Cairo University – Faculty of Medicine

Cardiovascular Diploma.

November,  2002. Part II, Paper 2.

Answer all questions

Time: 3 hours

(1) A 65 year old male patient complaining of dyspnea grade 2-3/4 (NYHA), which was progressive in the last 6 months. He had a history of two myocarial infarction attacks in the past 8 years and cerebral stroke with residual left hemiparesis 3 years ago. In the last year his BP was constantly elevated (170-240/100-130 mmHg), in spite of treatment.
Abnormal lab; urine: microhematuria, urea 98 mg/dl, creatinine 2.6 mg/dl, Cholesterol 290 mg/dl, TG 320 mg/dl, LDL 160 mg/dl and HDL 32 mg/dl.
He received ACE inhibitor, diuretics, long acting nitrates, asprin and statins. The heart failure manifestation improved without significant reduction of his BP.
 

- Discuss the differential diagnosis, investigations and management of this patient.

(40 mark).

(2) Outline the recent trends in the treatment of hypertrophic obstructive cardiomyopathy.

(20 mark).

(3) Discuss the possible causes, clinical presentation and management of acute mitral incompetence.

(40 mark).

Good Luck.