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Cardiovascular Diseases
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An 82-years-old retired solicitor presents to the ED with chest pain radiating to his jaw. He has hypertension treated with ramipril 5 mg bid (ACE inhibitor) but is otherwise normally fit and well. His admission ECG shows sinus rhythm with ventricular rate of 57 bpm, LV hypertension, and widespread ST segment depression. His peak troponin is 110 ng/l (normal <30 ng/l). He is started on treatment for an acute coronary syndrome and listed for an inpatient angiogram. You are asked to perform bedside echocardiogram as a systolic murmur is heard on the post-take ward round. His aortic valve is heavy calcified, maximal trans-aortic jet velocity is 4.3 m/s, peak trans-aortic gradient is 75 mmHg, mean trans-aortic gradient is 46 mmHg (Figure below). What is the next appropriate step in the management of the above-described patient?
Please name the type of aortic dissection shown below:
An 80-year-old woman is admitted with acute pulmonary oedema on a background of progressive shortness of breath with exertional chest pain for 6 months. She has a history of renal impairment with a eGFR of 40 ml/min. She is initially commenced on IV furosemide with good effect. An echocardiogram reveals LVEF 40% with severe aortic stenosis (AS) with an estimated valve area of 0.7 cm2. She is on sinus rhythm, 90 bpm. What would you do next?
Please identify the correct diagnosis based on images below a) chest x-ray (left) and b) computed tomography image (right).
Three main symptoms in patients with severe symptomatic aortic stenosis are presented below. Which symptom heralds the worst prognosis with median survival of two years?
Please identify the correct diagnosis based on images below a) chest x-ray (left) and b) computed tomography image (right).
An 82-years-old retired solicitor presents to the ED with chest pain radiating to his jaw. He has hypertension treated with ramipril 5 mg bid (ACE inhibitor) but is otherwise normally fit and well. His admission ECG shows sinus rhythm with ventricular rate of 57 bpm, LV hypertension, and widespread ST segment depression. His peak troponin is 110 ng/l (normal <30 ng/l). He is started on treatment for an acute coronary syndrome and listed for an inpatient angiogram. You are asked to perform bedside echocardiogram as a systolic murmur is heard on the post-take ward round. His aortic valve is heavy calcified, maximal trans-aortic jet velocity is 4.3 m/s, peak trans-aortic gradient is 75 mmHg, mean trans-aortic gradient is 46 mmHg (Figure below).