A 58-year-old man presents to your office with progressive dyspnea over the last three months. Previously, he had been able to work in his farm and take care of his cows, but now he feels short of breath after walking only 50 feet. He does not have chest pain at rest but has experienced retrosternal chest pressure with strenuous work. His sleep is also not ‘peaceful’ because he wakes up at night feeling short of breath, which is relieved within minutes by sitting upright in bed. On physical examination, he is afebrile, with a heart rate of 88 beats per minute (bpm), blood pressure of 145/92 mm Hg, and respiratory rate of 18 breaths per minute. On cardiac examination, his heart rhythm is regular with a normal S1 and S2 with a systolic murmur loudest over the second right intercostal space. He also has elevated jugular venous pressure (JVP), pedal edema and bilateral crackles in lungs. Echocardiogram reveals an ejection fraction of 30% and aortic stenosis. Which of the following medications is shown to improve long-term survival in this patient?

A 72-year-old man comes to your office complaining of vision change, nausea, vomiting, and diarrhea. His past medical history is significant for gout, hypertension, diabetes, and congestive heart failure. He takes all his prescribed medications regularly. Upon further questioning, he informs you that, he also has a blurry vision and, his vision has a yellow hue to it. An electrocardiogram demonstrates bradycardia, a prolonged PR interval, a shortened QT interval, ST-segment scooping, and T-wave inversion. Of the following, what would be the most frequent electrolyte abnormality you would expect in this patient?

A 72-year-old man comes to your office complaining of vision change, nausea, vomiting, and diarrhea. His past medical history is significant for gout, hypertension, diabetes, and congestive heart failure. He takes all his prescribed medications regularly. Upon further questioning, he informs you that, he also has a blurry vision and, his vision has a yellow hue to it. An electrocardiogram demonstrates bradycardia, a prolonged PR interval, a shortened QT interval, ST-segment scooping, and T-wave inversion. Of the following, which is the most likely culprit causing distress to this patient?

A 74-year-old man presents to the emergency room complaining of shortness of breath. He has markedly reduced his ordinary activities because he is no longer able to perform them without losing his breath. He stopped going to Penn State football games because he is concerned about climbing stairs in the Beaver Stadium. Even simple things like taking a bath, wearing his clothes and cooking a meal make him distressful. However, he reports no symptoms at rest. He prefers to sit on his couch most of the time. What is his NYHA Functional Classification for heart failure?

Mr. Isaiah is a 74-year-old man who presents to the emergency department complaining of progressively worsening dyspnea when walking briskly and climbing stairs. His grand daughter reports that he has become increasingly fatigued over the last few days. He must rest several times while walking to the train station on his commute to work, whereas 6 months ago he could easily walk to the station without resting. He finds himself awakening frequently at night feeling ‘heaviness in the chest’. His past medical history is significant for myocardial infarction 5 years ago. On examination, he is overweight (BMI 34 kg/m2)), heart rate is 93 bpm, and blood pressure (BP) is 174/89 mm Hg. Physical examination is significant for a 2/6 systolic murmur at the apex without gallop.You ordered some diagnostic tests. Patient’s ECG shows left ventricular hypertrophy and left atrial enlargement. Echocardiogram shows left ventricular systolic dysfunction with ejection fraction of 35% with global hypokinesis. There is concentric left ventricular hypertrophy (LVH) and mitral annular dilatation with mitral regurgitation. Which of the following is true concerning this disorder?

Mr. K is a 74-year-old man who presents to the emergency department complaining of progressively worsening dyspnea when walking briskly and climbing stairs. His grand daughter reports that he has become increasingly fatigued over the last few days. He must rest several times while walking to the train station on his commute to work, whereas 6 months ago he could easily walk to the station without resting. He finds himself awakening frequently at night feeling ‘heaviness in the chest’. His past medical history is significant for myocardial infarction 5 years ago. On examination, he is overweight (BMI 34 kg/m2)), heart rate is 93 bpm, and blood pressure (BP) is 174/89 mm Hg. Physical examination is significant for a 2/6 systolic murmur at the apex without gallop.You ordered some diagnostic tests. Patient’s ECG shows left ventricular hypertrophy and left atrial enlargement. Echocardiogram shows left ventricular systolic dysfunction with ejection fraction of 35% with global hypokinesis. There is concentric left ventricular hypertrophy (LVH) and mitral annular dilatation with mitral regurgitation. As you discuss the diagnosis with the patient, the patient’s granddaughter, who is a major in Biochemistry, asks you to explain the natural history of this disorder. Which of the following is true concerning the development of this disorder?

A 74-year-old male presents to the cardiology clinic reporting lightheadedness, near fainting, fatigue, chest discomfort, and shortness of breath. He had a medical history of myocardial infarction a month ago, treated with right coronary artery stenting in a local hospital. His current symptoms started two days after his discharge from the hospital. His temperature is 99 °F (37.2 °C), heart rate is 36 beats/min, blood pressure is 88/58 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 92% on room air. A cardiac event monitor, which the patient carries with him, has been showing consistent bradycardia with an average heart rate of 36 beats per minute. Of the following, which is most likely to treat his symptoms for long-term management?