CARDIOVASCULAR

SYSTEM PBL CASES

AND RELATED
QUESTIONS WITH
THEIR ANSWERS
ADRESS =https://t.me/wusomall
WU school of medicine,

PBL cases related to the cardiovascular system, along with sample questions and answers:

PBL Case: "Acute Myocardial Infarction (MI)"

Case Description:
A 55-year-old male presents to the emergency department with severe chest pain radiating to his left
arm, diaphoresis, and shortness of breath. He has a history of hypertension and hyperlipidemia.
Electrocardiogram (ECG) shows ST-segment elevation in leads V2-V4.

Questions:

What are the risk factors for developing acute myocardial infarction (MI) in this patient?
Possible answers: Risk factors include smoking, hypertension, hyperlipidemia (elevated cholesterol
levels), diabetes mellitus, obesity, family history of premature cardiovascular disease, and a sedentary
lifestyle.

What additional information would you like to gather from the patient's history?
Possible answers: Duration and characteristics of the chest pain, associated symptoms (such as
nausea or lightheadedness), previous history of cardiovascular disease or events, compliance with
medications, and recent stressors or triggers.

What specific physical examination findings would you expect in a patient with acute MI?
Possible answers: Diaphoresis, tachycardia, signs of respiratory distress, elevated blood pressure,
abnormal heart sounds (such as a third or fourth heart sound), and signs of heart failure (such as
crackles on lung auscultation or peripheral edema).

What diagnostic tests would you order to evaluate and confirm the suspected diagnosis of acute MI?
Possible answers: ECG to assess for ST-segment changes or other ischemic changes, cardiac enzyme
tests (such as troponin levels), echocardiography (to assess left ventricular function and wall motion
abnormalities), and coronary angiography (to assess the extent of coronary artery disease).

What are the treatment options for managing acute MI in this patient?
Possible answers: Reperfusion therapy is crucial, either through percutaneous coronary intervention
(PCI) or thrombolytic therapy. Medications may include antiplatelet agents, beta-blockers,
angiotensin-converting enzyme inhibitors (ACE inhibitors), statins, and anticoagulants. Lifestyle
modifications, cardiac rehabilitation, and secondary prevention strategies (such as smoking cessation
and lipid-lowering therapy) are also important.

PBL Case: "Hypertension Management"

Case Description:
A 62-year-old female is seen in the clinic for a routine check-up. During the visit, her blood pressure is
consistently elevated. She has a family history of hypertension and is overweight. Physical
examination shows no significant abnormalities.

Questions:

What are the risk factors for developing hypertension in this patient?
Possible answers: Risk factors include family history of hypertension, advancing age, obesity,
sedentary lifestyle, excessive sodium intake, excessive alcohol consumption, smoking, and certain
medical conditions (such as diabetes mellitus or chronic kidney disease).

What additional information would you like to gather from the patient's history?
Possible answers: Duration and level of hypertension, presence of symptoms (such as headaches or
dizziness), history of cardiovascular disease or other comorbidities, lifestyle factors (such as diet and
exercise habits), and medication history (including compliance).

What specific physical examination findings would you expect in a patient with hypertension?
Possible answers: Elevated blood pressure (measured in both arms), signs of end-organ damage (such
as retinopathy, left ventricular hypertrophy, or renal abnormalities), and signs of other cardiovascular
risk factors (such as obesity or abnormal lipid profiles).

What diagnostic tests would you order to evaluate and assess the patient's hypertension?
Possible answers: Ambulatory blood pressure monitoring (to assess blood pressure over a 24-hour
period), blood tests (such as complete blood count, electrolyte levels, and renal function tests), lipid
profile, and assessment of other cardiovascular risk factors (such as fasting blood glucose or
echocardiography).

What are the treatment options for managing hypertension in this patient?
Possible answers: Lifestyle modifications are essential, including dietary changes (such as adopting
the DASH diet), weight loss, regular physical activity, sodium restriction, moderation of alcohol
consumption, and smoking cessation. Medications may include thiazide diuretics, angiotensin-
converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), calcium channel
blockers, beta-blockers, or a combination of these.

PBL Case: "Atrial Fibrillation (AF) Management"

Case Description:
A 70-year-old male with a history of hypertension and coronary artery disease presents to the clinic
with palpitations and shortness of breath. Electrocardiogram (ECG) shows an irregularly irregular
rhythm consistent with atrial fibrillation. He is currently taking a beta-blocker for his hypertension.

Questions:

What are the risk factors for developing atrial fibrillation (AF) in this patient?
Possible answers: Risk factors include advancing age, hypertension, coronary artery disease, heart
failure, obesity, diabetes mellitus, valvular heart disease, thyroid dysfunction, and excessive alcohol
consumption.

What additional information would you like to gather from the patient's history?
Possible answers: Duration and frequency of symptoms, previous history of AF or other arrhythmias,
presence of other cardiovascular or comorbid conditions, medication history (including compliance
with antihypertensive medications), and lifestyle factors (such as caffeine or alcohol intake).

What specific physical examination findings would you expect in a patient with AF?
Possible answers: Irregularly irregular pulse, signs of heart failure (such as crackles on lung
auscultation or peripheral edema), signs of embolic events (such as focal neurologic deficits), and
signs of underlying cardiac disease (such as murmurs or abnormal heart sounds).

What diagnostic tests would you order to evaluate and assess the patient's atrial fibrillation?

Possible answers: ECG to confirm the diagnosis and assess the ventricular response rate,
echocardiography (to assess cardiac structure and function), thyroid function tests, and assessment of
other cardiovascular risk factors (such as lipid profile or fasting blood glucose).

What are the treatment options for managing atrial fibrillation in this patient?
Possible answers: Rate control and rhythm control strategies are considered. Rate control may involve
the use of beta-blockers, calcium channel blockers, or digoxin. Rhythm control may involve
antiarrhythmic medications or catheter ablation. Anticoagulation therapy with oral anticoagulants
(such as warfarin or direct oral anticoagulants) is also essential for stroke prevention.
PBL Case: "Heart Failure Management"

Case Description:
A 60-year-old female with a history of hypertension and diabetes mellitus presents to the emergency
department with worsening shortness of breath, fatigue, and lower extremity edema. Physical
examination reveals elevated jugular venous pressure, crackles on lung auscultation, and pitting
edema.

Questions:

What are the risk factors for developing heart failure in this patient?
Possible answers: Risk factors include hypertension, coronary artery disease, diabetes mellitus,
obesity, valvular heart disease, previous myocardial infarction, family history of heart failure, and
certain medications (such as nonsteroidal anti-inflammatory drugs or chemotherapeutic agents).

What additional information would you like to gather from the patient's history?
Possible answers: Duration and progression of symptoms, presence of other cardiovascular symptoms
(such as chest pain or palpitations), compliance with medications, recent changes in medication or
medical conditions, and lifestyle factors (such as diet and exercise habits).

What specific physical examination findings would you expect in a patient with heart failure?
Possible answers: Elevated jugular venous pressure, crackles on lung auscultation, displaced point of
maximal impulse, presence of an S3 or S4 heart sound, peripheral edema (such as pitting edema in
the lower extremities), and signs of underlying cardiac disease (such as murmurs or abnormal heart
sounds).

What diagnostic tests would you order to evaluate and assess the patient's heart failure?
Possible answers: Echocardiography (to assess cardiac structure and function), chest X-ray (to assess
for pulmonary congestion), electrocardiogram (ECG), complete blood count, renal function tests, and
assessment of other cardiovascular risk factors (such as lipid profile or fasting blood glucose).

What are the treatment options for managing heart failure in this patient?
Possible answers: Medications may include diuretics (to relieve symptoms of fluid overload),
angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs),
beta-blockers, aldosterone antagonists, and, in some cases, digoxin. Lifestyle modifications, such as
sodium restriction, fluid restriction, and regular physical activity, are also important. Management of
comorbidities (such as diabetes mellitus) and cardiac rehabilitation may be necessary.

PBL Case: "Peripheral Arterial Disease (PAD)"

Case Description:
A 65-year-old male smoker presents to the clinic with intermittent claudication, characterized by
cramping leg pain that occurs with walking and improves with rest. He has a history of hypertension
and hyperlipidemia. Physical examination reveals diminished pedal pulses and cool skin in the lower
extremities.

Questions:

What are the risk factors for developing peripheral arterial disease (PAD) in this patient?
Possible answers: Risk factors include smoking, hypertension, hyperlipidemia (elevated cholesterol
levels), diabetes mellitus, advancing age, obesity, sedentary lifestyle, and a family history of PAD or
cardiovascular disease.

What additional information would you like to gather from the patient's history?
Possible answers: Duration and progression of symptoms, presence of other cardiovascular symptoms
(such as chest pain or shortness of breath), previous history of cardiovascular disease or events,
smoking history (including pack-years), compliance with medications, and lifestyle factors (such as
physical activity levels or diet).

What specific physical examination findings would you expect in a patient with PAD?
Possible answers: Diminished or absent peripheral pulses, cool or pale skin in the affected limbs, hair
loss or thinning over the affected area, delayed capillary refill, and signs of chronic wounds or ulcers
(in severe cases).

What diagnostic tests would you order to evaluate and assess the patient's peripheral arterial disease?
Possible answers: Ankle-brachial index (ABI) measurement to assess the ratio of systolic blood
pressure in the ankle to that in the arm, arterial duplex ultrasound to assess blood flow and identify
stenosis or occlusions, and possibly further imaging studies (such as angiography or magnetic
resonance angiography) to assess the extent and location of arterial disease.

What are the treatment options for managing peripheral arterial disease in this patient?
Possible answers: Lifestyle modifications are crucial, including smoking cessation, regular physical
activity (such as supervised exercise programs), healthy diet, weight management, and control of
other cardiovascular risk factors (such as hypertension and hyperlipidemia). Medications may include
antiplatelet agents (such as aspirin or clopidogrel), statins, and medications to control hypertension.
In some cases, revascularization procedures (such as angioplasty or bypass surgery) may be
considered.

PBL Case: "Valvular Heart Disease"

Case Description:
A 45-year-old female presents with dyspnea on exertion, fatigue, and occasional palpitations. She has
a history of rheumatic fever in childhood. Physical examination reveals a diastolic murmur heard best
at the apex and mid-left sternal border.

Questions:

What are the risk factors for developing valvular heart disease in this patient?
Possible answers: Risk factors include a history of rheumatic fever, certain congenital heart conditions,
a history of infective endocarditis, advancing age, and conditions that contribute to the development
of atherosclerosis (such as hypertension or diabetes mellitus).

What additional information would you like to gather from the patient's history?
Possible answers: Duration and progression of symptoms, previous history of rheumatic fever or
other cardiac conditions, medication history (including compliance with prophylactic antibiotics), and
any recent infections or dental procedures.

What specific physical examination findings would you expect in a patient with valvular heart disease?
Possible answers: Presence of a murmur (systolic, diastolic, or both) heard over the affected valve,
abnormal heart sounds (such as an opening snap or an ejection click), signs of heart failure (such as
pulmonary congestion or peripheral edema), and signs of underlying cardiac disease (such as
abnormal jugular venous pulsations).

What diagnostic tests would you order to evaluate and assess the patient's valvular heart disease?
Possible answers: Echocardiography (transthoracic or transesophageal) to assess the structure and
function of the valves, Doppler studies to assess blood flow and pressure gradients across the valves,
and electrocardiogram (ECG) to assess for any conduction abnormalities or arrhythmias.

What are the treatment options for managing valvular heart disease in this patient?
Possible answers: Treatment depends on the severity and type of valvular disease. Medical
management may include diuretics (to relieve symptoms of fluid overload), medications to control
heart rate or rhythm, and medications to manage associated conditions (such as hypertension or
heart failure). In some cases, surgical intervention (such as valve repair or replacement) may be
necessary.

Remember that these are sample PBL cases and questions. In a real PBL session, participants would
collaborate to explore the case, generate questions, and discuss possible answers based on their
knowledge and research. The complexity and scope of the questions can vary depending on theI
apologize for the incomplete response. It seems that my previous response got cut off. Here are a few
more PBL cases and questions related to the cardiovascular system:

PBL Case: "Hypertension Management"

Case Description:
A 55-year-old male presents to the clinic for a routine check-up. His blood pressure readings
consistently range from 150/90 mmHg to 160/100 mmHg. He has a family history of hypertension and
is overweight. He does not have any symptoms related to his blood pressure.

Questions:

What are the risk factors for developing hypertension in this patient?
Possible answers: Risk factors include family history of hypertension, advancing age, obesity,
sedentary lifestyle, excessive sodium intake, excessive alcohol consumption, tobacco use, and certain
medical conditions (such as diabetes and chronic kidney disease).

What additional information would you like to gather from the patient's history?
Possible answers: Duration of hypertension, previous blood pressure measurements, medication
history (including over-the-counter medications and herbal supplements), lifestyle factors (such as
dietary habits, physical activity levels, and stress), and presence of any symptoms or complications
related to hypertension.

What specific physical examination findings would you expect in a patient with hypertension?
Possible answers: Elevated blood pressure readings on multiple occasions, signs of end-organ damage
(such as retinal changes, left ventricular hypertrophy, or renal abnormalities), and signs of
comorbidities associated with hypertension (such as obesity or signs of metabolic syndrome).

What diagnostic tests would you order to evaluate and assess the patient's hypertension?
Possible answers: Blood pressure measurements on multiple occasions, laboratory tests (such as
complete blood count, electrolytes, renal function tests, lipid profile, and fasting blood glucose), and
assessment of target organ damage through imaging studies (such as echocardiography or renal
ultrasound).

What are the treatment options for managing hypertension in this patient?
Possible answers: Lifestyle modifications are crucial, including weight loss, adoption of a healthy diet
(such as the DASH diet), sodium restriction, increased physical activity, moderation of alcohol
consumption, and smoking cessation. Medications may include thiazide diuretics, angiotensin-
converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), calcium channel
blockers, beta-blockers, and other antihypertensive agents.

PBL Case: "Acute Myocardial Infarction (Heart Attack)"

Case Description:
A 60-year-old male with a history of hypertension and hyperlipidemia presents to the emergency
department with severe chest pain radiating to his left arm. He is diaphoretic and appears distressed.
Electrocardiogram (ECG) shows ST-segment elevation in the anterior leads.

Questions:
What are the risk factors for developing acute myocardial infarction (heart attack) in this patient?
Possible answers: Risk factors include hypertension, hyperlipidemia (elevated cholesterol levels),
smoking, diabetes mellitus, family history of premature coronary artery disease, obesity, sedentary
lifestyle, and male gender.

What additional information would you like to gather from the patient's history?
Possible answers: Duration and characteristics of chest pain, previous history of cardiovascular events
or interventions, medication history (including compliance with antihypertensive and lipid-lowering
medications), family history of cardiovascular disease, and lifestyle factors (such as diet, exercise
habits, and tobacco use).

What specific physical examination findings would you expect in a patient with acute myocardial
infarction?
Possible answers: Severe chest pain or discomfort, diaphoresis, anxiety, signs of heart failure (such as
crackles on lung auscultation or peripheral edema), abnormal cardiac sounds (such as an S4 gallop or
new murmurs), and signs of cardiogenic shock (such as hypotension and cool extremities).

What diagnostic tests would you order to evaluate and assess the patient's acute myocardial
infarction?
Possible answers: Electrocardiogram (ECG) to assess for ST-segment elevation or other changes
suggestive of myocardial infarction, cardiac biomarkers (such as troponin levels), complete blood
count, lipid profile, renal function tests, and imaging studies (such as echocardiography or coronary
angiography).

What are the treatment options for managing acute myocardial infarction in this patient?
Possible answers: Immediate reperfusion therapy is crucial, which can be achieved through
percutaneous coronary intervention (PCI) or fibrinolysis (if PCI is not readily available). Aspirin and
other antiplatelet agents, beta-blockers, ACE inhibitors, statins, and other medications may be
prescribed to stabilize the patient, prevent further ischemic events, and manage comorbidities.

WU school of medicine, [11/14/2023 7:36 PM]

PBL Case: "Chest Pain in a Middle-Aged Male"

Case Description:
A 45-year-old male presents to the emergency department with acute-onset chest pain. He describes
the pain as a crushing sensation in the center of his chest that radiates to his left arm. He also
experiences shortness of breath and diaphoresis. He has a family history of coronary artery disease.

Questions:

What are the possible causes of chest pain in this patient?

Possible answers:
Possible causes include acute myocardial infarction (heart attack), unstable angina, pericarditis, aortic
dissection, pulmonary embolism, or gastroesophageal reflux disease (GERD).

What additional information would you like to gather from the patient's history?
Possible answers:
Duration and characteristics of chest pain, associated symptoms (such as nausea, vomiting, or
lightheadedness), risk factors for coronary artery disease (such as smoking, diabetes, hypertension, or
hyperlipidemia), previous cardiac history, and any recent physical or emotional stressors.

What specific physical examination findings would you expect in a patient with chest pain?
Possible answers:
Elevated heart rate and blood pressure, signs of distress (such as diaphoresis or pallor), abnormal
heart sounds (such as a murmur or extra heart sounds), signs of heart failure (such as crackles in the
lungs or peripheral edema), and signs of other associated conditions (such as pleuritic chest pain in
pericarditis).
What diagnostic tests would you order to evaluate and assess the patient's chest pain?
Possible answers:
Electrocardiogram (ECG), cardiac enzymes (such as troponin), chest X-ray, echocardiogram, stress test,
and coronary angiography may be considered based on the clinical suspicion.

What are the immediate treatment options for managing this patient with suspected acute coronary
syndrome?
Possible answers:
Immediate treatment options may include oxygen supplementation, nitroglycerin, aspirin, and
morphine for pain relief. Urgent revascularization procedures, such as percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG), may be necessary based on the severity
and extent of coronary artery disease.

PBL Case: "Palpitations and Dizziness in a Young Female"

Case Description:
A 25-year-old female presents to the clinic with complaints of palpitations and dizziness. She
describes episodes of a racing heartbeat that lasts for a few minutes and resolves spontaneously. She
has no significant medical history and denies any substance use.

Questions:

What are the possible causes of palpitations and dizziness in this patient?
Possible answers:
Possible causes include supraventricular tachycardia (SVT), premature ventricular contractions (PVCs),
anxiety or panic attacks, hyperthyroidism, anemia, mitral valve prolapse, or electrolyte imbalances.

What additional information would you like to gather from the patient's history?
Possible answers:
Frequency and duration of palpitations, precipitating factors or triggers, associated symptoms (such
as chest pain, shortness of breath, or syncope), family history of cardiac arrhythmias, recent stressors
or emotional disturbances, and any history of fainting or near-fainting episodes.

What specific physical examination findings would you expect in a patient with palpitations and
dizziness?
Possible answers:
Vital signs, including heart rate and blood pressure, signs of hemodynamic compromise (such as
hypotension or tachycardia), signs of anemia (such as pallor or tachycardia), and signs of other
associated conditions (such as hyperthyroidism or mitral valve prolapse).

What diagnostic tests would you order to evaluate and assess the patient's palpitations and dizziness?
Possible answers:
Electrocardiogram (ECG), Holter monitor or event recorder, blood tests (such as complete blood
count and thyroid function tests), and echocardiogram may be considered based on the clinical
suspicion.

WU school of medicine, [11/14/2023 7:36 PM]

What are the treatment options for managing this patient with suspected SVT or other arrhythmias?
Possible answers:
Treatment options for SVT may include vagal maneuvers, such as the Valsalva maneuver or carotid
sinus massage, to terminate the arrhythmia. If these maneuvers are ineffective, adenosine or other
antiarrhythmic medications may be used. In some cases, catheter ablation may be considered as a
definitive treatment.
PBL Case: "Shortness of Breath and Lower Extremity Edema in an Elderly Female"

Case Description:
An 80-year-old female presents to the primary care clinic with a complaint of progressive shortness of
breath and swelling in her legs. She reports difficulty performing activities of daily living and has
noticed weight gain over the past few weeks. She has a history of hypertension and atrial fibrillation.

Questions:

What are the possible causes of shortness of breath and lower extremity edema in this patient?
Possible answers:
Possible causes include congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD),
pulmonary hypertension, valvular heart disease (such as mitral regurgitation or aortic stenosis), deep
vein thrombosis (DVT), or renal dysfunction.

What additional information would you like to gather from the patient's history?
Possible answers:
Onset and progression of symptoms, associated symptoms (such as orthopnea or paroxysmal
nocturnal dyspnea), medication history (including compliance with diuretics or anticoagulants), recent
infections or exacerbations of chronic conditions, and any recent changes in renal function or urinary
output.

What specific physical examination findings would you expect in a patient with shortness of breath
and lower extremity edema?
Possible answers:
Vital signs, including heart rate, blood pressure, and oxygen saturation, signs of respiratory distress
(such as increased work of breathing or use of accessory muscles), abnormal lung sounds (such as
crackles or wheezes), signs of fluid overload (such as jugular venous distention or peripheral edema),
and signs of associated conditions (such as hepatomegaly in right-sided heart failure).

What diagnostic tests would you order to evaluate and assess the patient's symptoms?
Possible answers:
Chest X-ray, electrocardiogram (ECG), echocardiogram, complete blood count, renal function tests,
brain natriuretic peptide (BNP) level, and D-dimer test may be considered based on the clinical
suspicion.

What are the treatment options for managing this patient with suspected congestive heart failure?
Possible answers:
Treatment options for CHF may include diuretics (such as furosemide) to reduce fluid overload,
angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to improve
cardiac function, beta-blockers to control heart rate, and lifestyle modifications (such as sodium
restriction and weight management) to optimize heart failure management.

PBL Case: "Syncope and Exercise Intolerance in a Teenage Athlete"

Case Description:
A 16-year-old male presents to the sports medicine clinic with a history of recurrent episodes of
syncope during exercise. He reports feeling lightheaded and dizzy before losing consciousness. He is
an active athlete participating in competitive sports.

Questions:

What are the possible causes of syncope and exercise intolerance in this teenage athlete?
Possible answers:
Possible causes include vasovagal syncope, exercise-induced arrhythmias (such as long QT syndrome
or hypertrophic cardiomyopathy), dehydration or electrolyte imbalances, exercise-induced asthma, or
aortic stenosis.

What additional information would you like to gather from the patient's history?
Possible answers:
Frequency and duration of syncope episodes, circumstances surrounding each episode (such as
exertion level and environmental factors), any associated symptoms (such as palpitations or chest
pain), family history of syncope or sudden cardiac death, and any recent changes in exercise routine
or intensity.

What specific physical examination findings would you expect in a patient with syncope and exercise
intolerance?
Possible answers:
Vital signs, including heart rate and blood pressure in different positions (such as supine and standing),
signs of dehydration (such as dry mucous membranes or decreased skin turgor), signs of cardiac
abnormalities (such as murmurs or abnormal heart sounds), and signs of other associated conditions
(such as abnormal lung sounds in exercise-induced asthma).

What diagnostic tests would you order to evaluate and assess the patient's symptoms?
Possible answers:
Electrocardiogram (ECG), exercise stress test, echocardiogram, and possibly additional tests like
Holter monitor, cardiac MRI, or genetic testing may be considered based on the clinical suspicion.

What are the treatment options for managing this patient with suspected exercise-induced syncope?
Possible answers:
Treatment options may include lifestyle modifications (such as avoiding triggers and adequate
hydration), beta-blockers to control heart rate, and in some cases, procedural interventions (such as
catheter ablation) or surgical interventions (such as repair of valvular abnormalities) may be
necessary based on the underlying cause.

PBL Case: "Exertional Chest Pain in a Middle-Aged Male"

Case Description:
A 55-year-old male presents to the clinic with complaints of chest pain that occurs during physical
activity. He describes the pain as a tightness or pressure in his chest that subsides with rest. He is a
smoker and has a sedentary lifestyle. His father had a myocardial infarction at the age of 60.

Questions:

What are the possible causes of exertional chest pain in this patient?
Possible answers:
Possible causes include stable angina, coronary artery disease (CAD), aortic stenosis, hypertrophic
cardiomyopathy, or gastroesophageal reflux disease (GERD).

What additional information would you like to gather from the patient's history?
Possible answers:
Frequency, duration, and intensity of chest pain episodes, factors that trigger or relieve the pain,
associated symptoms (such as shortness of breath or diaphoresis), risk factors for CAD (such as
smoking, sedentary lifestyle, or family history), and any recent changes in exercise habits.

What specific physical examination findings would you expect in a patient with exertional chest pain?
Possible answers:
Vital signs, including heart rate and blood pressure, signs of distress or discomfort, abnormal heart
sounds (such as a murmur or extra heart sounds), signs of heart failure (such as crackles in the lungs
or peripheral edema), and signs of other associated conditions (such as aortic stenosis).
What diagnostic tests would you order to evaluate and assess the patient's exertional chest pain?
Possible answers:
Electrocardiogram (ECG), stress test (exercise or pharmacologic), cardiac imaging (such as coronary
angiography or cardiac CT), lipid profile, and possibly other tests like echocardiogram or stress
echocardiography may be considered based on the clinical suspicion.

What are the treatment options for managing this patient with suspected stable angina or CAD?
Possible answers:
Treatment options may include lifestyle modifications (such as smoking cessation, regular exercise,
and a heart-healthy diet), medications (such as aspirin, beta-blockers, statins, and nitroglycerin), and
in some cases, revascularization procedures like percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) may be necessary based on the severity and extent of CAD.

PBL Case: "New-Onset Hypertension in a Young Female"

Case Description:
A 30-year-old female presents to the clinic for a routine check-up. During her visit, her blood pressure
is measured to be consistently elevated. She has no significant medical history and denies any
symptoms. Her family history is notable for hypertension in her parents.

Questions:

What are the possible causes of new-onset hypertension in this patient?

Possible answers:
Possible causes include essential hypertension, secondary hypertension (such as renal artery stenosis
or primary aldosteronism), pregnancy-induced hypertension (preeclampsia), or medication-induced
hypertension.

What additional information would you like to gather from the patient's history?
Possible answers:
Duration and pattern of elevated blood pressure readings, any associated symptoms (such as
headaches, dizziness, or visual changes), family history of hypertension or other cardiovascular
diseases, medication history (including over-the-counter medications or herbal supplements), and any
recent changes in lifestyle or stress levels.

What specific physical examination findings would you expect in a patient with new-onset
hypertension?
Possible answers:
Vital signs, including blood pressure measurements in different positions, signs of end-organ damage
(such as retinopathy, renal dysfunction, or left ventricular hypertrophy), signs of secondary causes of
hypertension (such as abdominal bruits in renal artery stenosis), and signs of associated conditions
(such as obesity or metabolic syndrome).

What diagnostic tests would you order to evaluate and assess the patient's new-onset hypertension?
Possible answers:
Blood tests (such as complete blood count, renal function tests, electrolyte panel, and lipid profile),
urine analysis, electrocardiogram (ECG), and possibly imaging studies (such as renal ultrasound or CT)
may be considered based on the clinical suspicion.

What are the treatment options for managing this patient with new-onset hypertension?
Possible answers:
Treatment options may include lifestyle modifications (such as dietary changes, weight loss, regular
exercise, sodium restriction, and stress reduction), antihypertensive medications (such as ACE
inhibitors, angiotensin receptor blockers, diuretics, or calcium channel blockers), and in some cases,
further evaluation and treatment for secondary causes may be necessary.
PBL Case: "Restrictive Cardiomyopathy in an Elderly Patient"

Case Description:
A 70-year-old female presents with fatigue, exercise intolerance, and lower extremity swelling. She
has a history of rheumatoid arthritis and has been on long-term corticosteroid therapy. Physical
examination reveals elevated jugular venous pressure, hepatomegaly, and bilateral pitting edema.
Echocardiography shows normal-sized ventricles with diastolic dysfunction and restrictive filling
patterns.

Questions:

What is restrictive cardiomyopathy, and what are its potential causes?

Answer:
Restrictive cardiomyopathy is a condition characterized by stiffening of the heart muscle, leading to
impaired relaxation and filling of the ventricles. Potential causes include infiltrative diseases (e.g.,
amyloidosis, sarcoidosis), storage diseases (e.g., hemochromatosis), radiation therapy, certain
medications, and systemic diseases (e.g., connective tissue disorders).

What additional tests would you order to evaluate the patient's condition?
Answer:
Additional tests may include cardiac MRI or biopsy to assess for infiltrative diseases or storage
disorders, blood tests to evaluate for underlying systemic diseases, and pulmonary function tests to
assess lung function.

How would you manage this patient with restrictive cardiomyopathy?

Answer:
Management may involve treating the underlying cause if identified. Symptomatic treatment includes
diuretics for fluid management, medications to control heart rate and rhythm, and management of
comorbid conditions. In advanced cases, heart transplantation may be considered.

What are the potential complications associated with restrictive cardiomyopathy?

Answer:
Potential complications include heart failure, arrhythmias, blood clots, and sudden cardiac death.

PBL Case: "Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in a Young Patient"

Case Description:
A 25-year-old male presents with palpitations and episodes of lightheadedness. He is an active athlete
and has a family history of sudden cardiac death. Physical examination reveals normal jugular venous
pressure and a systolic murmur along the left sternal border. The ECG shows inverted T waves in leads
V1 to V3.

Questions:

What is arrhythmogenic right ventricular cardiomyopathy (ARVC), and what are its potential causes?
Answer:
ARVC is a condition characterized by fibrofatty replacement of the right ventricular myocardium,
leading to ventricular arrhythmias and potential right-sided heart failure. It is primarily caused by
genetic mutations affecting desmosomal proteins.

What additional tests would you order to evaluate the patient's condition?
Answer:
Additional tests may include echocardiography to assess for structural abnormalities and right
ventricular dysfunction, cardiac MRI to evaluate for fatty infiltration or fibrosis, genetic testing to
identify specific mutations, and Holter monitoring or exercise stress testing to assess arrhythmias.
How would you manage this patient with arrhythmogenic right ventricular cardiomyopathy?
Answer:
Management may involve avoiding intense physical activity or competitive sports due to the risk of
life-threatening arrhythmias. Medications such as beta-blockers or antiarrhythmic drugs may be
prescribed to suppress arrhythmias. In some cases, implantable cardioverter-defibrillator (ICD)
placement may be considered for primary prevention of sudden cardiac death.

What are the potential complications associated with arrhythmogenic right ventricular
cardiomyopathy?
Answer:
Potential complications include ventricular arrhythmias, heart failure, and sudden cardiac death.
PBL Case: "Stable Angina in a Middle-Aged Male"
Case Description:
A 55-year-old male presents with recurring chest pain that occurs
during exertion and is relieved by rest. He has a history of
hypertension and dyslipidemia, for which he takes medications.
Physical examination and routine blood tests are unremarkable.
Questions:
1.
What is stable angina, and what are its typical characteristics?
Answer: Stable angina is chest pain or discomfort that occurs
predictably during physical exertion or emotional stress. It is
often described as a pressure or squeezing sensation in the
chest and typically lasts a few minutes. Rest or nitroglycerin
usually relieves the symptoms.
2.

What are the risk factors for developing stable angina?

Answer: Risk factors for stable angina include age (older adults
are more susceptible), smoking, hypertension, dyslipidemia,
diabetes, obesity, sedentary lifestyle, family history of
cardiovascular disease, and underlying coronary artery disease.
3.

What additional tests would you order to evaluate the patient's

condition?
Answer: Additional tests may include an exercise stress test
(treadmill test) or stress imaging (such as stress
echocardiography or nuclear stress test) to assess the presence
and severity of coronary artery disease. Additionally, an
electrocardiogram (ECG) and cardiac biomarkers may be
obtained to assess for acute coronary syndrome.
 4.

How would you manage this patient with stable angina?

Answer: Management of stable angina involves lifestyle
modifications (such as smoking cessation, regular exercise, and
a heart-healthy diet), medications to control risk factors (such
as antiplatelet agents, beta-blockers, and statins), and symptom
relief with nitroglycerin. In some cases, revascularization
procedures (such as percutaneous coronary intervention or
coronary artery bypass grafting) may be considered to restore
blood flow to the affected coronary arteries.

PBL Case: "Variant (Prinzmetal's) Angina in a Young Female"

Case Description:
A 30-year-old female presents with recurrent episodes of chest pain
at rest, often occurring in the early morning hours. The pain is severe,
lasts several minutes, and is associated with transient ST-segment
elevations on the electrocardiogram (ECG). Routine blood tests,
including cardiac biomarkers, are within normal limits.
Questions:
1.
What is variant (Prinzmetal's) angina, and what differentiates it
from stable angina?
Answer: Variant angina (Prinzmetal's angina) is a type of angina
caused by coronary artery spasm, typically occurring at rest.
Unlike stable angina, variant angina is not necessarily triggered
by physical exertion or emotional stress, and it may be
associated with transient ST-segment elevations on the ECG
during episodes of chest pain.
2.

What additional tests would you order to evaluate the patient's

condition?
Answer: Additional tests may include an exercise stress test or
stress imaging to assess for inducible ischemia during exercise.
Coronary angiography may be considered to evaluate for
coronary artery spasm and any associated fixed coronary artery
disease. Provocation testing with ergonovine or acetylcholine
during cardiac catheterization can help confirm the diagnosis.
 3.

How would you manage this patient with variant angina?

Answer: Management of variant angina involves relieving
coronary artery spasm and preventing future episodes.
Medications such as calcium channel blockers (particularly
those with vasodilatory properties) and nitrates are commonly
used to prevent and alleviate coronary artery spasm. Smoking
cessation and risk factor modification are also important.
4.

What are the potential complications associated with variant

angina?
Answer: Variant angina can lead to potentially serious
complications, including myocardial infarction (due to
prolonged coronary artery spasm causing complete occlusion)
or life-threatening arrhythmias. Prompt recognition and
appropriate management are crucial to prevent these
complications.