Module Cardio-MI

A 66-year-old man with chronic kidney disease (CKD) is referred for office evaluation after a recent admission for an acute coronary syndrome. Which of the following statements is TRUE concerning chronic kidney disease (CKD) and cardiovascular disease?

An 80-year-old woman is admitted with acute pulmonary edema on a background of progressive shortness of breath with exertional chest pain for 6 months. She has a history of renal impairment with an eGFR of 40 mL/min. She is initially commenced on IV furosemide with good effect. An echocardiogram reveals LVEF 40% with severe aortic stenosis (AS) with an estimated valve area of 0.7 cm2. What would you do next?

You get a phone call from the heart failure nurse specialist regarding a patient followed up in clinic for titration of medication. He has dilated cardiomyopathy with an EF of 30%. His most recent BP is 110/60 mmHg with heart rate 60 bpm. He is currently on bisoprolol 7.5 mg od and ramipril 5 mg od. His renal function test results have been phoned through to the specialist nurse: Na 136 mmol/L, K 5.5 mmol/L, urea 13 mmol/L, creatinine 270 μmol/L. (Baseline before titration of ACE inhibitor: Na 138 mmol/L, K 4.8 mmol/L, urea 8 mmol/L, creatinine 180 μmol/L.) What would be your advice?

A 57-year-old woman with known heart failure and EF 42% is reviewed in clinic. She is breathless on walking up one flight of stairs or half a mile on the flat. On examination, her BP is 130/90 mmHg and her heart rate is 75 bpm (SR, ECG QRS < 120 ms). Her chest is clear to auscultation. There are no signs of fluid overload. Her current medication is carvedilol 25 mg bd, furosemide 40 mg od, and digoxin 62.5 micrograms od. Her recent renal function tests are Na 141 mmol/L, K 5.1 mmol/L, urea 13.5 mmol/L, and creatinine 236 μmol/L. She has not previously tolerated an ACE inhibitor or spironolactone because of deteriorating renal function and hyperkalemia. What would you do next?

A 65-year-old hypertensive non-diabetic has an eGFR < 40. Screening tests showed microalbuminuria and a normal renal ultrasound. Which class of antihypertensive medication should you start?

A 52 year-old woman has been treated for several years with amlodipine and lisinopril for what has been presumed to be primary hypertension. She is seen by her GP having complained of persistent left loin pain. Her BP is 150/95 mmHg. She is tender in the left loin and both kidneys appear to be enlarged. On urine dipstick testing, there is microscopic haematuria. Which of the following is likely to be the most appropriate investigation at this point?

A 65-year-old diabetic with a creatinine of 1.6 was started on an angiotensin converting enzyme inhibitor for hypertension and presents to the emergency room with weakness. His other medications include a statin for hypercholesterolemia, a beta blocker and spironolactone for congestive heart failure, insulin for diabetes, and aspirin. Laboratory examinations include: K: 7.2 meq/L, Creatinine: 1.8, Glucose: 400 mg/dL, CPK: 400 IU/L. If this patient has a widened QRS on ECG, the first drug given is

An 80-year-old man presents with dyspnea and is found to have CHF caused by systolic dysfunction. He also has mild renal insufficiency, with a creatinine level of 1.4. Which of the following statements is true regarding ACE inhibitor therapy in this patient?

An 82-year-old woman with HTN and chronic renal failure (serum creatinine 3.5 mg/dL) is referred to you for the management of PAF. She has no other risk factors for coronary atherosclerosis and has wellpreserved ventricular function. Her ECG is essentially normal, with a QTcinterval of 400 msec. Which of the following drugs will be suitable for her rhythm management?

A patient with renal failure (creatinine, 3.4 mg/dL) and thrombocytopenia (platelet count, 35,000mm3) presents to you with a pericardial effusion. He is hemodynamically stable. You are concerned about a paracardiac malignancy and would like to characterize the pericardial effusion further. What would be the best method of evaluating this possibility?

1. An 80-year-old woman is admitted with acute pulmonary edema on a background of progressive shortness of breath with exertional chest pain for 6 months. She has a history of renal impairment with​​ an eGFR of 40 mL/min. She is initially commenced on IVfurosemide with good effect. An echocardiogram reveals LVEF 40% with severe aortic stenosis (AS) with an estimated valve area of 0.7 cm2. What would you do next?