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Cairo University – Faculty of Medicine
Master Degree
In
Cardiovascular Diseases
November, 2004.
Paper II.
Answer all questions
Time: 3 hours
(1)
Give a concise account on cardiac involvement in systemic
malignant disease.
(25 marks)
(2)
Describe the value of ECG in localization of the site of coronary artery
occlusion in a first attack acute myocardial infarction.
(25 marks)
(3)
Discuss the management of asymptomatic child discovered by echocardiography to
have corrected transposition of the great vessels.
(25 marks)
(4)
An 81 year old female patient was referred because of slow heart rate, easy
fatigue, a tendency to sleep, dizziness and headache. She had hypertension for
several years but there was no history of diabetes. She was admitted to hospital
9 months ago complaining of excessive somnolence, vomiting and epigastric pain.
The ECG recorded during that admission is provided,
Click here for ECG (1) . She received treatment and
remained in hospital for one week.
She also
developed an episode of confusion, disorientation, loss of speech and weakness
of the right upper and lower limbs 7 months ago. However, she improved on
treatment and resumed normal ambulation.
On
examination, the patient was alert, the pulse was 40 beats/minute regular, the
jugular venous pulsations showed frequent cannon waves, blood pressure was
150/90 mmHg. The right posterior tibial and dorsalis pedis pulses were absent.
The chest was clear, abdomen free. Neurological examination was normal except
for an equivocal extensor planter reflex on the right side.
Cardiac
examination showed normal S1 and S2 and a short ejection systolic murmur at the
base. A tracing from Holter monitor (Click here for tracing
2) is provided.
The
echocardiogram showed (in cm) LVEDD 4.9, LVESD 2.8, S 0.76, PW 0.98, LA 4.5, Ao
3.2, RV 2.0.
The left
ventricle showed hypokinesia of the basal inferior wall, akinesia of the apex
and a normal ejection fraction. There was mild mitral regurgitation, but no
other abnormal findings.
The blood
picture was normal, serum creatinine 1.2 mg/dl, total serum cholesterol
226, HDL 55, LDL 151, Triglycerides 101 mg/dl.
On the
second day of hospitalization the patient developed an attack of epigastric
pain, vomiting, sweating and shortness of breath. An ECG was recorded,
Click here for ECG (3).
a) Discuss the investigations and diagnosis of this
case.
(15 marks)
b) Outline the management of this patient.
(10 marks)
Good Luck.
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