July 22nd, 2014 · Leave a Comment

Test Your Knowledge Tuesday #10

By Amy Beeman

This week our board exam prep question comes from Dr. Robert Frantz and covers the necessity of screening for pulmonary arterial hypertension (PAH) in various patient populations.

Question:

Pulmonary arterial hypertension can occur in a variety of clinical contexts.  The 2009 Dana Point conference provided guidelines for screening at-risk populations.

For which of the following groups does pulmonary arterial hypertension occur with sufficient frequency to warrant periodic screening?

A. HIV positivity
B. Scleroderma spectrum of diseases
C. Patients with a previous splenectomy
D. Obstructive sleep apnea
E. Systemic hypertension

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July 17th, 2014 · Leave a Comment

Grand Rounds Video: Knowledge Gaps In Prosthetic Valve Thrombosis

By Amy Beeman

In today’s Grand Rounds, Dr. Mackram Eleid and Dr. Michael Cullen introduce two case studies to help in understanding the ACC/AHA guidelines for treatment of prosthetic valve thrombosis.

Learning objectives for this presentation include:

  • Choosing appropriate anticoagulation regimens for different prostheses
  • Assessing clot burden and degree of obstructions
  • Applying guideline-recommended therapy
  • Safely administering thrombolytic therapy in selected cases

Cardiovascular Videos on the Grand Rounds page

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July 15th, 2014 · Leave a Comment

Test Your Knowledge Tuesday #9

By Amy Beeman

The Mayo Clinic CV Board Review course is one month away. Today, we continue with a weekly question to help you prepare.

Dr. Samuel Asirvatham, editor-in-chief of the “Mayo Clinic Electrophysiology Manual,” challenges you with an electrocardiogram:

A 39-year-old male presents with severe chest pain. An ECG reveals the following:

MCQ9 Graphic

His ECG is most consisted with:

A. Early repolarization – normal variant
B. Anterior myocardial infarction
C. Myocarditis
D. Pericarditis
E. Inferior myocardial infarction

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July 12th, 2014 · Leave a Comment

Sample Mayo Clinic’s CV Board Review Course

By Amy Beeman

Here’s a chance to experience the type of practical advice and immediate feedback that Mayo Clinic’s Cardiovascular Board Review course provides.  In this video from a previous Mayo Clinic board review course, Dr. Charanjit Rihal covers revascularization for coronary artery disease.

 

To learn more about Mayo Clinic’s CV Board Review course (Aug. 15-20, 2014 in Rochester), visit: http://www.mayo.edu/cme/cardiovascular-diseases-2014r221

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July 8th, 2014 · Leave a Comment

Test Your Knowledge Tuesday

By Amy Beeman

This week our board exam prep question covers hypertension.  Dr. Michael Hogan offers a case study aimed at recognizing the important clinical information pertaining to the pathophysiology involved, and using that information to arrive at the likely diagnosis.

Case:

You are asked to see 53-year-old woman, a dietitian, in consultation for hypertension.  She was found to have an elevated blood pressure on an FAA flight physical four years ago.  She has followed her physician’s recommendations and strictly avoids salt (uses Morton’s NoSalt™), limits alcohol consumption and exercises. She adopted a vegetarian diet. Despite these measures, her blood pressure remained above normal and her doctor prescribed several medication regimens. However, her pressure could not be maintained at less than 160/95.

Her medications include:

1)     Prempro (0.625/2.5 mg) - daily
2)     Triamterene/Hydrochlorothiazide (37.5/25mg) – daily
3)     Lisinopril (20 mg) – twice daily
4)     Atenolol (50 mg) - daily

Your examination detects the following:

1)    BP:  188/100 (seated), 190/100 (standing); HR: 80 beats/min.
2)    Normal funduscopic examination
3)    Normal peripheral pulses and no abdominal bruits
4)    Normal cardiopulmonary examination

Initial laboratory results include:

1)    Normal complete blood  count
2)    Creatinine 1.9  mg/dl  (N:0.6-1.0)
3)    Sodium 145 mEq/l  (N:135-145)
4)    Potassium 3.5 mEq/l   (N:3.5-4.5)
5)    Uric acid:  3.0 mg/dl  (N: 2.3-6.0)
6)    ECG:  LVH by voltage criteria
7)    Chest X-ray: normal

Question:

The most likely secondary form of hypertension in this setting is:

A. Primary aldosteronism
B. Renal artery stenosis
C. Pheochromocytoma
D. Chronic renal failure

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