Cairo University – Faculty of Medicine

Master Degree In

Cardiovascular Diseases

 May,  2004. Paper II.

Answer all questions

Time: 3 hours

(1) A 54 years old female complaining of dyspnea grade 2/4 (NYHA), easy fatigability and swelling of the lower limbs since one year. She had a long standing history of rheumatic heart disease and was subjected to balloon mitral valvuloplasty a year ago. She is receiving digoxin, lasix 40 mmHg. She experience marked easy fatigability and dizziness on increasing the dose of lasix. The relevant physical signs were; AF pulse with 116 BPM, BP 95/70 mmHg, JVP to the angle of the mandible, lower limb edema to both knees, moderately enlarged liver and moderate ascites. The lungs were relatively clear. Cardiac examination revealed RVH, diastolic shock and grade 2/4 systolic murmur over the lower sternal edge and apex. Echocardiography showed; mitral valve disease with an echo score of 10-11/16. MVA of 1.3 cm2 (planimetry) and 1.7 cm2 (pressure half time), mean diastolic gradient of 7 mmHg. Mitral regurgitation jet to mid LA. The LA diameter in M-mode was 6.2 cm. Normal LV dimension and contractility, mildly thickened aortic valve with a small opening. The right heart side was markedly dilated and the tricuspid valve was mildly thickened with moderate incompetence. The estimated pulmonary artery systolic pressure was 68 mmHg.

A- Possible causes of deterioration of the condition.

(5 marks)

B- Discrepancy of MVA measurements.

(5 marks)

C- Investigations and management of this case.

(5 marks)
 

(2) Discuss how to assess malfunctioning implanted cardiac pacemaker.

(20 marks)

(3) Outline the clinical presentation and diagnosis of Kawasaki disease.

(15 marks)

(4) Discuss the predictors of increased morbidity and mortality in:
A- Dilated cardiomyopathy.

(20 marks)

B- Adults late after repair of TOF.

(15 marks)

C- Sclerotic aortic stenosis.

(15 marks)

Good Luck.