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Category: Critical Care Medicine-Cardiovascular Disorders--->Valvular Heart Disease
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Question 1#Print Question

An 86-year-old female presents with lower gastrointestinal hemorrhage requiring massive transfusion. The bleeding subsides without additional intervention; however, persistent hypotension is encountered. Coagulation studies are normal except for a slightly prolonged activated partial thromboplastin time (aPTT). Echocardiography from 6 months ago demonstrates peak/mean aortic valve gradient of 80/40 mm Hg, with an estimated aortic valve area of 0.8 cm2 and reduced left ventricular function.

Which coagulation abnormality should be expected?

A. Disseminated intravascular coagulation
B. Willebrand disease
C. Vitamin K deficiency
D. Hemophilia A


Question 2#Print Question

A 68-year-old female with severe chronic obstructive pulmonary disease experienced a syncopal event while climbing the stairs at home. She presented to the emergency department with multiple rib and upper extremity fractures as well as a displaced hip fracture. Following an urgent hip fracture repair, she arrives to the ICU intubated and sedated. On physical examination, she has a laterally displaced point of maximal impulse with a systolic murmur heard best at the left sternal border.

Which transthoracic echocardiographic view would best aid in diagnosis and grading of severity?

A. Apical 4-chamber
B. Suprasternal
C. Apical 3-chamber
D. Parasternal basal short axis


Question 3#Print Question

A 46-year-old female with a history of hepatitis C and intravenous drug abuse presents to the emergency department with fevers, rigors, confusion, and acute shortness of breath.

The vital signs are as follows:

  • heart rate 105 bpm
  • blood pressure 120/70 mm Hg
  • temperature 39.4 C
  • arterial saturation 85%

Chest radiograph shows diffuse pulmonary edema. Echocardiography demonstrates a vegetation on the noncoronary cusp of the aortic valve with severe aortic regurgitation. Although awaiting surgery, the patient is admitted to the cardiology ICU.

Which intervention in the most appropriate next step?

A. Nitroprusside
B. Epinephrine
C. Norepinephrine
D. Furosemide


Question 4#Print Question

A 78-year-old male presents to the ICU with chest pain, shortness of breath, and respiratory distress requiring urgent intubation. The chest radiograph shows diffuse pulmonary edema, worse in the lower lung lobes.

His vital signs are as follows:

  • heart rate 114 bpm
  • blood pressure 90/50 mm Hg
  • pulse oxymetry 87%

The patient’s electrocardiogram demonstrates ST-segment elevation in lead II, III, and aVF with reciprocal changes in leads I and aVL. On physical examination, he has a systolic murmur, bilateral crackles on lung auscultation, and cold and clammy extremities. Cardiac enzymes are pending.

What interventions should be considered?

 

A. Intra-aortic balloon pump
B. Norepinephrine
C. Inhalational epoprostenol
D. Milrinone


Question 5#Print Question

A 46-year-old female with a history of hypertension, intracranial arteriovenous malformation, and previous mechanical mitral valve replacement is admitted to cardiology ICU with new onset of atrial fibrillation, shortness of breath, tachypnea, and crackles at both lung bases on auscultation.

The patient has:

  • a heart rate of 137 bpm
  • blood pressure of 87/66 mm Hg
  • cold and clammy extremities
  • urine output of 10 mL/h
  • potassium of 5.6 mmol/L

International normalized ratio (INR) is 1.8. Transesophageal echocardiography demonstrates the following image of the bioprosthetic mitral valve (red arrows) in the midesophageal two-chamber view. The mean transmitral gradient was measured 12 mm Hg with continuous wave Doppler.

What is the next step in management?

A. Heparin infusion and nitroglycerin infusion for afterload reduction
B. Heparin infusion and thrombolytic therapy
C. Heparin infusion and urgent mitral valve replacement
D. Heparin infusion and metoprolol for rate control and improved flow through the stenotic mitral valve




Category: Critical Care Medicine-Cardiovascular Disorders--->Valvular Heart Disease
Page: 1 of 2