Cardiovascular

A 58-year-old man with crushing chest pain radiating to the left arm is brought to the ER. ECG shows ST elevation in leads II, III, and aVF.

A 72-year-old woman presents with orthopnea, bilateral leg edema, and rales at lung bases. BNP is elevated.

A 45-year-old hypertensive man presents with sudden tearing chest pain radiating to the back. BP is higher in the right arm than the left.

A 66-year-old man presents with syncope. ECG shows fixed PR interval with intermittent dropped QRS complexes.

A 50-year-old woman with long-standing hypertension presents with headache and blurred vision. Fundoscopy reveals flame hemorrhages and cotton wool spots.

A 68-year-old man collapses while walking. ECG reveals sinus pauses lasting >3 seconds.

A 40-year-old man presents with palpitations after alcohol binge. ECG shows irregularly irregular rhythm without P waves.

A 59-year-old woman presents with exertional chest pain relieved by rest. Stress test shows ST depression.

A 73-year-old man presents with dizziness and palpitations. ECG shows wide complex tachycardia with AV dissociation.

A 62-year-old woman presents with sharp chest pain and a pericardial friction rub. ECG shows diffuse ST elevation.

A 55-year-old man with poorly controlled hypertension presents with sudden severe headache, vomiting, and left-sided weakness. CT brain shows a basal ganglia bleed.

A 34-year-old woman presents with recurrent syncope during exertion. Harsh systolic murmur best heard at right upper sternal border radiating to carotids.

A 70-year-old smoker presents with abdominal pulsatile mass and back pain. BP is 85/50 mmHg.

A 25-year-old man presents with fever, new diastolic murmur, and positive blood cultures for Strep viridans.

A 48-year-old woman presents with palpitations. ECG shows narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail.

A 63-year-old man with long history of hypertension presents with severe dyspnea, frothy pink sputum, and pulmonary edema on chest X-ray.

A 36-year-old woman presents with palpitations, sweating, and episodic headache. BP is 180/100 mmHg.

A 77-year-old man presents with progressive dyspnea and ankle swelling. JVP is elevated, hepatomegaly and ascites present.

A 42-year-old man presents with palpitations. ECG shows sawtooth flutter waves with ventricular rate ~150.

A 68-year-old woman presents with fatigue and dyspnea. Exam shows displaced apex beat, pansystolic murmur at apex radiating to axilla.

A 62-year-old man presents with progressive dyspnea and fatigue. On exam: displaced apex beat, loud S1, and an opening snap with diastolic rumble at the apex.

A 70-year-old woman with history of hypertension presents with sudden-onset speech difficulty and right-sided weakness. CT head shows no hemorrhage.

A 56-year-old man presents with palpitations and a collapsing pulse. On exam: early diastolic murmur at left sternal border.

A 40-year-old woman with lupus presents with chest pain worsened by inspiration and lying flat, improved when leaning forward.

A 28-year-old man presents with recurrent fainting spells during exertion. ECG shows short PR interval, delta wave, and wide QRS.

A 75-year-old man presents with sudden-onset left hemiplegia. Carotid Doppler shows 85% stenosis of right internal carotid artery.

A 45-year-old woman presents with palpitations and anxiety. ECG shows polymorphic ventricular tachycardia with twisting QRS complexes. Electrolytes reveal hypomagnesemia.

A 64-year-old man presents with crushing chest pain. ECG shows ST elevation in V1–V4. He suddenly develops pulseless electrical activity.

A 55-year-old man presents with palpitations. Exam reveals wide pulse pressure and head bobbing with heartbeat.

A 35-year-old man presents with chest pain after cocaine use. ECG shows ST elevation in V2–V4.

A 70-year-old woman with history of atrial fibrillation presents with sudden abdominal pain and bloody diarrhea. CT angiography shows superior mesenteric artery occlusion.

A 61-year-old man presents with dizziness and syncope. ECG shows complete AV dissociation with independent atrial and ventricular activity.

A 59-year-old woman presents with hemoptysis and dyspnea. Echocardiogram reveals left atrial enlargement and thickened mitral valve leaflets.

A 48-year-old man presents with fever, Janeway lesions, and a new holosystolic murmur at apex. Blood culture grows Staph aureus.

A 62-year-old man presents with palpitations. ECG shows regular narrow complex tachycardia at 200 bpm, terminated by carotid massage.

A 70-year-old man presents with chest pain, hypotension, JVP distension, and muffled heart sounds.

A 50-year-old woman presents with exertional dyspnea. Echocardiogram shows hypertrophied interventricular septum and systolic anterior motion of mitral valve.

A 63-year-old man presents with leg pain while walking that improves with rest. Exam reveals diminished dorsalis pedis pulse.

A 57-year-old man presents with chest pain, hypotension, and clear lungs. ECG shows ST elevation in II, III, and aVF.

A 71-year-old man presents with syncope. ECG shows prolonged QT interval and polymorphic ventricular tachycardia. He recently started on quinidine.

A 58-year-old man presents with crushing chest pain radiating to the left arm. Troponin I is elevated but ECG shows no ST elevation.

A 70-year-old woman presents with severe dyspnea at night. She sleeps with three pillows. Exam reveals bilateral basal crackles.

A 62-year-old man collapses suddenly. ECG shows pulseless electrical activity.

A 50-year-old man presents with palpitations. ECG shows irregularly irregular rhythm with narrow QRS complexes.

A 65-year-old woman presents with chest pain after dialysis. ECG shows ST elevation in diffuse leads and PR depression.

A 28-year-old man collapses while playing basketball. ECG shows ventricular fibrillation.

A 60-year-old smoker presents with intermittent calf pain on exertion, relieved by rest.

A 40-year-old woman presents with palpitations and syncope. ECG shows long QT interval.

A 52-year-old man presents with substernal chest pain relieved by nitroglycerin. ECG is normal, troponins are normal.

A 70-year-old woman presents with hypotension, muffled heart sounds, and distended jugular veins.

A 63-year-old man presents with palpitations. ECG shows narrow complex tachycardia at 180 bpm that terminates with adenosine.

A 58-year-old woman presents with syncope. ECG shows polymorphic ventricular tachycardia twisting around baseline.

A 55-year-old man presents with fever, splinter hemorrhages, and new murmur.

A 65-year-old man presents with severe tearing chest pain radiating to the back. BP difference between arms is 40 mmHg.

A 46-year-old woman presents with exertional dyspnea. Echocardiogram shows thickened mitral leaflets and left atrial enlargement.

A 72-year-old man presents with ankle swelling, ascites, and elevated JVP.

A 60-year-old man presents with sudden vision loss. Fundoscopy shows cherry-red spot and pale retina.

A 52-year-old woman presents with chest pain and palpitations. ECG shows delta wave and wide QRS.

A 70-year-old man presents with syncope while urinating. ECG shows sinus bradycardia at 35 bpm.

A 65-year-old woman presents with crushing chest pain. ECG shows ST depression in V2–V4. Troponin is elevated.

A 40-year-old woman with SLE presents with chest pain and pericardial rub. ECG shows diffuse ST elevation.

A 59-year-old man with diabetes presents with calf pain while walking. ABI is 0.6.

A 52-year-old woman presents with episodic palpitations and syncope. ECG shows prolonged QT. She is taking sotalol.

A 70-year-old man presents with exertional angina. Echo shows aortic valve area 0.8 cm² and mean gradient 50 mmHg.

A 48-year-old woman presents with palpitations and dizziness. ECG shows complete AV block with ventricular escape rhythm.

A 55-year-old man with fever, Osler nodes, and positive blood cultures. Echo shows vegetation on mitral valve.

A 62-year-old woman presents with severe chest pain. ECG shows ST elevation in leads I, aVL, V5–V6.

A 70-year-old man presents with acute pulmonary edema after MI. He develops new systolic murmur at apex.

A 50-year-old woman presents with syncope while standing. BP falls >20 mmHg on standing.

A 40-year-old man presents with chest pain and palpitations after marathon. ECG shows wide complex tachycardia.

A 65-year-old woman presents with exertional dyspnea. Echo shows EF 30%.

A 60-year-old man presents with syncope. ECG shows sinus bradycardia 30 bpm.

A 55-year-old man presents with sudden chest pain and diaphoresis. ECG shows ST elevation in V2–V4.

A 72-year-old woman presents with exertional dyspnea. Murmur: mid-diastolic rumble at apex.

A 50-year-old man with recent MI presents with persistent fever and pericardial pain.

A 70-year-old man with COPD presents with JVP elevation, hepatomegaly, and ankle edema.

A 63-year-old man presents with palpitations. ECG shows sawtooth waves.

A 40-year-old woman presents with chest pain after trauma. Echo shows free fluid in pericardial sac.

A 68-year-old man presents with dizziness. ECG shows progressive PR prolongation until a QRS is dropped.

A 52-year-old woman with chest pain. ECG shows diffuse ST elevation, PR depression. Pain relieved by sitting up.

A 62-year-old man with history of diabetes presents with exertional chest pain. Angiography shows 90% stenosis of left main coronary artery.

A 50-year-old woman presents with syncope. ECG shows wide complex tachycardia with AV dissociation.

A 73-year-old man presents with chest pain and dyspnea. ECG shows ST elevation in II, III, aVF. He is hypotensive with clear lungs.

A 59-year-old woman presents with severe dyspnea, orthopnea, and pink frothy sputum.

A 66-year-old man with long-standing hypertension presents with renal bruit and resistant hypertension.

A 42-year-old man presents with fever, Roth spots, and new systolic murmur.

A 70-year-old man presents with syncope. ECG shows complete dissociation between P waves and QRS complexes.

A 45-year-old man presents with acute chest pain. ECG shows ST elevation in V2–V4. Troponin is elevated.

A 53-year-old woman presents with syncope during emotional stress. ECG during event shows sinus bradycardia.

A 68-year-old man presents with fever, new holosystolic murmur, and splenomegaly.

A 60-year-old woman presents with acute chest pain, hypotension, and muffled heart sounds.

A 48-year-old man presents with severe dyspnea and chest pain. ECG shows ST elevation in all leads, echo shows pericardial effusion.

A 70-year-old man presents with exertional chest pain. Echo shows EF 25% with dilated ventricles.

A 35-year-old woman presents with palpitations. ECG shows irregularly irregular narrow complex tachycardia.

A 50-year-old man presents with chest pain after MI one week ago. He has fever and pericardial friction rub.

A 61-year-old man presents with exertional chest pain. Coronary angiogram shows 70% stenosis in three major vessels.

A 67-year-old woman presents with acute chest pain, sweating, and hypotension. ECG shows ST elevation in II, III, aVF.

A 70-year-old man presents with syncope. ECG shows progressive PR interval prolongation until a QRS is dropped.

A 44-year-old man presents with palpitations and wide pulse pressure. Exam shows early diastolic murmur.

A 75-year-old woman presents with severe dyspnea and pulmonary edema. Echo shows ruptured chordae tendineae.

A 68-year-old man presents with syncope and chest pain. ECG shows ventricular fibrillation.

A 56-year-old man presents with sharp chest pain improved by leaning forward. ECG shows diffuse ST elevation and PR depression.

A 45-year-old man presents with severe hypertension, headache, and retinal hemorrhages.

A 60-year-old woman presents with fatigue, dyspnea, and diastolic murmur. Echo shows restrictive filling pattern.

A 70-year-old man presents with sudden tearing chest pain. Chest X-ray shows widened mediastinum.

A 50-year-old woman presents with palpitations. ECG shows sawtooth flutter waves with ventricular rate 150.

A 64-year-old man presents with sudden dyspnea and chest pain post-MI. Echo shows VSD.

A 72-year-old woman presents with progressive dyspnea. Exam shows pansystolic murmur at apex radiating to axilla.

A 59-year-old man presents with palpitations. ECG shows irregularly irregular rhythm with absence of P waves.

A 65-year-old woman presents with severe chest pain radiating to the jaw. ECG shows ST elevation in V5–V6, I, aVL.

A 72-year-old man presents with recurrent syncope. ECG shows sinus pauses >4 seconds.

A 50-year-old woman presents with exertional chest pain. Coronary angiography shows 95% LAD stenosis.

A 63-year-old man presents with fatigue and dyspnea. Echo shows concentric LV hypertrophy with preserved EF.

A 70-year-old man presents with chest pain. ECG shows ST elevation in V1–V4 and reciprocal ST depression in II, III, aVF.

A 55-year-old man presents with fever and a new murmur. Echo shows vegetation on aortic valve.

A 68-year-old woman presents with dyspnea. Exam shows diastolic murmur at apex with opening snap.

A 60-year-old man presents with palpitations. ECG shows irregular narrow complex tachycardia.

A 48-year-old man presents with exertional angina. Stress test shows ST depression at 5 METs.

A 72-year-old man presents with syncope while walking. ECG shows complete heart block.

A 65-year-old woman presents with palpitations after thyroid surgery. ECG shows irregularly irregular narrow complex tachycardia.

A 70-year-old man presents with acute chest pain and tearing sensation radiating to the back. BP is 200/110 mmHg. Chest X-ray shows widened mediastinum.

A 55-year-old woman with rheumatic heart disease presents with progressive dyspnea. Exam reveals diastolic murmur with opening snap.

A 62-year-old man presents with severe dyspnea and orthopnea. Echo shows EF 30% with dilated LV.

A 46-year-old man presents with fever, petechiae, and splinter hemorrhages. New murmur at apex.

A 70-year-old woman presents with palpitations and dyspnea. ECG shows irregularly irregular rhythm with absent P waves.

A 58-year-old man presents with chest pain after blunt trauma. ECG shows electrical alternans.

A 72-year-old woman presents with dizziness. ECG shows dropped QRS after some P waves, constant PR interval.

A 60-year-old man with COPD presents with right heart failure signs (edema, JVD, hepatomegaly).

A 48-year-old woman presents with palpitations. Exam shows bounding pulses and diastolic murmur at left sternal border.

A 54-year-old man presents with chest pain and ST depression in II, III, aVF during exercise test.

A 63-year-old man presents with syncope while urinating at night.

A 68-year-old woman presents with crushing chest pain. ECG shows ST elevation in II, III, aVF.

A 72-year-old man presents with palpitations and syncope. ECG shows torsades de pointes.

A 66-year-old woman presents with progressive exertional dyspnea. Exam reveals harsh systolic murmur radiating to carotids.

A 55-year-old man presents with chest pain. ECG shows ST elevation in V1–V4.

A 60-year-old man presents with recurrent syncope. ECG shows prolonged QT interval.

A 72-year-old woman presents with dyspnea. Echo shows thickened pericardium and diastolic dysfunction.

A 70-year-old man presents with sudden chest pain after MI. Echo shows free wall rupture and pericardial effusion.

A 50-year-old woman presents with palpitations. ECG shows short PR interval and delta wave.

A 68-year-old man presents with crushing chest pain, hypotension, and ST elevation in V2–V4.

A 60-year-old woman presents with severe hypertension and papilledema.

A 72-year-old man presents with leg swelling and JVD. Echo shows preserved EF but concentric LV hypertrophy.

A 66-year-old woman presents with syncope. ECG shows AV dissociation and escape rhythm at 30 bpm.

A 75-year-old man with chronic atrial fibrillation presents with sudden leg pain. Exam shows absent pulses in leg.

A 60-year-old man presents with fever and new systolic murmur. Blood cultures grow Staphylococcus aureus.

A 48-year-old woman presents with palpitations. ECG shows paroxysmal narrow complex tachycardia terminated with carotid massage.

A 72-year-old man presents with chest pain. ECG shows diffuse ST elevation and PR depression.

A 65-year-old man presents with sudden dyspnea. Echo shows papillary muscle rupture.

A 50-year-old woman presents with severe hypertension, headache, and sweating. Labs show high catecholamines.

A 73-year-old man presents with acute chest pain. ECG shows ST elevation in V2–V5. Troponin is positive.

A 60-year-old man presents with recurrent palpitations. ECG shows irregular rhythm, multiple P wave morphologies.

A 67-year-old woman presents with edema, ascites, and hepatomegaly. Echo shows RV dysfunction with normal LV.

A 54-year-old man presents with chest pain. ECG shows ST elevation in I, aVL, V5, V6.

A 71-year-old man presents with syncope. ECG shows sinus bradycardia with pauses up to 6 seconds.

A 45-year-old man presents with exertional dyspnea. Echo shows asymmetric septal hypertrophy and systolic anterior motion of mitral valve.

A 63-year-old man presents with chest pain. ECG shows ST elevation in II, III, aVF with reciprocal depression in I, aVL.

A 59-year-old man presents with severe dyspnea and orthopnea. Echo shows EF 25%.

A 68-year-old woman presents with sudden tearing chest pain radiating to the back. BP unequal in arms.

A 50-year-old man presents with fever, new murmur, and Osler nodes.

A 70-year-old woman presents with syncope and wide complex tachycardia.

A 32-year-old woman presents 1 month after delivery with progressive dyspnea, orthopnea, and ankle swelling. Echocardiography shows dilated LV with EF 25% and no prior heart disease.

A 45-year-old man with a mechanical aortic valve is scheduled for dental extraction. He has no active infection.

A 68-year-old man with persistent atrial fibrillation, hypertension, and diabetes (CHA₂DS₂-VASc = 3) asks about stroke prevention.

A 59-year-old man presents within 60 minutes of chest pain onset. ECG shows STEMI in V2–V5. PCI-capable facility is available now.

A 38-year-old man with Marfan syndrome has progressive exertional dyspnea and a diastolic decrescendo murmur at left sternal border; wide pulse pressure is noted.

A 58-year-old man with inferior STEMI develops hypotension, clear lungs, and JVP elevation. Right-sided leads show ST elevation in V4R.

A 27-year-old man with a recent flu-like illness presents with chest pain, dyspnea, and elevated troponin. Echo shows global hypokinesis with mildly reduced EF.

A 51-year-old woman with resistant hypertension and muscle weakness has hypokalemia and metabolic alkalosis.

A 64-year-old man started hydrochlorothiazide for hypertension and now presents with a painful swollen big toe. Serum uric acid is elevated.

A 55-year-old woman develops a persistent dry cough 2 weeks after starting lisinopril for hypertension.

A 60-year-old man on high-intensity atorvastatin complains of muscle pain; CK is markedly elevated.

A 68-year-old woman with HFrEF (EF 30%) on ACE inhibitor and beta-blocker remains symptomatic (NYHA II–III). Potassium is 4.6, creatinine normal.

A 72-year-old man with HFrEF presents with orthopnea and pulmonary crackles; weight is up 3 kg in 1 week.

A 63-year-old woman with AF for 5 days is planned for electrical cardioversion. She has had no anticoagulation.

A 41-year-old woman has episodic chest pain at rest with transient ST elevation that resolves with sublingual nitroglycerin; angiography shows no fixed stenoses.

A 48-year-old man has recurrent nocturnal syncope. ECG shows coved ST elevation in V1–V3 with RBBB pattern. Family history of sudden death.

A 45-year-old woman reports fever, weight loss, and exertional dyspnea. On exam, a “tumor plop” is heard; symptoms worsen when upright and improve lying down.

A 69-year-old man with peripheral arterial disease develops rest pain and nonhealing toe ulcer with absent dorsalis pedis pulse.

A 29-year-old pregnant woman with a mechanical mitral valve seeks anticoagulation advice for the first trimester.

A 59-year-old man with acute anterior STEMI presents 4 weeks after an ischemic stroke. Fibrinolysis is being considered in a non-PCI facility.