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Cairo University Faculty of Medicine
Master Degree
In
Cardiovascular Diseases
May, 2003.
Paper II.
Answer all questions
Time: 3 hours
1) Discuss the aetiology,
electrocardiographic findings and differential diagnosis in patients presenting
with acute chest pain and ST segment deviation in precordial leads V1 , V2 .
(30 marks)
2) Give the definition, cardiovascular significance and management (when
applicable) of each of the following :
a- Bradycardia-tachycardia syndrome.
(15 marks)
b- HDL-cholestrol.
(10 marks)
c- Drug-eluting
stents.
(10 marks)
d- Laplace law.
(10 marks)
3) A 52 year old male
patient presented with a recent history of gradually progressive shortness of
breath, easy fatigue and leg oedema. Other symptoms included hoarseness of voice
and constipation. Examination showed an increased jugular venous pressure of 8
cm, sinus rhythm with frequent premature beats, blood pressure 140/96 mmHg,
periorbital oedema and bilateral ankle oedema. The liver was enlarged 2 fingers,
the chest showed bilateral crepitations and wheezes and an S3 gallop was heard
over the apex.
Chest radiography
showed cardiomegaly, left ventricular enlargement, dilated main pulmonary artery
and upper lobe vessels and interstitial pulmonary oedema. The ECG is provided;
ECG (1) July 2002. Echocardiography showed in (cm) LV end-diastolic diameter
7.2, LV end-systolic diameter 6.5, septum 0.8, posterior wall 1.1, left atrium
4.5, right ventricle 1.9, and fractional shortening 9%. There was severe
impairment of global left ventricular systolic function but no segmental wall
motion abnormalities. Cardiac valves were normal. A mild pericardial effusion
was detected.
Laboratory
investigations showed normal blood picture, blood glucose, urine analysis as
well as liver and renal function tests. However TSH was markedly elevated at 101
µIU/ml.
The patient received medical treatment,
for 5 months. At follow-up there was a significant clinical improvement and the
patient had lost 6 Kg of weight. The chest radiograph showed regression of heart
size to normal and complete clearing of lung fields. The ECG is provided; ECG
(2) December 2002. Echocardiography showed (cm) LVEDD 5.9, LVESD 4.2, left
atrium 3.4, fractional shortening 28.8%. No pericardial effusion.
a- Discuss the pathogenesis and management of
congestive heart failure in this case.
(10 marks)
b- Explain the
difference in electrocardiographic findings in ECG (1) and (2).
(5 marks)
c- Enumerate the causes
of reversible congestive heart failure. Indicate the mechanisms of
reversibility.
(10 marks)
Good Luck.
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