A 62-year-old man comes to the physician for decreased exercise tolerance. Over the past four months, he has noticed progressively worsening shortness of breath while walking his dog. He also becomes short of breath when lying in bed at night. His temperature is 36.4°C (97.5°F), pulse is 82/min, respirations are 19/min, and blood pressure is 155/53 mm Hg. Cardiac examination shows a high-pitch, decrescendo murmur that occurs immediately after S2 and is heard best along the left sternal border. There is an S3 gallop. Carotid pulses are strong. Which of the following is the most likely diagnosis?
AAortic valve regurgitation
BTricuspid valve regurgitation
CMitral valve prolapse
DMitral valve regurgitation
EMitral valve stenosis
A 76-year-old male with a history of chronic uncontrolled hypertension presents to the emergency room following an episode of syncope. He reports that he felt lightheaded and experienced chest pain while walking his dog earlier in the morning. He notes that he has experienced multiple similar episodes over the past year. A trans-esophageal echocardiogram demonstrates a thickened, calcified aortic valve with left ventricular hypertrophy. Which of the following heart sounds would likely be heard on auscultation of this patient?
ACrescendo-decrescendo murmur radiating to the carotids that is loudest at the right upper sternal border
BDiastolic rumble following an opening snap with an accentuated S1
CEarly diastolic high-pitched blowing decrescendo murmur that is loudest at the left sternal border
DHolosystolic murmur radiating to the axilla that is loudest at the apex
EMidsystolic click that is loudest at the apex
A 64-year-old man presents to his physician for a scheduled follow-up visit. He has chronic left-sided heart failure with systolic dysfunction. His current regular medications include captopril and digoxin, which were started after his last episode of symptomatic heart failure approximately 3 months ago. His last episode of heart failure was accompanied by atrial fibrillation, which followed an alcohol binge over a weekend. Since then he stopped drinking. He reports that he has no current symptoms at rest and is able to perform regular physical exercise without limitation. On physical examination, mild bipedal edema is noted. The physician suggested to him that he should discontinue digoxin and continue captopril and scheduled him for the next follow-up visit. Which of the following statements best justifies the suggestion made by the physician?
ALong-term digoxin therapy produces significant survival benefits in patients with heart failure, but at the cost of increased heart failure-related admissions.
BBoth captopril and digoxin are likely to improve the long-term survival of the patient with heart failure, but digoxin has more severe side effects.
CCaptopril is likely to improve the long-term survival of the patient with heart failure, unlike digoxin.
DDigoxin does not benefit patients with left-sided heart failure in the absence of atrial fibrillation.
EDigoxin is useful to treat atrial fibrillation, but does not benefit patients with systolic dysfunction who are in sinus rhythm.
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