1. A 59-year-old man with no prior cardiac history presents to the emergency department with

symptoms of retrosternal chest pain starting at rest and lasting 30 minutes. The pain radiates to

the left armand is associated with diaphoresis and dyspnea.

On physical examination, his blood pressure is 150/90 mm Hg, pulse is 100/min, the heart

sounds are normal, and the lungs are clear to auscultation. Which of the following is the next

most appropriate investigation?

2. A 37-year-old African-American woman is seen in the office for evaluation of an elevated blood

pressure of 140/100 mm Hg at rest. She has no associated symptoms and her past medical

history is negative. Her family history reveals that her father also has hypertension.

On physical examination the pertinent negatives are a normal funduscopic examination,

normal heart sounds, absence of an S4, and no renal bruits. Table 1-1 shows laboratory

investigations for this patient. Which of the following is the most likely diagnosis?

3. An 8-year-old boy is brought to the clinic for evaluation of symptoms of easy fatigability. He

reports no chest pressure, shortness of breath, or weakness. The symptoms of the fatigue are

more pronounced when he is playing with his friends and his mother notes that he usually cannot

keep up with his peers. His past medical history and family history is noncontributory.

On physical examination, the blood pressure is 140/90 mm Hg, heart rate is 80/min, and

there is a soft continuous murmur in the upper back. The femoral pulses are diminished in

4. A 64-year-old male executive is evaluated in the clinic for routine follow up after a large

anterior MI 3 years ago. At the time he developed anterior Q-waves and his course was

complicated by heart failure. On his ECG there is anterior Q-waves and persistent ST

elevation. Since then he has done well and has no symptoms of chest pain on exertion, shortness

of breath, or palpitations. He continues on his medications which are aspirin, metoprolol,

enalapril, and atorvastatin. What is the abnormality seen on the patient's x-ray shown in

5. A 70-year-old man is evaluated in emergency department for symptoms of dyspnea, orthopnea,

and paroxysmal nocturnal dyspnea. His past medical history is significant for hypertension, type

2 diabetes, chronic kidney disease, and hypothyroidism. Medications are furosemide, enalapril,

atorvastatin, metformin, and insulin.

On physical examination he has generalized cardiomegaly and pulmonary and systemic

venous hypertension. The ECG is shown in Figure 1-15. What is the cardiac rhythm seen on

the ECG?

6. A 77-year-old woman comes to the emergency department because of feeling "light-headed and

dizzy." Except for the irregular pulse, her physical examination is normal. What is the rhythm

in the lead tracing shown in Figure 1-16?

7. A 42-year-old woman is seen in the office for assessment of anterior chest pain of a somewhat

atypical nature. The pain is in the anterior chest and occurs intermittently at rest and on exertion

but there is no consistency. The pain does not change with respiration and she reports no other

symptoms. The patient's pain has been present for a number of years now and there is no change

in the frequency or quality of the pain. Her physical examination is normal. An ECG is done and

shown in Figure 1-17. It is not changed from a previous tracing 6 months ago. What is the

interpretation of the ECG?

8. A 67-year-old woman is seen in the emergency department complaining of retrosternal chest pain

which started 30 minutes prior to presentation. Her medical history is significant for angina,

hypertension, and dyslipidemia. The pain is similar to her usual angina but more severe and

nonresponsive to sublingual nitroglycerine.

Her initial ECG reveals ST-elevation in the inferior leads and she is treated with aspirin

and thrombolytic therapy. A follow up ECG obtained just after she received the thrombolytic

therapy is shown in Figure 1-18. What is the rhythmseen on the ECG?

9. A 78-year-old man with chronic kidney disease presents to the emergency department because he

is feeling unwell. He can not elaborate any specific symptoms other than generalized malaise.

His past medical history also includes heart failure, hypertension, and type 2 diabetes.

Medications are ramipril, insulin, furosemide, and metoprolol.

On physical examination, the blood pressure is 155/90 mm Hg, heart rate is 100/min, and

respiration 24/min. His heart sounds are normal, there is no edema, and the lungs clear on

auscultation. An ECG is performed and shown in Figure 1-19. What is the most likely

diagnosis based on the ECG findings?

10. A 58-year-old man whom you have followed dies suddenly, spurring you into doing some

research on sudden death. Which of the following is the most likely cause forthis individual?