A 34 year-old male comes to your primary care clinic for a physical examination before he undergoes a dental procedure. He has a history of calcified aortic stenosis. He denies any alcoholism, cigarette smoking or drug use. He asks you whether he needs antibiotic prophylaxis for endocarditis as he goes for this dental procedure. What would be the best recommendation to this patient?
A 68-year-old man presents to the clinic complaining of worsening exertional dyspnea. He feels short of breath even after walking with his dog more than a couple of blocks from his home. He does not have chest pain at rest but has experienced retrosternal chest pressure with strenuous exertion. He admits that he passed out a week ago for unclear reasons. He wakes up at night feeling short of breath. He denies any significant medical history. He has not seen a doctor in 25 years. On physical examination, he is afebrile, with a heart rate of 88 beats per minute (bpm), blood pressure of 140/95 mm Hg, and respiratory rate of 18 breaths per minute. Examination of the head and neck reveals distended neck veins. On cardiac examination, you detect a soft S2 and a coarse, late-peaking crescendo-decrescendo, systolic ejection murmur heard best at the aortic area of the heart. You suspected a cardiac disorder in this patient. Which of the following is the best initial diagnostic modality to confirm the diagnosis?
A 64-year-old woman presents to the emergency room complaining of shortness of breath, fatigue, palpitations and chest pain. She is not able to lie down on her bed because it makes her shortness of breath worse. On physical examination, you note that she has a holosystolic, high-pitched, blowing murmur with a midsystolic click heard best at the apex with radiation to the axilla. When you used some bedside maneuvers, the murmur decreased in intensity with Valsalva and standing and increased in intensity with handgrip. Which of the following is the most likely diagnosis in this patient?
A 24-year-old man presents to the emergency room with acute chest pain and a nonproductive cough for the last 3 days. The chest pain increases with inspiration, ‘it is always there’, it is ‘bearable’ and sometimes moves to his neck and back. In review of systems, he reports that the chest pain gets worse with lying flat and improves by sitting up. His medical history is significant for Covid-19 infection ten days ago. He attends a local university and is a member of the athletic team. His temperature is 101 ⁰ F, heart rate is 62 beats per minute, respiratory rate is 12 breaths per minute, and blood pressure is 110/80 mm Hg. Physical examination is significant for a friction rub. No lymphadenopathy, no skin rashes, no oral abnormalities noted. ECG reveals diffuse upsloping ST segment elevation and PR segment elevation in lead aVR and PR segment depression in other leads.No pathologic Q waves or reciprocal changes are present .Laboratory tests reveal elevated troponin and C reactive protein. Chest x-ray is normal. Echocardiogram is normal. Which of the following is the most likely diagnosis in this patient?
A 38-year-old male comes to the emergency room complaining of shortness of breath on exertion for a few weeks. His medical history is significant for malignant melanoma. Physical examination is significant for dyspnea, jugular venous distention, pericardial friction rub,muffled cardiac tones, and hypotension. ECG shows low-voltage electrical waves. You suspected pericardial tamponade in this patient. Which of the following is the definitive treatment for this patient?
Of the following which is the most convenient modality to diagnose and confirm the presence of pericardial tamponade?
A 38-year-old male comes to the emergency room complaining of shortness of breath on exertion for a few weeks. His medical history is significant for malignant melanoma. Physical examination is significant for dyspnea, jugular venous distention, pericardial friction rub,muffled cardiac tones, and hypotension. ECG shows low-voltage electrical waves. You suspected pericardial tamponade in this patient and wanted to do measure pulsus paradoxus. How do you measure pulsus paradoxus in this patient?
A 38-year-old male comes to the emergency room complaining of shortness of breath on exertion for a few weeks. His medical history is significant for malignant melanoma. Physical examination is significant for dyspnea, jugular venous distention, pericardial friction rub,muffled cardiac tones, and hypotension. ECG shows low-voltage electrical waves. You suspected pericardial tamponade in this patient and wanted to do a bed-side maneuver to establish the diagnosis. Of the following, the measurement of which would help you in reaching the correct diagnosis in this patient?
