A 60-year-old female patient with previous lymphoma has been referred to cardiology clinic with breathlessness. She has previously received mediastinal radiotherapy.
Which one of the following is unlikely to be a cardiac cause of her symptoms?
Left-sided valve lesions are much more common than pulmonary or tricuspid valve involvement in post-radiotherapy patients. The reasons for this are unclear. Coronary Heart failure | answers 63 disease is a risk due to intimal proliferation and accelerated atherosclerosis, even in the absence of traditional risk factors. Sick sinus syndrome and even complete heart block due to fibrosis have been seen. Constrictive pericarditis is a long-term sequela of radiation therapy and presents with signs of right heart failure. The treatment is pericardectomy.
A 52-year-old patient presents with breathlessness. He has had hypertension for many years but has been non-compliant with his medication. His echocardiogram demonstrates an EF of 70%, with marked concentric hypertrophy.
Which one of the following therapies is not appropriate?
The treatment for patients with hypertensive heart disease is adequate blood pressure control. However, not all agents are effective. ACE inhibitors and ARBs are the most effective, with calcium antagonists able to reduce LV mass. Atenolol is associated with a higher mortality because of its inability to prevent ventricular fibrillation.
A 42-year-old Caucasian woman presents to the outpatient clinic when she is 10 weeks pregnant. This is her second pregnancy and was unplanned. Her first pregnancy was complicated by peripartum cardiomyopathy with moderate impairment of left ventricular systolic function. However, she did have complete resolution of systolic function 6 months after the birth of her first child.
Which one of the following statements is true?
Patients with previous peripartum cardiomyopathy with complete resolution of LV function have a low mortality risk in subsequent pregnancies. The risk of re-developing the cardiomyopathy is higher, with 20% presenting with heart failure with a reduction in the likelihood of resolution of LV function. ACE inhibitors are contraindicated in the first trimester of pregnancy. Examination findings in preganancy can be very misleading as systolic murmurs, third heart sound, and ankle oedema can be detected in normal pregnancy.
A 50-year-old white female nonsmoker without history of cardiovascular disease (CVD) and treated only with ramipril for hypertension was hospitalized for UA. The ECG revealed T inversion in the lateral leads. The medical student who admitted the patient asks you what is the proportion of patients that undergo coronary angiography for ACS who have nonsignificant CAD.
20% to 30%. A proportion of patients who present with suspected ACS are found to have insignificant CAD during coronary angiography. Of the 5,767 patients with non-ST-segment-elevation ACS who were enrolled in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin (Eptifibatide) Therapy (PURSUIT) trial and who underwent inhospital angiography, 88% had significant CAD (any stenosis >50%), 6% had mild CAD (any stenosis >0% to ≤50%), and 6% had no CAD (no stenosis identified). Overall, 12% of the patients had nonsignificant CAD. Patients with nonsignificant CAD were more likely to be women, nonwhite, younger, nondiabetic, nonhypercholesterolemic, without history of CVD, without ST-segment changes, but with more T-wave inversion compared with patients with significant CAD. Based on the profile of the patient admitted, her probability of having nonsignificant CAD is >12%.
Your patient is a 50-year-old woman with nonischemic cardiomyopathy who just received an orthotopic heart transplant.
Which of the following is NOT important to help prevent transplant vasculopathy?
Use of rapamycin as part of the immunosuppressive regimen. Transplant vasculopathy is a possible complication after transplant that is best to be avoided. The recommended intervention is to control cardiovascular risk factors and start every patient on a statin. Once there is vasculopathy, proliferation signal inhibitors (PSIs) such as sirolimus and everolimus can be used (substituted for mycophenolate mofetil or azathioprine).
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