|
Cairo University – Faculty of Medicine
Cardiology Department
Examination of the
Master Degree
in
Cardiovascular
Diseases
Basic Cardiology
May, 2001.
Answer all questions
Time: 3 hours
1)
Outline the risk profile and risk management of hypertrophic cardiomyopathy.
(20
marks)
2)
Give the definition and clinical significance of each of the following:
a-
Hypertriglyceridemia.
(15
marks)
b-
Gallop rhythm.
(10
marks)
c-
Serum troponins.
(10
marks)
d-
Proarrhythmia.
(10
marks)
e-
Diuretic
resistance.
(10
marks)
3)
A
52
year old male patient sought medical advice because of recurrent attacks of
retrosternal chest pain, shortness of breath, insomnia and loss of weight over
the past
2
months. The patient did not smoke and there was no history of diabetes.
The chest pain occurred at
rest, during effort, and sometimes woke hip up from sleep. Examination revealed
a restless anxious patient, normal jugular venous pressure, blood pressure
156/96
mmHg, and S4
gallop over the apex. ECG showed sinus tachycardia and nonspecific T wave
changes. The chest X-ray and echocardiogram were normal. Routine blood tests
were normal apart from elevation of the serum cholesterol.
The exercise test was positive
for chest pain and
2
mm ST segment depression in stage II. Coronary angiography showed single vessel
disease as
70%
proximal stenosis in the circumflex artery. The patient was discharged on
atenolol
50
mg, ramipril
2.5
mg, simvastatin
20
mg, aspirin
150
mg, and clopidogrel
75
mg for one month.
In the follow-up visits the
patient continued to complain of shortness of breath, easy fatigue and atypical
chest pain. He noticed that he was unable to climb the stairs because of leg
weakness. In the last visit his temperature was
37ºC
and the blood pressure was well controlled. The patient was anxious and
exhausted because of lack of sound sleep. He was disappointed because his effort
tolerance did not improve after coronary artery stenting.
a-
How would you proceed to investigate this case.
(10
marks)
b-
Discuss the diagnosis and differential diagnosis.
(15
marks)
|
