July 29th, 2014 · Leave a Comment

Test Your Knowledge Tuesday #11

By Amy Beeman

Board exam prep continues with a question this week from Dr. Charles Bruce covering findings in a cardiac physical exam.

 A 35 year-old woman presents with mild exertional shortness of breath. She has a history of rheumatic fever when she was a young child. On exam her pulse is 78 beats per minute and blood pressure is 138/70. The lungs are clear to auscultation.  The cardiac exam reveals a loud first heart sound and S2 is physiologically split with a loud S2P component. The apical impulse is tapping, non-displaced and discrete. There is a high pitched early diastolic snapping sound heard clearly at the apex and followed by a long, low pitched, diastolic murmur with pre-systolic accentuation. There is an RV lift.  Jugular venous pressure is 10 cm H20. Based on the associated findings, you feel the patient may have severe mitral stenosis.

 What other clinical observations would you expect to find in this patient?

A. Atrial fibrillation
B. Prominent “a” wave in the JVP
C. Reversed splitting of S2
D. S3
E. Wide aortic closure to mitral valve opening interval

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July 24th, 2014 · Leave a Comment

Implications of CAD in Heart Failure With Preserved Ejection Fraction

By Amy Beeman

Coronary artery disease (CAD) is common in patients with heart failure with preserved ejections fraction (HFpEF), but it remains unclear how CAD should be categorized, evaluated and treated in HFpEF.

A recent study using Mayo Clinic data investigated the characteristics, evaluation, prognostic impact, and treatment of CAD in HFpEF patients.

Mayo Clinic Cardiologist Dr. Barry Borlaug co-authored a paper on the study, which appeared in the July 1 issue of the “Journal of American College of Cardiology” (JACC).

Results of this study showed that CAD is common in patients with HFpEF and is associated with increased mortality and greater deterioration in ventricular function. Revascularization may be associated with preservation of cardiac function and improved outcomes in patients with CAD. Given the paucity of effective treatments for HFpEF, prospective trials are urgently needed to determine the optimal evaluation and management of CAD in HFpEF.

To read the full text of Dr. Borlaug’s paper, see  JACC article on CAD in HFpEF

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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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