Adult Cardiac 4

A 61-year-old woman with a past medical history of hypertension, myocardial infection, chronic kidney disease, sarcoidosis, and hypothyroidism is seen in the emergency department for a two-day history of chest pain and dyspnea on exertion. Initial cardiac work-up does not reveal a troponinemia or ischemic ECG findings. A CBC shows a Hgb of 12.2, WBC of 11,000, and a platelet count of 337,000 and her chemistry panel shows a potassium of 3.7, BUN of 88, and creatinine of 3.2. Echocardiogram demonstrates a large, circumferential pericardial effusion. Which of the following represents the most likely etiology of her pericardial effusion?

A 64-year-old male with a past medical history of COPD is seen for a three-week history of dyspnea, cough, and leg-swelling. On physical exam, you note jugular vein distension (JVD) and 3+ pitting edema of the lower extremities. Cardiac findings include a regular rate and rhythm, no murmurs, and a loud, high-pitched sound in early diastole. Which of the following represents the most likely diagnosis?

Beck’s triad consists of hypotension, muffled heart sounds, and:

A 63-year-old woman with a past medical history of mediastinal lymphoma treated radiation has now developed constrictive pericarditis. After a thorough work-up, you proceed with a pericardiectomy. Following the sternotomy, you note several suspicious lesions on the pericardium. Which of the following represents the best next step?

A 72-year-old male with a past medical history of COPD, coronary artery disease, and chronic kidney disease presents to the emergency department with a two-week history of dyspnea, fatigue, and lower-extremity edema. His work-up reveals a 7.8 cm lung mass that is highly suspicious for malignancy along with an adrenal mass and a large mass in the right ventricle. There is also a large pericardial effusion. Echocardiogram confirms a loculated pericardial effusion and reveals moderate tricuspid regurgitation due to the tumor. Pericardiocentesis produces hemorrhagic fluid which relieves the patient’s dyspnea. Which of the following represents the best next step in managing this patient’s cardiac issues?

A 66-year-old male with a past medical history of hypertension and coronary artery disease is undergoing a pre-operative work-up for coronary artery bypass grafting (CABG). His echocardiogram reveals a small, pedunculated mobile density on the aortic valve measure 1.3 cm. He is otherwise healthy and denies a history of intravenous drug use. Blood cultures are negative. How should the finding be managed?

A patient is referred for evaluation of lipomatous hypertrophy of the interatrial septum (LHIS) identified incidentally on cardiac MRI. The patient is asymptomatic. Management should entail:

The most common primary malignant tumor of the heart is:

A 68-year-old woman with a past medical history of well-controlled hypertension presents to the emergency department with a three-year history of fatigue and dyspnea on exertion that has acutely worsened over the past two days. She now has dyspnea at rest and additionally endorses lower-extremity edema. Work-up is significant for a ECG that demonstrates left atrial hypertrophy and a NT-proBNP of 10,000 pg/ml. An echocardiogram reveals a heterogenous mass in the left atrium that prolapses into the left ventricle during diastole. It appears to be situated on the intra-atrial septum. Which of the following represents the best definitive management?

A 22-year-old male with no significant past medical history is referred to cardiac surgery for evaluation management of an incidentally found cardiac mass. Echocardiogram revealed a 1.2 cm mobile mass located in the left atrium along the intra-atrial septum. She denies any symptoms of heart failure. Two of his maternal uncle both had similar masses and his mother suffered from hypoparathyroidism. On physical exam, you note several small pigmented lesions on his face which he states have been present since childhood. Based on the most likely diagnosis, what is your management plan?

The most common acute manifestation of a cardiac tumor is:

Rhabdomyomas in children occur with what disorder in 50% of patients?

Survival may be improved by resection of tumors invading the heart of which origin?

A 33-year-old man with no previous past medical history is referred to you for evaluation of a newly-diagnosed cardiac tumor. He asks you what percentage of these types of tumors are benign. Assuming the tumor is a primary cardiac tumor, what do you tell him?

A 63-year-old woman with severe mitral regurgitation secondary to mitral valve prolapse persistent atrial fibrillation (AF) undergoes a mitral valve repair (MVr) and radiofrequency ablation for her AF. The patient tolerates the procedure well without any apparent complications and is transferred to the ICU post-operatively. Her recovery is unremarkable except for a persistent leukocytosis. On post-operative day (POD) 7, she has a white blood cell count of 30,000 cells/mm^3 and pain with swallowing. An IV contrast CT scan demonstrates mediastinal air at the level of the carina. What is the best nest step?

The incidence of atrial fibrillation among the general population in the United States is approximately:

Indications for surgical management of atrial fibrillation (AF) include all of the following except:

Atrial fibrillation requiring pharmacologic or electrical cardioversion is described as

Which of the following carries a Class I recommendation with level of evidence A for surgical ablation of atrial fibrillation (AF)?

What vessel is at risk during a MAZE procedure: