour. One week ago, she had fever, sore throat, and cough. Respiratory rate is 30/min, bilateral lungs show diffuse dry and wet rales/crackles, cardiac borders are enlarged bilaterally, and a grade 2/6 systolic blowing murmur is heard at the apex. The most likely diagnosis is:
A 35-year-old woman has experienced palpitations, shortness of breath, poor appetite, and edema for 5 years following exertion, with worsening symptoms over the past 2 weeks after an upper respiratory infection. Examination reveals: BP 120/70 mmHg, cardiomegaly, a diastolic rumbling murmur at the apex, heart rate 120 bpm with irregular rhythm and variable heart sounds, jugular venous distension, bilateral basal crackles, liver 3 cm below the costal margin with tenderness (+), no palpable spleen, and lower extremity edema (+). The pulse rate is 80 bpm. The clinical presentation is most consistent with:
A 35-year-old male presents with exertional dyspnea, palpitations, shortness of breath, oliguria, and lower extremity edema for over 1 year. Symptoms worsened 1 week ago with sore throat, cough, productive cough with yellow sputum, and inability to lie flat at night. Echocardiogram (ECHO) shows dilation of both ventricles, diffuse hypokinesis, and left ventricular ejection fraction (LVEF) of 30%. He is on digoxin 0.25mg once daily with no significant past medical history. Based on the clinical presentation and investigations, the most likely diagnosis is:
A 35-year-old female with a 10-year history of rheumatic arthritis presents with 4 years of palpitations and shortness of breath on exertion, recently worsened and unable to lie flat at night. On examination: diastolic rumbling murmur at the apex, fine crackles heard at the lung bases, abdominal distension, and bilateral lower extremity edema. The most likely diagnosis is:
A 70-year-old male with a 6-year history of hypertension (HTN) suddenly developed headache, agitation, hyperhidrosis, and pallor upon waking this morning. Blood pressure (BP) was 250/125 mmHg, heart rate 125 bpm with regular rhythm. Bilateral lungs exhibited medium and fine crackles with scattered wheezes. Liver and spleen were non-palpable, and no lower limb edema was present. What is the most appropriate diagnosis?
A 35-year-old woman presents with intermittent chest tightness for 2 years, accompanied by transient visual blackouts. Over the past week, the episodes of blackouts have increased in frequency, with one syncopal episode. Resting electrocardiogram (ECG) is normal. Which of the following is the first-choice investigation to determine the cause of syncope?
A 38-year-old woman with rheumatic heart disease (RHD), mitral valve disease, and long-standing atrial fibrillation suddenly develops a regular ventricular rhythm at 50 bpm after taking digoxin 0.25mg daily for 12 days. The most likely ECG diagnosis is:
A 56-year-old male presents with dizziness and palpitations for one week, occasional syncope. Past medical history includes hypertension (HTN) and coronary artery disease (CAD). Blood pressure (BP) is 105/60 mmHg, heart rate is 34 bpm with irregular rhythm. Electrocardiogram (ECG) shows PR interval of 0.22s with occasional dropped QRS complexes after P waves. The ECG diagnosis is:
A 38-year-old female with a diagnosis of moderate mitral stenosis (MS) due to rheumatic heart disease (RHD) presents with sudden-onset palpitations for 2 days, accompanied by dyspnea and inability to lie flat. Examination reveals: BP 95/75 mmHg, cyanosis of the lips, bilateral lung crackles, heart rate 150 bpm, irregularly irregular rhythm with variable intensity of the first heart sound, diastolic rumbling murmur at the apex, no hepatomegaly, and no lower limb edema. On palpation of the radial pulse, which finding is most likely?
A 30-year-old male has experienced paroxysmal palpitations for 10 years, with each episode lasting 30 minutes to 3 hours. This episode has persisted for 30 minutes. Examination: BP 90/60 mmHg, heart rate 200/min, absolutely regular rhythm, no murmurs, no abnormal lung findings. The most likely arrhythmia is:
An 8-year-old boy is admitted with chest tightness and palpitations for 1 week. Past medical history is unremarkable. Physical examination: BP 120/70 mmHg, heart rate 75 bpm, thin build, mild cyanosis of the lips, coarse breath sounds in both lungs without rales, heart rate 75 bpm with regular rhythm, and a grade III/6 systolic murmur at the left 3rd intercostal space. Investigations: CXR shows prominence of the pulmonary artery segment, CBC reveals WBC 10.5×10<sup>9</sup>/L, ECHO demonstrates a 5 mm ventricular septal defect (VSD) with left-to-right shunt, and ECG shows sinus rhythm. Based on these findings, the diagnosis is:
A 67-year-old male with hypertensive heart disease for 5 years presents with sudden BP elevation to 200/120 mmHg (26.7/16 kPa) due to emotional stress, followed by acute left HF. The preferred vasodilator is:
A 62-year-old woman with a 4-year history of hypertension and family history presents with repeated BP measurements of 190–196/110 mmHg (25.3/14.7 kPa) and grade III retinopathy. The diagnosis is:
A 65-year-old male with a history of hypertension (HTN) for over 10 years and a past history of wheezing suddenly presented with unconsciousness and left-sided hemiplegia. BP was 200/120 mmHg, blood glucose 11.2 mmol/L, and blood cholesterol 7.8 mmol/L. To what level should the BP be reduced during antihypertensive treatment?
A 40-year-old male has experienced episodic blood pressure (BP) spikes up to 210/120 mmHg over the past 2 months, accompanied by palpitations, profuse sweating, and headache. Symptoms resolve spontaneously within 2 hours, with BP returning to normal. The most likely diagnosis is:
A 50-year-old male with a 5-year history of hypertension (HTN) recently missed his medications. Two hours ago, he developed severe headache, agitation, palpitations, hyperhidrosis, pallor, and blurred vision. BP is 230/130 mmHg. The most likely diagnosis is:
A 54-year-old male has been experiencing substernal oppressive chest pain daily during afternoon naps or at 1 AM for the past month, lasting 20 minutes each time, relieved by nitroglycerin within 5 minutes. Clinical diagnosis is variant angina pectoris. During chest pain episodes, the expected electrocardiogram (ECG) change in variant angina is:
A 61-year-old male with coronary artery disease (CAD) and angina pectoris accompanied by left-sided heart failure (HF) was admitted. After digitalis administration, he developed frequent multifocal ventricular premature beats. The most likely cause of this arrhythmia is:
A 75-year-old male with angina pectoris lasting 4 hours. Nitroglycerin is ineffective. Electrocardiogram (ECG) shows 6mm ST-segment elevation in leads II, III, aVF with a concave upward pattern, and 4mm horizontal ST-segment depression in leads V1-3, with occasional ventricular premature beats. The most appropriate management for acute myocardial infarction (AMI) is:
A patient with acute extensive anterior wall myocardial infarction (MI) and a history of intermittent atrial fibrillation for 8 years was found to have left ventricular mural thrombus on echocardiography before discharge. The thrombus attachment site showed outward expansion with paradoxical motion. The most likely cause is:
A 68-year-old male with a 12-year history of coronary artery disease (CAD) and angina pectoris was admitted due to severe retrosternal pain lasting 8 hours after emotional agitation. No history of hypertension (HTN). Blood pressure (BP) on admission was 150/90 mmHg. Diagnosed with acute inferior wall myocardial infarction. The electrocardiogram (ECG) localization is:
A 42-year-old male presents with recurrent substernal chest pain over the past year. The episodes are unrelated to exertion but often occur when walking against cold wind or at 5 AM. Pain is relieved by nitroglycerin. Baseline electrocardiogram (ECG) shows horizontal ST-segment depression of 0.75 mm in leads II, III, and aVF. During episodes, the ECG appears normal. The most likely diagnosis is:
A 42-year-old male has experienced recurrent substernal pain for 1 year. The episodes are unrelated to exertion but often occur during brisk walking in cold wind or at 5 AM. Pain is relieved by nitroglycerin. Baseline ECG shows horizontal ST-segment depression of 0.75 mm in leads II, III, and aVF. During episodes, the ECG is normal. On the second day of hospitalization, the patient develops acute myocardial infarction (AMI). Which of the following is most valuable for assessing infarct size?
A 60-year-old male with a history of coronary artery disease (CAD) and angina pectoris presents with two episodes of transient visual obscurations. Electrocardiogram (ECG) shows sinus rhythm with a heart rate of 82 bpm, P-R interval of 0.28 sec, qR pattern in lead I, rS pattern in leads II and III (SIII > SII), rSR' pattern in V1, qRs pattern in V5 with widened S wave, and QRS duration of 0.18 sec. The ECG diagnosis is:
A 61-year-old male with a 3-year history of angina pectoris has recently experienced frequent episodes unrelieved by medication. Cardiac enzymes are normal. Clinically diagnosed with unstable angina, emergency coronary angiography reveals >90% obstruction of the left main coronary artery and its bifurcation. Which of the following is correct regarding the prognosis?
A 46-year-old male with rheumatic heart disease (RHD) involving both mitral and aortic valves for 10 years, frequently hospitalized for heart failure (HF) in the past 5 years. Currently admitted again for HF. Physical exam: semi-recumbent position, jugular vein distension, enlarged cardiac borders, heart rate 140 bpm, atrial fibrillation, gallop rhythm audible at apex. Systolic and diastolic murmurs heard over both mitral and aortic valves. Left lung base shows rales/crackles, right lung exhibits dullness on percussion and absent breath sounds. Liver palpable 2 fingerbreadths below costal margin, soft consistency. Spleen not palpable, no ascites. Mild lower limb edema. The mechanism of right-sided pleural effusion in this case is:
A 50-year-old male with a known heart murmur for 20 years presents with exertional palpitations and shortness of breath for the past 6 months. Examination reveals BP 110/70 mmHg, enlarged cardiac borders, heart rate 132 bpm with irregular rhythm, variable S1 intensity, pulse deficit, grade III pansystolic murmur at the apex radiating to the axilla, mild diastolic rumbling murmur, and basal rales. The most accurate diagnosis is:
A 45-year-old male with a 5-year history of rheumatic heart disease and mitral valve disorder presents with atrial fibrillation for 9 months, admitted for electrical cardioversion. An echocardiogram (ECHO) is performed first to assess:
A 29-year-old woman with a 5-year history of recurrent rheumatic fever experiences dyspnea during exertion or emotional stress for the past 6 months, occasionally with nocturnal dyspnea. Multiple ECGs show sinus rhythm. No lower extremity edema has occurred. Which test is most clinically valuable for assessing valvular heart disease?
A 45-year-old male presents with a 2-year history of chest tightness and palpitations on exertion, with poor response to nitroglycerin. BP: 130/80 mmHg (17.3/10.7 kPa). Physical exam reveals cardiomegaly, normal IgE, heart rate 80 bpm with regular rhythm, audible S4 at the apex, and a systolic ejection murmur at the left 3rd-4th intercostal space. Lungs clear, abdomen unremarkable. Echocardiogram shows normal left ventricular cavity, septal thickness 1.5 cm, posterior wall thickness 1.0 cm, systolic anterior motion (SAM) of the mitral valve with septal contact, and outflow tract narrowing. The diagnosis is:
A 25-year-old male has experienced chest pain and episodic syncope over the past 3 years. Cardiac auscultation reveals a systolic murmur at the left sternal border (3rd-4th intercostal spaces), with mild cardiomegaly. Electrocardiogram (ECG) shows pathological Q waves in leads II, III, and aVF. The preliminary diagnosis is:
A 40-year-old male presents with progressive palpitations, shortness of breath, abdominal distension, and lower extremity edema over the past year. Physical exam: Generally well, cardiac dullness on percussion extends bilaterally, weakened apical impulse and S1, 3/6 systolic murmur at the apex, heart rate 100 bpm with regular rhythm, bilateral basal rales/crackles, jugular venous distension, liver palpable 4 cm below the costal margin, spleen not palpable, bilateral lower extremity edema (+), BP 130/90 mmHg. ECG shows complete right bundle branch block. The most likely diagnosis is:
A 20-year-old female had sore throat, runny nose, and cough 2 weeks ago, which improved with treatment for a cold. Over the past week, she developed palpitations and chest tightness, and experienced syncope 2 days ago, prompting hospitalization. Examination findings: BP 100/70 mmHg (13.3/9.3 kPa), heart rate 40 bpm, enlarged cardiac borders, 2/6 systolic murmur at the apex, no abnormal lung findings. ECG shows Qr pattern in leads II, III, aVF with ST-segment elevation of 0.1 mV, ventricular rate 40 bpm, atrioventricular dissociation (P waves and QRS complexes are unrelated, P wave rate > QRS rate). Lab results: CPK 400 U/L, CPK-MB 40 U/L. The most likely diagnosis is:
A 14-year-old male patient presents with palpitations and shortness of breath for 10 days. He had a history of fever and sore throat 3 weeks prior. Physical examination reveals leftward and downward cardiac enlargement, diminished heart sounds. Electrocardiogram (ECG) shows sinus tachycardia and frequent ventricular premature beats (VPBs). The most likely diagnosis is:
A 41-year-old female patient presents with palpitations, shortness of breath, and bilateral lower extremity edema for 4 months. Physical examination reveals cardiomegaly with bilateral cardiac border expansion, and a grade 3/6 harsh systolic blowing murmur at the apex. Echocardiogram (ECHO) shows generalized cardiac enlargement, predominantly left atrial and ventricular dilation, left ventricular wall thinning, and diffuse hypokinesis. The most likely diagnosis is:
A 68-year-old male was admitted with dyspnea, palpitations, right upper quadrant pain, and lower extremity edema for 2 weeks. He was diagnosed with dilated cardiomyopathy and heart failure (HF). After digitalis treatment during hospitalization, he developed digitalis toxicity. Besides discontinuing digitalis, which electrocardiogram (ECG) abnormality requires immediate intervention?
A 52-year-old male presents with paroxysmal palpitations for 6 months, occasional chest tightness, dyspnea when climbing 2 floors for 3 months, and lower extremity edema for 3 days. ECG shows sinus rhythm, heart rate 64 bpm, PR interval 0.24 sec with complete right bundle branch block. Diagnosed with dilated cardiomyopathy and HF. Treated with digitalis, diuretics, and vasodilators. On day 4, sudden loss of consciousness and convulsions occurred, with absent heart sounds and BP 0 kPa. After resuscitation, consciousness returned, heart rate was 45 bpm with frequent premature beats. The loss of consciousness and convulsions should be considered as:
A 56-year-old male diagnosed with ischemic cardiomyopathy, NYHA class IV heart failure, shows left ventricular dilation (EF 0.22) on echocardiogram (ECHO) and frequent ventricular premature contractions on electrocardiogram (ECG). Serum potassium (K) is 4.5 mmol/L and digoxin level is 1.1 ng/mL. The preferred antiarrhythmic drug for this case is:
A 65-year-old male with a history of hypertension for over 10 years and a past history of wheezing suddenly presented with unconsciousness and left-sided hemiplegia. BP was 200/120 mmHg, blood glucose 11.2 mmol/L, and blood cholesterol 7.8 mmol/L. Why should the blood pressure be reduced to the aforementioned level?
A 28-year-old male presents with precordial pain radiating to the left shoulder, exacerbated on inspiration and relieved by sitting upright, accompanied by fever, chills, BP 110/80 mmHg, heart rate 110/min (regular rhythm), and temperature 38.5°C. Other examinations are unremarkable. ECG shows ST-segment elevation (except in aVR). On day 3 of hospitalization, the patient develops hypotension, elevated venous pressure, distended neck veins, and shock. The most likely diagnosis is:
A 56-year-old woman with a history of breast cancer surgery 5 years ago, followed by 6 months of chemotherapy. Six months ago, left supraclavicular lymphadenopathy was noted. For the past 2 months, she has experienced chest tightness and shortness of breath. Laboratory tests show: Hb 109g/L, WBC 6×10<sup>9</sup>/L, erythrocyte sedimentation rate (ESR) 40mm/hr. Chest X-ray reveals a right lung mass shadow and cardiomegaly with bilateral enlargement and weakened cardiac pulsations. The simplest and most feasible diagnostic method is:
A 28-year-old male presents with severe chest pain and high fever (39°C) for 1.5 days. Two weeks prior, he had nasal congestion and rhinorrhea. Physical exam reveals slightly enlarged cardiac borders and pericardial friction rub. Chest X-ray (CXR) shows small pleural effusion on the left side. Echocardiogram (ECHO) demonstrates normal heart function with small-to-moderate pericardial effusion. The most likely diagnosis is:
A 22-year-old female presents with low-grade fever for 1 month, accompanied by palpitations, shortness of breath, and lower extremity edema for 1 week. Physical exam reveals BP 90/70 mmHg, jugular venous distension, bilateral cardiac enlargement, faint heart sounds, hepatomegaly (2 cm below costal margin), and bilateral lower extremity edema. Echocardiogram shows a 1.0 cm pericardial effusion, and X-ray reveals cardiomegaly. The most likely diagnosis is:
A 35-year-old male presents with chest tightness for the past 6 months, occasionally feeling a heavy pressure on the anterior chest. Over the past month, he reports dyspnea on exertion. Physical exam: Supine position shows prominent jugular vein distension, enlarged cardiac dullness, normal heart sounds, heart rate 98/min (regular), no murmurs. Lungs clear. Liver palpable 2 fingerbreadths below costal margin with positive hepatojugular reflux sign. Echocardiography reveals moderate pericardial effusion with normal chamber sizes. Pericardiocentesis yields 500ml of deep yellow fluid. Laboratory tests: Specific gravity >1.018, protein 45g/L (4.5g/dl), cell count 0.4×10<sup>9</sup>/L (400/μl) with 80% lymphocytes. The most likely diagnosis is:
A 46-year-old male with a history of hypertension suddenly experiences severe tearing chest pain radiating to the sternum and epigastrium, accompanied by profuse sweating, persisting for 1 hour without relief. Examination: BP 200/110 mmHg (26.7/14.7 kPa), HR 90 bpm, no abnormal cardiac findings, no abnormal lung findings, ECG shows left ventricular hypertrophy with 0.1 mV ST-segment depression in V4-V6. The most likely diagnosis is:
A 48-year-old woman with a history of hypertension suddenly experiences severe tearing chest pain radiating to the retrosternal and epigastric regions, accompanied by profuse sweating, lasting for 1 hour without relief. Physical examination: blood pressure 200/110 mmHg, heart rate 90 bpm, no cardiopulmonary abnormalities. Electrocardiogram (ECG) shows left ventricular hypertrophy with 0.1 mV ST-segment depression in V4-V6. The most likely diagnosis is:
A 60-year-old male with a 10-year history of hypertension (HTN), well-controlled BP, suddenly develops severe tearing chest pain upon waking, with loss of pulse in one arm. HR 110/min, regular rhythm, diastolic murmur over aortic area. Initial diagnosis is:
A 56-year-old female with a 6-year history of hypertension (HTN) suddenly experiences severe tearing chest pain for 1 hour without obvious cause, radiating to the back, accompanied by profuse sweating, anxiety, and pallor. The most likely diagnosis is:
A 32-year-old woman presents with palpitations and shortness of breath on exertion for over 3 years, inability to lie flat at night, and 1 hour of cough with pink frothy sputum. One week ago, she had fever, sore throat, cough, respiratory rate of 30/min, bilateral rales/crackles on lung auscultation, cardiomegaly, and a grade 2/6 systolic blowing murmur at the apex. The precipitating factor for this episode is:
A 35-year-old woman has had palpitations, shortness of breath, poor appetite, and edema for 5 years, with worsening symptoms after an upper respiratory infection 2 weeks ago. Examination: BP 120/70 mmHg, cardiomegaly, diastolic rumbling murmur at the apex, heart rate 120/min, irregular rhythm with varying heart sound intensity, jugular vein distension, bilateral basal crackles, liver 3 cm below the costal margin with tenderness (+), no splenomegaly, lower extremity edema (+), pulse rate 80/min. The irregular rhythm in this patient is:
A 35-year-old male presents with exertional dyspnea, palpitations, shortness of breath, oliguria, and lower extremity edema for over 1 year. Symptoms worsened 1 week ago after sore throat, cough with yellow sputum, and dyspnea at night (orthopnea). Echocardiogram shows dilation of both ventricles, diffuse hypokinesis, and left ventricular ejection fraction (LVEF) of 30%. He takes digoxin 0.25mg once daily with no significant past medical history. The most likely cause is:
A 35-year-old female with a 10-year history of rheumatic arthritis presents with 4 years of palpitations and shortness of breath on exertion, recently worsened and unable to lie flat at night. Physical exam reveals: diastolic rumbling murmur at the apex, fine crackles heard at the lung bases, abdominal distension, and bilateral lower extremity edema. The type of heart failure in this patient is:
A 35-year-old woman presents with intermittent chest tightness for 2 years, accompanied by recurrent episodes of blackouts. Over the past week, the frequency of blackouts has increased, with one episode of syncope. If diagnosed with sick sinus syndrome, what is the optimal treatment?
A 38-year-old woman with rheumatic heart disease (RHD), mitral valve disease, and long-standing atrial fibrillation takes digoxin 0.25mg daily for 12 days. Suddenly, her ventricular rhythm becomes regular at 50 bpm. The most likely cause of this ECG change is:
A 56-year-old male presents with dizziness and palpitations for one week, with occasional syncope. Past medical history includes hypertension (HTN) and coronary artery disease (CAD). Blood pressure (BP) is 105/60 mmHg, heart rate is 34 beats/min with irregular rhythm. Electrocardiogram (ECG) shows a PR interval of 0.22s with occasional dropped QRS complexes after P waves. The most effective treatment is:
A 62-year-old woman with a 4-year history of hypertension (HTN) and family history, repeatedly measured BP 190-196/110 mmHg (25.3/14.7 kPa), grade III retinopathy. The appropriate antihypertensive treatment approach is:
A 50-year-old male with a 5-year history of hypertension (HTN) recently missed his medications. Two hours ago, he developed severe headache, agitation, palpitations, hyperhidrosis, pallor, and blurred vision. His blood pressure (BP) was 230/130 mmHg. The primary cause of these clinical manifestations is:
A 54-year-old male presents with retrosternal pressure-like pain occurring daily during afternoon naps or at 1 AM for the past month, lasting 20 minutes each episode and relieved within 5 minutes by nitroglycerin. The clinical diagnosis is variant angina pectoris. The drug of choice is:
A 61-year-old male with coronary artery disease (CAD) and angina pectoris accompanied by left-sided heart failure (HF) was hospitalized. After digitalis administration, he developed frequent multifocal ventricular premature beats. Which medication is most appropriate for this condition?
A 60-year-old male with a history of myocardial infarction and recurrent irregular rhythm on atenolol therapy presents with recurrent precordial pain and syncope for 1 week. He has a 15-year history of hypertension (HTN). The most valuable diagnostic test is:
A 65-year-old male with 10-year history of coronary artery disease (CAD) experienced severe retrosternal pain 6 hours ago, described as crushing and radiating to the left arm. Took nitroglycerin 4 times with slight relief. Now presents with restlessness and sweating. Examination shows acute distress, temperature 36.5°C, BP 100/70 mmHg, pulse rate 110 bpm; normal cardiac size, regular rhythm, diminished heart sounds, no gallop or murmurs; few crackles in both lungs; liver/spleen not palpable. On day 3 of admission, sudden severe chest pain and orthopnea occurred. Echocardiography reveals significant mitral regurgitation. Which finding is most diagnostic on physical examination?
A 44-year-old male presented to the emergency department with severe retrosternal pain for 5 hours and was admitted with a diagnosis of hyperacute myocardial infarction (MI). Immediate coronary angiography revealed mid-segment obstruction of the left anterior descending coronary artery (LAD). The patient died suddenly 10 hours after admission. The most likely cause of death in this case is:
A 75-year-old male with angina pectoris lasting 4 hours, unresponsive to nitroglycerin. ECG shows 6mm ST-segment elevation in leads II, III, aVF and 4mm horizontal ST depression in V1-3, with occasional ventricular premature beats. Diagnosed with acute myocardial infarction (AMI), the patient develops restlessness, low blood pressure (BP), heart rate of 45 bpm, and third-degree atrioventricular block (AV block) with frequent atrial premature beats after 10 hours. What is the first-line treatment?
A patient with acute extensive anterior wall myocardial infarction (MI), with a history of intermittent atrial fibrillation for 8 years, is found to have a left ventricular mural thrombus on echocardiography before discharge. The thrombus attachment site shows outward expansion and paradoxical motion. The patient's treatment should NOT include
A patient with acute inferior wall myocardial infarction suddenly develops dyspnea, cold sweats, and inability to lie flat on day 5 of hospitalization. Physical examination reveals a grade 3/6 systolic murmur at the heart base. The most effective treatment should be:
A 68-year-old male with a 12-year history of coronary artery disease (CAD) and angina pectoris was admitted due to severe retrosternal pain lasting 8 hours after emotional agitation. No history of hypertension (HTN). On admission, blood pressure (BP) was 150/90 mmHg, diagnosed with acute inferior wall myocardial infarction. The patient developed sinus bradycardia with a heart rate of 40 bpm. The most appropriate therapeutic drug is:
A 62-year-old male presents with sudden severe retrosternal pain for 16 hours. ECG shows acute extensive anterior wall myocardial infarction (MI). One hour after admission, cardiac arrest occurs, with ECG revealing ventricular fibrillation. Apart from ventricular fibrillation, which of the following conditions may also be considered for electrical cardioversion?