Final Exam: Cardiology 101

A 58-year-old male with a history of hypertension presents to the emergency department with chest pain and diaphoresis. EKG shows ST-segment elevation in leads II, III, and aVF. Troponin levels are elevated. What is the initial treatment for this patient?

J.M. is a 64-year-old woman who presents to the emergency department with a 3-hour history of chest pain radiating to her left arm. She has a history of type 2 diabetes, hypertension, and hyperlipidemia. She is currently on metformin, lisinopril, and atorvastatin. On examination, her blood pressure is 140/90 mmHg, heart rate is 88 bpm, and her ECG reveals ST-segment elevation in the anterior leads.

Question: Which of the following is the most likely underlying pathophysiology causing J.M.’s presentation?

L.T., a 68-year-old male, presents to the emergency department with a 4-hour history of chest pain. His ECG reveals ST-segment elevation in the inferior leads. Upon further history, you discover that he had an ischemic stroke 2 months ago. A CT scan of the head at that time did not show any hemorrhage.

Question: Given L.T.’s history of a recent ischemic stroke, is he a candidate for fibrinolytic therapy?

A 62-year-old patient with chronic hypertension is started on an angiotensin-converting enzyme (ACE) inhibitor. Which laboratory value should be closely monitored?

A.C. is a 58-year-old male who comes to the clinic for a routine check-up. He has a family history of heart disease, smokes half a pack of cigarettes daily for the past 30 years, and leads a sedentary lifestyle. He occasionally experiences chest discomfort after heavy meals, which he attributes to indigestion. His blood pressure is 155/95 mmHg, and his cholesterol panel reveals an LDL of 170 mg/dL.

Question: Which of the following is the most significant modifiable risk factor for developing acute coronary syndrome (ACS) in A.C.?

FM is a 42-year-old male (87 kg) who presents to the ED with severe headache and hypertension (212/122 mmHg). He has been diagnosed with high blood pressure in the past but is not currently on any medication. A stat head CT shows no sign of intracranial pathology. Labs are drawn and his BMP is normal, except for a SCr of 2.1. His baseline SCr was 0.8 a year ago, and he denies any history of renal dysfunction. Based on his current situation, which of the following represents the best initial goals for reducing FM’s blood pressure?

A 65-year-old male patient with a history of NYHA class III heart failure and an LVEF of 33% is currently taking an ACE inhibitor and a β-blocker. His most recent laboratory results show a serum creatinine (SCr) of 2.2 mg/dL and a potassium (K) level of 4.8 mEq/L. The patient has been experiencing increased fatigue and weakness. Which of the following medications would be the most appropriate addition to the patient’s current therapy to reduce morbidity and mortality?

A 48-year-old patient with a history of hypertension presents with a blood pressure reading of 210/110 mmHg. There are no signs of acute end-organ damage. What is the most appropriate initial treatment for hypertensive urgency?

K.L. is a 70-year-old woman who presents to the emergency department with sudden-onset chest pain that began while she was gardening. The pain is described as “crushing” in nature, located in the center of her chest, and is associated with shortness of breath and diaphoresis. She denies any nausea, vomiting, or dizziness. On examination, she appears anxious, her blood pressure is 110/70 mmHg, heart rate is 100 bpm, and she has rales in her lung bases.

Question: What are the typical signs and symptoms of myocardial ischemia/infarction in K.L.’s presentation?

A 55-year-old male presents to the clinic with a blood pressure of 160/100 mmHg. He has a history of hypertension for the past 10 years and has been taking lisinopril 20 mg daily for the past 5 years. He denies any symptoms, is allergic to chlorthalidone, and his physical exam is unremarkable. His laboratory values are within normal limits. What is the most appropriate next step in the management of this patient’s hypertension?

A 68-year-old male with known heart failure presents with acute dyspnea, tachycardia, and bilateral crackles on lung examination. His oxygen saturation is 88%. Which is the initial management?

S.R. is a 55-year-old male presenting with intermittent chest pain for the past two days. The pain is described as a pressure sensation, lasting for about 10 minutes each episode, and is relieved by rest. He has a history of hypertension controlled with lisinopril and has a family history of coronary artery disease. On examination, his vitals are stable. An ECG is obtained which does not show any ST-segment elevation but has T-wave inversions in the inferior leads. His initial troponin level is elevated.

Question: Based on the ECG findings and the troponin level, how would you classify S.R.’s acute coronary syndrome (ACS)?

A 65-year-old male with a history of hypertension, diabetes, and coronary artery disease presents to the emergency department with shortness of breath, fatigue, and ankle swelling. Physical examination reveals elevated jugular venous pressure, bibasilar crackles, and peripheral edema. Chest X-ray shows cardiomegaly and pulmonary congestion. Labs reveal elevated BNP levels and renal dysfunction. The patient is diagnosed with acute decompensated heart failure and admitted to the hospital.

A 72-year-old patient with chronic heart failure and reduced ejection fraction is already on guideline-directed medical therapy including ACE inhibitors, beta-blockers, and diuretics. What medication class has shown mortality benefit in this patient population?

D.F. is a 60-year-old woman who presents to the emergency department with chest pain that started 6 hours ago. Her ECG shows non-specific T-wave changes. She has a history of type 2 diabetes and hyperlipidemia. Initial cardiac biomarkers are ordered, her troponin level returns elevated, and her CK-MB is also above the reference range.

Question: What is the significance of an elevated troponin and CK-MB level in D.F.’s presentation?

A 65-year-old male with a history of hypertension, diabetes, and coronary artery disease presents to the clinic with complaints of shortness of breath and fatigue. On physical examination, he has bilateral lower extremity edema and jugular venous distension. His labs show an elevated BNP level and an ejection fraction of 30%. An echocardiogram reveals left ventricular dilation and dysfunction. What is the recommended target dose and titration schedule for carvedilol in the management of chronic heart failure?

A 55-year-old patient with newly diagnosed chronic hypertension has a family history of gout. Which antihypertensive medication should be avoided in this patient?

L.T., a 68-year-old male, presents to the emergency department with a 4-hour history of chest pain. His ECG reveals ST-segment elevation in the inferior leads. Upon further history, you discover that he had an ischemic stroke 2 months ago. A CT scan of the head at that time did not show any hemorrhage.

Question: Given L.T.’s history of a recent ischemic stroke, is he a candidate for fibrinolytic therapy?

BL is a 78-year-old female (67kg) who arrives at the Emergency Department (ED) experiencing difficulty breathing and coughing up pink foam. She has a history of high blood pressure but hasn’t taken her prescribed medications (lisinopril and hydrochlorothiazide) for several days. BL believes her blood pressure escalated due to stress from her family and an unusual diet filled with rich foods, but her difficulty breathing worsened rapidly within the last couple of hours. Upon examination, her blood pressure is 220/146, RR 34, O2 saturation 86% on room air, and her work of breathing is visibly increased. The physician believes that BL has Sympathetic Crashing Acute Pulmonary Edema (SCAPE). The respiratory therapist places BL on BiPAP, and the physician asks for your recommendation regarding medication therapies. Which of the following is the most appropriate recommendation for BL?

A 56-year-old male patient with a history of hypertension presents to your clinic for a follow-up appointment. His blood pressure remains uncontrolled at 155/95 mm Hg despite being on maximum doses of a single antihypertensive medication. You decide to initiate combination therapy to better control his blood pressure. Based on the American Society of Hypertension’s recommendations, which of the following combinations is considered a preferred choice for this patient?

A 60-year-old patient with chronic heart failure and NYHA class II symptoms remains symptomatic despite optimal guideline-directed medical therapy. Which medication can improve symptoms and reduce hospitalizations?

V.L., a 59-year-old male with a BMI of 32, is diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). He is started on clopidogrel, an antiplatelet agent. On review of his medication list, you note that he is also taking omeprazole for gastroesophageal reflux disease (GERD) and atorvastatin for hyperlipidemia. His liver function tests are within normal limits.

Question: Given V.L.’s current medications, what major drug interaction should be considered regarding clopidogrel?

A 63-year-old female with a history of hypertension and diabetes presents to the emergency room with sudden onset of dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On examination, she has rales in both lung fields, elevated jugular venous pressure (JVP), and an S3 heart sound. Based on her presentation and findings, what is the most likely diagnosis?

A 70-year-old patient presents with hypertensive urgency and blood pressure reading of 190/100 mmHg. There are signs of acute end-organ damage, including retinal hemorrhages and acute kidney injury. What is the immediate goal of blood pressure reduction?

MJ is a 52-year-old female presenting to the emergency department (ED) with radiating chest pain that began 3 hours ago. A 12-lead ECG shows ST elevation and hyperacute T waves in V2-4, indicating acute coronary syndrome (ACS). She has a history of hypertension, no allergies, takes amlodipine 10 mg daily, and weighs 90 kg. Her vital signs are: heart rate 114 beats/min, blood pressure 110/58 mm Hg (MAP 75 mm Hg), respiratory rate 22 breaths/min, and oxygen saturation 98%. Laboratory findings include: BG 152 mg/dL, Na 148 mmol/L, K 3.9 mmol/L, serum creatinine 1.3 mg/dL, Cl 101 mmol/L, bicarbonate 21 mmol/L, pH 7.35, Mg 1.5 mg/dL, and high sensitivity troponin T 115.8 ng/L. She received aspirin 325 mg, clopidogrel 600 mg, and sublingual nitroglycerin 0.4 mg for chest pain relief. What is the most appropriate anticoagulation treatment strategy for this patient with ACS?

A 65-year-old male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril 20mg daily, metformin 1000mg twice daily, and furosemide 40mg daily. His blood pressure is 130/80 mmHg, heart rate is 80 beats per minute, and respiratory rate is 20 breaths per minute. His physical exam is significant for bilateral crackles in the lung bases and peripheral edema. Which of the following is the most appropriate pharmacologic therapy for the management of chronic heart failure in this patient?

A 65-year-old patient with a history of chronic heart failure with reduced ejection fraction (25%) is on guideline-directed medical therapy. The patient experiences worsening symptoms and decreased exercise tolerance. Which medication can improve contractility and symptoms in this patient?

What is the most appropriate recommendation for anticoagulation in a patient with non-ST-elevation myocardial infarction (NSTEMI) who is not a candidate for catheterization?

A 60-year-old female presents to her primary care physician with a history of hypertension. She reports that she has been taking lisinopril 10mg daily for the past year, but her blood pressure has not been well controlled. Her current blood pressure is 150/90 mm Hg. She has a past medical history of hyperlipidemia and is currently taking atorvastatin 20mg daily. She denies any history of cardiovascular disease or diabetes. Her family history is significant for hypertension in both parents. What is the appropriate initial treatment for this patient’s uncontrolled hypertension?

A 45-year-old male with acute chest pain and ST-segment elevation in leads V1-V4 is admitted to the emergency department. His troponin levels are elevated, and he is hemodynamically stable. Which pharmacotherapy should be initiated immediately?

A 58-year-old female with a previous medical history of hyperlipidemia, type 2 diabetes mellitus, and myocardial infarction, presents to the emergency department reporting chest pain. She appears anxious with a respiratory rate of 26 breaths per minute, and her blood oxygen saturation reads 89% on room air. Her vital signs are a blood pressure of 110/80 mmHg and a pulse rate of 94 beats per minute. An ECG reveals ST-segment elevation. Due to the lack of facilities for coronary stenting, the managing physician has decided to administer tissue plasminogen activator (t-PA). Considering that the patient’s weight is 73 kg, what is the generally recommended total dose of alteplase for infusion in this case?

A 55-year-old male patient with a history of hypertension, type 2 diabetes, and high cardiovascular risk presents to your clinic. His current blood pressure is 145/85 mm Hg. Based on the 2017 ACC/AHA guideline and other evidence, what should be the target blood pressure goal for this patient?

A 55-year-old male presents to the clinic with a blood pressure of 160/100 mmHg. He has a history of hypertension for the past 10 years and has been taking lisinopril 20 mg daily for the past 5 years. He denies any symptoms, is allergic to chlorthalidone, and his physical exam is unremarkable. His laboratory values are within normal limits. What is the most appropriate next step in the management of this patient’s hypertension?

V.L., a 59-year-old male with a BMI of 32, is diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). He is started on clopidogrel, an antiplatelet agent. On review of his medication list, you note that he is also taking omeprazole for gastroesophageal reflux disease (GERD) and atorvastatin for hyperlipidemia. His liver function tests are within normal limits.

Question: Given V.L.’s current medications, what major drug interaction should be considered regarding clopidogrel?

A 56-year-old male with a history of hypertension and type 2 diabetes presents for a routine checkup. His medications include lisinopril, metformin, and hydrochlorothiazide 25 mg daily. The patient complains of muscle cramps and fatigue. Laboratory results show a serum potassium level of 3.1 mEq/L (normal range: 3.5-5.0 mEq/L). Which of the following modifications to his antihypertensive regimen is most appropriate to address the patient’s hypokalemia?

Mr. S is a 52-year-old male with a history of hypertension, type 2 diabetes mellitus, and a 30-pack-year smoking history. He comes to the clinic complaining of increasing fatigue and shortness of breath on exertion. Based on his medical history, which condition confers the greatest risk for developing heart failure in Mr. S?

A 45-year-old male patient presents to your clinic with a recent diagnosis of hypertension. His blood pressure is 150/95 mmHg, and he is currently not on any antihypertensive medications. The patient is overweight with a BMI of 29, has a sedentary lifestyle, and consumes a high-sodium diet. As his primary care provider, which of the following nonpharmacological interventions would be most appropriate to recommend for this patient to help manage his hypertension?

A 55-year-old patient with chest pain is admitted to the emergency department. His ECG results are consistent with an acute myocardial infarction. As part of the treatment plan, the medical team has decided to initiate nitroglycerin therapy. Before this, which of the following medications should be checked in the patient’s medication history to avoid potentially lethal interactions?

Patient Profile:

Demographics: 52-year-old male

History of Present Illness: Patient complains of paroxysmal headaches, sweating, tachycardia, and palpitations. He also reports episodes of orthostatic hypotension and muscle cramps.

Past Medical History: Hypertension

Family History: Father had hypertension and died of a stroke at age 65; mother has type 2 diabetes.

Other Pertinent Details: The patient had a recent laboratory evaluation that showed hypokalemia, proteinuria, and red blood cells in the urine.

Based on the patient’s profile and symptoms, which of the following secondary causes of hypertension is most likely responsible for his condition?

Mrs. L, a 65-year-old female, presents with complaints of exertional dyspnea. She has a history of hypertension and atrial fibrillation. Her ECG reveals left ventricular hypertrophy, and her echocardiogram shows an ejection fraction of 58%. Based on her findings, which feature is consistent with heart failure with preserved ejection fraction (HFpEF)?

A 60-year-old male with a history of hypertension, type 2 diabetes, and chronic kidney disease (CKD) presents to your clinic for a follow-up appointment. His current medication regimen includes an ACE inhibitor and a thiazide diuretic. He reports experiencing a persistent dry cough since starting the ACE inhibitor. Based on his medical history and current symptoms, which of the following medication changes would be most appropriate?

A 67-year-old woman with a known history of heart failure is admitted with severe fatigue, worsening dyspnea, and decreased urine output. Despite optimizing her fluid status and medications, her symptoms persist, and she exhibits signs of poor perfusion. Which clinical finding suggests the need for positive inotropic therapy in her ADHF?

A 56-year-old male patient with a history of hypertension presents to your clinic for a follow-up appointment. His blood pressure remains uncontrolled at 155/95 mm Hg despite being on maximum doses of a single antihypertensive medication. You decide to initiate combination therapy to better control his blood pressure. Based on the American Society of Hypertension’s recommendations, which of the following combinations is considered a preferred choice for this patient?

A 45-year-old male presents to the clinic with a blood pressure reading of 150/90 mmHg. He has no significant past medical history and is not taking any medications. He denies any symptoms such as headache, chest pain, shortness of breath, or visual changes. Physical examination is unremarkable except for elevated blood pressure.

A 60-year-old female presents to her primary care physician with a history of hypertension. She reports that she has been taking lisinopril 10mg daily for the past year, but her blood pressure has not been well controlled. Her current blood pressure is 150/90 mm Hg. She has a past medical history of hyperlipidemia and is currently taking atorvastatin 20mg daily. She denies any history of cardiovascular disease or diabetes. Her family history is significant for hypertension in both parents. What is the appropriate initial treatment for this patient’s uncontrolled hypertension?

According to the 2017  ACC/AHA Hypertension guideline, what is the definition of a hypertensive emergency?

A 55-year-old male patient with a history of hypertension, type 2 diabetes, and high cardiovascular risk presents to your clinic. His current blood pressure is 145/85 mm Hg. Based on the 2017 ACC/AHA guideline and other evidence, what should be the target blood pressure goal for this patient?

In the DOSE trial, what was the comparison made in the study regarding the strategies for diuretic administration in acute decompensated heart failure?

A 65-year-old male with a history of chronic heart failure presents to the clinic for a routine follow-up. He is currently on a regimen of lisinopril, carvedilol, and spironolactone. His blood pressure is 120/80 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. His physical exam is unremarkable. His laboratory results show a serum potassium level of 4.5 mEq/L and a serum creatinine level of 1.2 mg/dL. Which of the following is a potential adverse effect of spironolactone in the management of chronic heart failure?

A 78-year-old female patient with a history of hypertension, diabetes, and chronic kidney disease (CKD) presents to your clinic for a follow-up visit. Her blood pressure is consistently above 140/90 mm Hg, and she has moderately increased albuminuria. You decide to initiate pharmacologic therapy to manage her hypertension and reduce the risk of further kidney deterioration and cardiovascular events. Which of the following antihypertensive medications would be the most appropriate choice for this patient?

According to the “2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction,” what is the recommended time frame for primary PCI in patients with STEMI at a PCI-capable hospital?

A 78-year-old female patient with a history of hypertension, diabetes, and chronic kidney disease (CKD) presents to your clinic for a follow-up visit. Her blood pressure is consistently above 140/90 mm Hg, and she has moderately increased albuminuria. You decide to initiate pharmacologic therapy to manage her hypertension and reduce the risk of further kidney deterioration and cardiovascular events. Which of the following antihypertensive medications would be the most appropriate choice for this patient?

A 45-year-old male presents to the clinic with a blood pressure reading of 150/90 mmHg. He has no significant past medical history and is not taking any medications. He denies any symptoms such as headache, chest pain, shortness of breath, or visual changes. Physical examination is unremarkable except for elevated blood pressure.

According to the LIFE study published in The Lancet, which medication was found to prevent more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure?

A 65-year-old male with a history of hypertension presents to the clinic with complaints of dizziness, fatigue, and lightheadedness. He reports that he has been taking his antihypertensive medication as prescribed. His blood pressure is 130/80 mmHg, and his heart rate is 70 beats per minute. He denies any chest pain, shortness of breath, or palpitations.

In the 2017  ACC/AHA Hypertension guideline, what is the recommended initial goal for BP reduction in patients with a hypertensive emergency?

A 55-year-old male patient with a history of hypertension visits your clinic. His blood pressure readings have been consistently above 140/90 mmHg, and he is currently taking a generic ACE inhibitor as monotherapy. The patient is concerned about the cost of his treatment and wants to know if there are other options available. As a healthcare provider, which of the following strategies would be most appropriate to control the cost of care without increasing the morbidity and mortality associated with uncontrolled hypertension?

In the article “Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure,” what was the primary objective of the study?

A 65-year-old African American female with a history of hypertension and stable ischemic heart disease presents to the clinic. Her current medications include a β-blocker and a thiazide diuretic, but her blood pressure is consistently above the target range. Her physician is considering adding a calcium channel blocker (CCB) to her treatment plan. Which of the following CCBs would be the most appropriate choice for this patient?

According to the findings in the article “Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure,” which group showed a significant reduction in the risk of death from cardiovascular causes?

A 65-year-old male presents to the emergency department with shortness of breath, fatigue, and peripheral edema. He has a history of hypertension, type 2 diabetes, and chronic heart failure. His vital signs are as follows: blood pressure 95/60 mm Hg, heart rate 95 beats/min, respiratory rate 22 breaths/min, and oxygen saturation 92% on room air. Physical examination reveals jugular venous distension, rales in both lung fields, and 2+ pitting edema in both lower extremities. Laboratory results show a serum creatinine of 1.8 mg/dL and a potassium level of 5.2 mEq/L. The patient is currently on guideline-directed medical therapies, including an ACE inhibitor, a beta-blocker, and a loop diuretic.

Based on the patient’s presentation and hemodynamic parameters, which of the following treatment options is most appropriate for this patient with acute decompensated heart failure (ADHF)?

Based on the “2013 ACCF/AHA Guideline,” what is the recommended approach for risk stratification in patients with STEMI?

A 68-year-old male with a history of hypertension, hyperlipidemia, and coronary artery disease presents to the emergency department with shortness of breath, orthopnea, and lower extremity edema. He reports that his symptoms have been worsening over the past week. Vital signs are significant for a blood pressure of 150/90 mmHg, heart rate of 110 beats per minute, respiratory rate of 24 breaths per minute, and oxygen saturation of 88% on room air. Physical examination reveals bilateral crackles in the lung bases and 3+ pitting edema in the lower extremities. Laboratory studies show a B-type natriuretic peptide (BNP) level of 1200 pg/mL (normal <100 pg/mL) and a serum creatinine level of 1.5 mg/dL (normal 0.6-1.3 mg/dL).

What was the primary outcome of the INTERACT3 trial?

According to the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended initial dose of carvedilol for patients with heart failure and reduced ejection fraction (HFrEF)?

A 67-year-old male with a history of chronic heart failure (HF) presents to the emergency department with acute decompensated heart failure (ADHF) characterized by dyspnea, peripheral edema, and pulmonary congestion. His past medical history includes hypertension, diabetes, and atrial fibrillation. The patient’s current medications include metoprolol, furosemide, and digoxin. His blood pressure is 190/70 mm Hg, heart rate is 88 bpm, and oxygen saturation is 90% on room air.

Question:

In the management of this patient’s acute decompensated heart failure, which of the following therapeutic interventions would be most appropriate to provide symptomatic relief while preserving hemodynamic stability?

A 58-year-old female with a previous medical history of hyperlipidemia, type 2 diabetes mellitus, and myocardial infarction, presents to the emergency department reporting chest pain. She appears anxious with a respiratory rate of 26 breaths per minute, and her blood oxygen saturation reads 89% on room air. Her vital signs are a blood pressure of 110/80 mmHg and a pulse rate of 94 beats per minute. An ECG reveals ST-segment elevation. Due to the lack of facilities for coronary stenting, the managing physician has decided to administer tissue plasminogen activator (t-PA). Considering that the patient’s weight is 73 kg, what is the generally recommended total dose of alteplase for infusion in this case?

A 68-year-old male with a history of hypertension, hyperlipidemia, and coronary artery disease presents to the emergency department with shortness of breath and bilateral lower extremity edema. His vital signs are as follows: blood pressure 87/40 mmHg, heart rate 120 beats per minute, respiratory rate 24 breaths per minute, and oxygen saturation 90% on room air. Physical examination reveals bibasilar crackles and jugular venous distension. Chest X-ray shows pulmonary edema. Laboratory results show elevated B-type natriuretic peptide (BNP) levels.

In the management of acute decompensated heart failure, which of the following is an indication for the use of vasoactive agents?

According to the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended initial treatment for patients with acute decompensated heart failure (ADHF) and volume overload?

A 60-year-old male with a history of ischemic cardiomyopathy, hypertension, and type 2 diabetes mellitus presents to the emergency department with worsening dyspnea, orthopnea, and lower extremity edema. The patient reports adherence to prescribed medications including an ACE inhibitor, beta-blocker, and aldosterone antagonist. Vital signs are as follows: blood pressure 90/60 mmHg, heart rate 110 bpm, respiratory rate 24 breaths/min, and oxygen saturation 88% on room air. Lab results reveal a B-type natriuretic peptide (BNP) of 1500 pg/mL, serum creatinine 2.5 mg/dL, and potassium 5.2 mmol/L. Echocardiography shows an ejection fraction of 20%. After initial stabilization, the patient is admitted for acute decompensated heart failure.

Which of the following criteria would qualify this patient for advanced heart failure therapy, such as a left ventricular assist device (LVAD) or heart transplantation?

In the ACCOMPLISH trial, how were the patients categorized based on their BMI?

A 65-year-old male with a history of hypertension, diabetes, and coronary artery disease presents to the emergency department with shortness of breath, fatigue, and ankle swelling. Physical examination reveals elevated jugular venous pressure, bibasilar crackles, and peripheral edema. Chest X-ray shows cardiomegaly and pulmonary congestion. Labs reveal elevated BNP levels and renal dysfunction. The patient is diagnosed with acute decompensated heart failure and admitted to the hospital.

According to the CLUE trial, what was the primary outcome and how was it defined?

A 63-year-old female with a history of hypertension and diabetes presents to the emergency room with sudden onset of dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On examination, she has rales in both lung fields, elevated jugular venous pressure (JVP), and an S3 heart sound. Based on her presentation and findings, what is the most likely diagnosis?

According to the PLATO trial, how did the rates of overall major bleeding in patients treated with Ticagrelor compare to those treated with Clopidogrel?

Mr. G, a 78-year-old male with a history of systolic heart failure, comes to the emergency department in acute respiratory distress. His oxygen saturation is 88% on room air. What is the best initial therapy?

In the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended target dose of sacubitril/valsartan for patients with HFrEF who are eligible for this therapy?

A 67-year-old woman with a known history of heart failure is admitted with severe fatigue, worsening dyspnea, and decreased urine output. Despite optimizing her fluid status and medications, her symptoms persist, and she exhibits signs of poor perfusion. Which clinical finding suggests the need for positive inotropic therapy in her ADHF?

A 65-year-old male with a history of hypertension, hyperlipidemia, and chronic heart failure presents to the clinic for a routine follow-up. He is currently on lisinopril, carvedilol, and spironolactone. His blood pressure is 130/80 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. His physical exam is unremarkable except for bilateral lower extremity edema. His laboratory results show a BNP level of 500 pg/mL (normal range <100 pg/mL) and a serum creatinine level of 1.2 mg/dL (normal range 0.6-1.3 mg/dL).

A 65-year-old male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril 20mg daily, metformin 1000mg twice daily, and furosemide 40mg daily. His blood pressure is 130/80 mmHg, heart rate is 80 beats per minute, and respiratory rate is 20 breaths per minute. His physical exam is significant for bilateral crackles in the lung bases and peripheral edema. Which of the following is the most appropriate pharmacologic therapy for the management of chronic heart failure in this patient?

A 65-year-old male with a history of chronic heart failure presents to the clinic for a routine follow-up. He is currently on a regimen of lisinopril, carvedilol, and spironolactone. His blood pressure is 120/80 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. His physical exam is unremarkable. His laboratory results show a serum potassium level of 4.5 mEq/L and a serum creatinine level of 1.2 mg/dL. Which of the following is a potential adverse effect of spironolactone in the management of chronic heart failure?

In the LIFE study, by how much did the blood pressure fall in the losartan group compared to the atenolol group?

A 65-year-old African American male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril, metformin, metoprolol, eplerenone and furosemide. On physical examination, he has bilateral crackles in his lungs and an elevated jugular venous pressure. His echocardiogram shows an ejection fraction of 30%. Which medication should be added to the patient’s current regimen to reduce mortality in the management of chronic heart failure?

A 65-year-old male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril, metformin, and furosemide. On physical examination, he has bilateral crackles in his lungs and jugular venous distension. His blood pressure is 130/80 mmHg, heart rate is 90 beats per minute, and oxygen saturation is 92% on room air. Laboratory results show a B-type natriuretic peptide (BNP) level of 800 pg/mL (normal range <100 pg/mL).  Which medication should be added to the patient’s current regimen to manage chronic heart failure?

A 65-year-old male patient with a history of NYHA class III heart failure and an LVEF of 33% is currently taking an ACE inhibitor and a β-blocker. His most recent laboratory results show a serum creatinine (SCr) of 2.2 mg/dL and a potassium (K) level of 4.8 mEq/L. The patient has been experiencing increased fatigue and weakness. Which of the following medications would be the most appropriate addition to the patient’s current therapy to reduce morbidity and mortality?

A 65-year-old male with a history of hypertension, diabetes, and coronary artery disease presents to the clinic with complaints of shortness of breath and fatigue. On physical examination, he has bilateral lower extremity edema and jugular venous distension. His labs show an elevated BNP level and an ejection fraction of 30%. An echocardiogram reveals left ventricular dilation and dysfunction. What is the recommended target dose and titration schedule for carvedilol in the management of chronic heart failure?

According to the ACCOMPLISH trial, which two single-pill combinations were compared for their effects on cardiovascular outcomes in hypertensive patients?

Mr. S is a 52-year-old male with a history of hypertension, type 2 diabetes mellitus, and a 30-pack-year smoking history. He comes to the clinic complaining of increasing fatigue and shortness of breath on exertion. Based on his medical history, which condition confers the greatest risk for developing heart failure in Mr. S?

Mrs. L, a 65-year-old female, presents with complaints of exertional dyspnea. She has a history of hypertension and atrial fibrillation. Her ECG reveals left ventricular hypertrophy, and her echocardiogram shows an ejection fraction of 58%. Based on her findings, which feature is consistent with heart failure with preserved ejection fraction (HFpEF)?

A 60-year-old female with a history of uncontrolled hypertension presents to the emergency department with a sudden onset of severe headache, nausea, and vomiting. Her blood pressure on arrival is 215/125 mmHg. A computed tomography (CT) scan of the head reveals an intracranial hemorrhage. Which of the following medications is most appropriate for initial treatment of this patient’s hypertensive emergency?

A 65-year-old female with a history of uncontrolled hypertension presents to the emergency department with a sudden onset of severe chest pain radiating to the back. Her blood pressure on arrival is 210/115 mmHg. A computed tomography (CT) scan reveals a dissection of the ascending aorta. Which of the following medications is most appropriate for the initial treatment of this patient’s hypertensive emergency?

A 58-year-old male with a history of uncontrolled hypertension presents to the emergency department with a severe headache, blurred vision, and shortness of breath. His blood pressure on arrival is 220/130 mmHg. Further examination reveals papilledema on fundoscopy and bilateral crackles on lung auscultation. The patient’s past medical history includes type 2 diabetes mellitus and hyperlipidemia. He reports non-adherence to his antihypertensive medications. In managing this hypertensive emergency, which of the following medications is most appropriate for initial treatment?

A 55-year-old male with a history of uncontrolled hypertension presents to the emergency department with chest pain and shortness of breath. His blood pressure on arrival is 200/120 mmHg. An electrocardiogram (ECG) shows ST-segment elevation in leads II, III, and aVF, suggesting an inferior wall myocardial infarction. Based on the patient’s presentation, which of the following best defines a hypertensive emergency?

A 68-year-old female with a history of uncontrolled hypertension presents to the emergency department with severe headache, confusion, and blurred vision. Her blood pressure on arrival is 220/130 mmHg. A computed tomography (CT) scan of the head reveals a small intracerebral hemorrhage. Based on the patient’s presentation, which of the following is the main goal of treatment for hypertensive emergencies?

FM is a 42-year-old male (87 kg) who presents to the ED with severe headache and hypertension (212/122 mmHg). He has been diagnosed with high blood pressure in the past but is not currently on any medication. A stat head CT shows no sign of intracranial pathology. Labs are drawn and his BMP is normal, except for a SCr of 2.1. His baseline SCr was 0.8 a year ago, and he denies any history of renal dysfunction. Based on his current situation, which of the following represents the best initial goals for reducing FM’s blood pressure?

BL is a 78-year-old female (67kg) who arrives at the Emergency Department (ED) experiencing difficulty breathing and coughing up pink foam. She has a history of high blood pressure but hasn’t taken her prescribed medications (lisinopril and hydrochlorothiazide) for several days. BL believes her blood pressure escalated due to stress from her family and an unusual diet filled with rich foods, but her difficulty breathing worsened rapidly within the last couple of hours. Upon examination, her blood pressure is 220/146, RR 34, O2 saturation 86% on room air, and her work of breathing is visibly increased. The physician believes that BL has Sympathetic Crashing Acute Pulmonary Edema (SCAPE). The respiratory therapist places BL on BiPAP, and the physician asks for your recommendation regarding medication therapies. Which of the following is the most appropriate recommendation for BL?

A 55-year-old patient with chest pain is admitted to the emergency department. His ECG results are consistent with an acute myocardial infarction. As part of the treatment plan, the medical team has decided to initiate nitroglycerin therapy. Before this, which of the following medications should be checked in the patient’s medication history to avoid potentially lethal interactions?

A 58-year-old male with a medical history of chronic hypertension presents to the emergency department (ED) with a severe headache and blurred vision. His blood pressure is recorded at 220/130 mmHg. The ED provider decides to initiate treatment with a calcium channel blocker for a hypertensive emergency. Which of the following is the recommended initial dose for nicardipine?

According to the “2013 ACCF/AHA Guideline,” what is the recommended duration of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor for patients with STEMI undergoing PCI with a drug-eluting stent?

In the “2013 ACCF/AHA Guideline,” what is the recommended approach for beta-blocker therapy in patients with STEMI without contraindications?

The “2013 ACCF/AHA Guideline” emphasizes the importance of ACE inhibitors in STEMI management. In which of the following patient populations is the initiation of ACE inhibitors specifically emphasized?

In the PLATO trial, what was one of the significant safety concerns associated with Ticagrelor?

Which population was specifically excluded from the PLATO trial comparing Ticagrelor and Clopidogrel?

Which type of diuretic was primarily used in the DOSE trial?

In the DOSE trial, what was the conclusion regarding the continuous infusion vs. bolus injection of diuretics?

According to the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended approach to diuretic dosing in patients with ADHF?

In the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended approach to fluid management in patients with ADHF?

According to the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended first-line diuretic therapy for patients with heart failure and fluid retention?

In the “2013 ACCF/AHA Guideline for the Management of Heart Failure”, what is the recommended management strategy for patients with heart failure and preserved ejection fraction (HFpEF)?

What was the name of the trial referred to in the article “Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure”?

In the study presented in “Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure,” what was one of the primary endpoints?

According to the 2017  ACC/AHA Hypertension guideline, what are some examples of intravenous antihypertensive medications that can be used for patients with a hypertensive emergency?

In the 2017  ACC/AHA Hypertension guideline, what are some factors that should be considered when choosing an intravenous antihypertensive medication for a patient with a hypertensive emergency?

What were the key findings of the INTERACT3 trial?

What are the implications of the INTERACT3 trial for clinical practice?

What were the limitations of the INTERACT3 trial?

According to the CLUE trial, what were the dosing protocols for nicardipine and labetalol?

In the CLUE trial, what were the main results and conclusions?

In the LIFE study, how many patients in the losartan group experienced the primary composite endpoint compared to the atenolol group?

According to the conclusions of the LIFE study, which statement is true regarding the benefits of Losartan?

In the ACCOMPLISH trial, among patients allocated benazepril and hydrochlorothiazide, which BMI group had the highest primary endpoint (per 1000 patient-years)?