Cairo University – Faculty of Medicine

Master Degree In

Cardiovascular Diseases

November,  2002. Paper II.

Answer all questions

Time: 3 hours

1) Discuss the aetiology, clinical presentation and management of acute mitral regurgitation.

(25 marks)

2) Discuss the diagnosis and management of each of the following:
    a- Resistant hypertension.

(15 marks)

    b- Thrombus-containing lesions in acute coronary interventions.

(15 marks)

3) Outline the management of the following post-operative complicatiosn after coronary artery bypass graft sugery.
    a- Atrial fibrillation.

(10 marks)

    b- Early post-operative hypertension.

(5 marks)

    c- Post-cardiotomy syndrome.

(5 marks)

4) A 52 year old business man collapsed in a hospital while visiting a friend. He was found unconscious, cyanosed and pulseless. Cardiopulmonary resuscitation was immediately performed by a trained physician who transferred the patient to the CCU. The monitor showed ventricular tachycardia which was converted to sinus rhythm by D/C shock. Following resuscitation the patient was fully alert and free from symptoms. Examination showed normal findings except for obesity and S4 gallop over the apex. The blood pressure was 140/90 mmHg. The patient gave a history of hypertension and hypercholesterolemia for which he received irregular treatment in the form of diuretics and lipid-lowering therapy.
The ECG showed left anterior hemiblock and nonspecific T wave changes. The chest x-ray and echocardiogram were normal. Serum potassium was 3.1 mg/dL. Blood picture, renal and liver function tests were normal. Serial measurements of serum troponin and CK-MB were normal.
    a- What treatment would you prescribe for this patient on admission to the CCU.

(10 marks)

    b- Discuss the diagnosis and further investigations of this case.

(15 marks)

Good Luck.