ABFM KSA Heart Disease Latest

ABFM + KSA Heart Disease (Latest Update 2025 / 2026) Questions & Answers | Grade A | 100% Correct (Verified Answers)

Question:

A 65-year-old female who had an ST-elevation myocardial infarction (STEMI) treated with fibrinolytic therapy 2 days ago has a sudden onset of chest pain and shortness of breath. Clinical evaluation reveals the presence of pulmonary edema with a blood pressure of 86/50 mm Hg, wet rales, a harsh holosystolic murmur along the left sternal border radiating toward the base and apex, and an S3 gallop. A pulmonary artery monitoring catheter is placed and oxygen saturation is found to be higher in the pulmonary artery than in the right atrium. Which one of the following complications does the patient most likely have?

a) Acute papillary muscle rupture

b) Ventricular septal rupture

c) Ventricular free wall rupture

d) Left ventricular aneurysm

e) Severe left ventricular failure

Answer:

B

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In the patient with an ST-elevation myocardial infarction (STEMI), cardiogenic shock should be considered if pulmonary edema and hypotension develop. Although extensive left ventricular dysfunction is responsible for 75% of cases, mechanical complications (e.g., acute, severe mitral regurgitation due to papillary muscle rupture, ventricular septal rupture, or subacute free wall rupture with tamponade) are another important cause. Conditions that can mimic cardiogenic shock include aortic dissection and hemorrhagic shock. Of the conditions listed, only ventricular septal rupture is associated with a pulmonary artery oxygenation that is higher than right atrial oxygenation.

Question:

A 65-year-old African-American male presents with a 2-month history of exertional dyspnea and ankle swelling. His past medical history is notable for hypertension and angioedema related to a peanut allergy.On examination his blood pressure is 155/98 mm Hg. His jugular veins are mildly distended and bibasilar rales are noted. The cardiac examination reveals a regular rhythm with a soft S3 and no murmur. Examination of the lower extremities reveals 1+ pitting ankle edema. Echocardiography shows an estimated left ventricular ejection fraction of 40%.Which one of the following medications should be AVOIDED in this patient?

a) Amlodipine (Norvasc)

b) Carvedilol (Coreg)

c) Enalapril (Vasotec)

d) Furosemide (Lasix)

e) Hydralazine

Answer:

C

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Angioedema occurs in less than 1% of patients taking an ACE inhibitor but is more common in African-Americans. The American Heart Association recommends that ACE inhibitors not be initiated in any patient with a history of angioedema (SOR C). Calcium channel blockers, particularly those with negative inotropic effects such as verapamil and diltiazem, can cause a worsening of heart failure and should also be avoided (SOR C).Although angiotensin receptor blockers (ARBs) would be regarded as safe in this patient and may be considered as alternative therapy for patients who develop angioedema while taking an ACE inhibitor, angioedema can also occur in patients taking ARBs and extreme caution is advisable when substituting an ARB in a patient with a history of ACE inhibitor-associated angioedema (SOR C). There are no contraindications to the use of a diuretic or a β-blocker in this patient.

Question:

A 74-year-old female presents with a 2-month history of increased dyspnea on exertion. She was a long-time cigarette smoker but quit 20 years ago. She has COPD treated with inhaled ipratropium (Atrovent), a combination inhaled corticosteroid, and a long-acting β-agonist. She can walk up one flight of stairs in her home but for the past 2 months she has had to stop and rest before reaching the top due to increased dyspnea. She also has severe osteoarthritis of the left hip treated with acetaminophen, 1000 mg three times daily, and tramadol (Ultram), 50 mg twice daily. A resting EKG in the office is normal. Which one of the following would be the most appropriate initial study to evaluate this patient for ischemic heart disease?

a) A treadmill exercise test

b) An adenosine technetium 99m test

c) A dipyridamole thallium test

d) Treadmill echocardiography

e) Dobutamine echocardiography 3 / 4

Answer:

E

This patient's severe degenerative joint disease would likely limit her ability to exercise sufficiently to achieve 85% of her expected heart rate, which is required for an adequate treadmill exercise test, unless the patient is on β- blocker therapy, which would allow 65% of the predicted heart rate to be considered adequate. Dipyridamole and adenosine are contraindicated for patients with severe asthma, COPD, hypotension, bradycardia, or heart block.A resting EKG and resting echocardiography might be appropriate, but would not rule out ischemic heart disease. Dobutamine provides a pharmacologic means to stress the heart in patients who cannot exercise. These agents enhance myocardial contractile performance and wall motion, thus making poorly functioning areas assessable by echocardiography. In patients unable to exercise to the target heart rate, pharmacologic agents are needed to complete stress testing.

Question:

A 59-year-old male sees you for a follow-up office visit after having a drug- eluting stent placed 6 weeks ago following a non-ST-elevation myocardial infarction. He also has a 2-year history of type 2 diabetes. He was discharged

on the following medications:Aspirin, 81 mg dailyClopidogrel (Plavix), 75 mg

dailyAtorvastatin (Lipitor), 40 mg dailyMetoprolol tartrate (Lopressor), 25 mg twice dailyRamipril (Altace), 10 mg dailyMetformin (Glucophage), 500 mg twice dailyThe patient has been asymptomatic since being discharged from the hospital. On examination he has a blood pressure of 142/86 mm Hg and a heart rate of 52 beats/min. The remainder of the examination is unremarkable. A lipid profile reveals an LDL-cholesterol level of 65 mg/dL, an HDL-cholesterol level of 30 mg/dL, and a serum triglyceride level of 260 mg/dL. His hemoglobin A1c is 7.2%.Which one of the following would be most appropriate at this time?

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