A 66-year-old woman presents to the emergency department after a fall 4 hours ago. She was on her way to the bathroom when she fell to the ground and lost consciousness. Although she regained consciousness within one minute, she experienced lightheadedness for almost half an hour. She has experienced on-and-off dizziness for the past 2 weeks whenever she tries to stand. She has a history of type 2 diabetes mellitus, hypertension, hypercholesterolemia, and chronic kidney disease secondary to polycystic kidneys. Her medications include aspirin, bisoprolol, doxazosin, erythropoietin, insulin, rosuvastatin, and calcium and vitamin D supplements. She has a blood pressure of 111/74 mm Hg while supine and 84/60 mm Hg on standing, the heart rate of 48/min, the respiratory rate of 14/min, and the temperature of 37.0°C (98.6°F). CT scan of the head is unremarkable. Electrocardiogram reveals a PR interval of 250 ms. What is the next best step in the management of this patient?
ATilt table testing
BHolter monitoring
CStop antihypertensive medicines
DElectroencephalogram
EStart anti-epileptics
A 59-year-old man is brought to the emergency department one hour after developing shortness of breath and “squeezing” chest pain that began while he was mowing the lawn. He has asthma, hypertension, and erectile dysfunction. Current medications include salmeterol, amlodipine, lisinopril, and vardenafil. His pulse is 110/min and blood pressure is 122/70 mm Hg. Physical examination shows diaphoresis. An ECG shows sinus tachycardia. Sublingual nitroglycerin is administered. Five minutes later, his pulse is 137/min and his blood pressure is 78/40 mm Hg. Which of the following is the most likely mechanism of this patient's hypotension?
ABradykinin accumulation
BCyclic GMP elevation
CDecreased nitric oxide production
DCalcium channel antagonism
EAlpha-1 receptor antagonism
A woman with coronary artery disease is starting to go for a walk. As she begins, her heart rate accelerates from a resting pulse of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her chest. She stops walking to rest and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement?
AThis patient's chest pain is indicative of transmural ischemia
BPerfusion of the myocardium takes place equally throughout the cardiac cycle
CIncreasing the heart rate increases the amount of time spent during each cardiac cycle
DIncreasing the heart rate decreases the relative amount of time spent during diastole
EPerfusion of the myocardium takes place primarily during systole
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