One of your patients who has a family history of Marfan's syndrome has recently been diagnosed with the condition.
What is the most important investigation to monitor their condition?
Correct Answer B: Marfan's syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the fibrillin-1 gene on chromosome 15 and affects around 1 in 3,000 people.
Marfan's syndrome Features:
The life expectancy of patients used to be around 40-50 years. With the advent of regular Echocardiography monitoring and beta-blocker/ACE-inhibitor therapy this has improved significantly over recent years. Aortic dissection and other cardiovascular problems remain the leading cause of death however.
An elderly man with aortic stenosis is assessed. Which one of the following would make the ejection systolic murmur quieter?
Correct Answer A: Left ventricular systolic dysfunction will result in a decreased flow-rate across the aortic valve and hence a quieter murmur.
Features of severe aortic stenosis:
Causes of aortic stenosis:
Management:
An 82-year-old man is referred to cardiology by his GP with increasing dyspnoea or exertion and a systolic murmur. Examination demonstrates a blood pressure of 100/80 mmHg and a slow rising pulse.
What is the most likely cause of his underlying condition?
Correct Answer D:
Aortic stenosis - most common cause:
This patient has aortic stenosis.
You are called to the coronary care unit. A patient who has been admitted following a myocardial infarction has developed a broad complex tachycardia. You suspect a diagnosis of polymorphic ventricular tachycardia.
Which one of the following factors is most likely to have precipitated this?
Correct Answer C: Hypokalemia is the most important cause of ventricular tachycardia (VT) clinically, followed by hypomagnesaemia. Severe hyperkalaemia may cause VT in certain circumstances, for example in patients with structural heart disease, but it is not as common a cause as hypomagnesaemia.
Ventricular tachycardia (VT)is broad-complex tachycardia originating from a ventricular ectopic focus. It has the potential to precipitate ventricular fibrillation and hence requires urgent treatment.
There are two main types of VT:
Causes of a prolonged QT interval:
Which one of the following features would best indicate severe aortic stenosis?
Aortic stenosis:
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