A 45-year-old man comes to the emergency department due to a 2-day history of dyspnea, orthopnea, and ankle swelling.  This morning, he also had nausea, vomiting, and a headache.  Blood pressure is elevated, and physical examination shows pulmonary crackles and bilateral pitting edema up to the knees.  A sodium nitroprusside infusion is begun.  Which of the following left ventricular pressure/volume relationships best represents the effects of this therapy?

*Solid line = before nitroprusside; dashed line = during nitroprusside infusion.

A 35-year-old previously healthy man is evaluated for several episodes of syncope in the past 6 weeks.  Physical examination is unremarkable.  Echocardiogram shows no structural heart defect.  An electrophysiologic study is performed during which catheters are passed into the patient’s right and left atrium to record atrial electric potentials.  Cardiac monitor currently shows normal sinus rhythm.  Which of the following is the most likely earliest site of electric activation?

A 64-year-old man presents to the office with chest discomfort and mild shortness of breath that started one hour ago after an argument with his wife.  He has a long history of hypertension and diabetes mellitus.  His blood pressure is 180/100 mmHg and his heart rate is 100/min.  An EKG taken in the emergency department shows no signs of acute ischemia.  Cardiac auscultation in the left decubitus position on full expiration reveals a presystolic sound.  Which of the following best explains this physical examination finding?

A 32-year-old woman comes to the office for preconception medical evaluation.  She feels well, reports no health issues, and has had regular menstruations.  The patient is an elite long-distance swimmer and recently retired from professional career of 10 years.  She still continues to practice swimming regularly.  The patient does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 114/66 mm Hg and pulse is 60/min.  Physical examination shows no abnormalities.  Compared to a person of similar age and sex with sedentary lifestyle, which of the following cardiac changes are most likely present in this patient?

A 45-year-old woman participates in a cardiovascular health study.  She undergoes continuous 24-hour ECG monitoring with a wearable device.  A few instances of the following pattern were found on her ECG:

Which of the following best represents the relative left ventricular end-diastolic volumes just prior to the heart beats represented by the letters?

A 30-year longitudinal study that follows untreated individuals with no known cardiovascular disease from age 50 to 80 is performed to investigate normal age-related cardiovascular changes.  Several parameters are measured annually.  Patients age 80 are most likely to show which of the following changes compared to when they were age 50?

A 62-year-old woman comes to the emergency department due to palpitations and shortness of breath that began an hour ago.  Medical history includes hypertension, coronary artery disease, and paroxysmal atrial flutter.  Blood pressure is 108/76 mm Hg and pulse is rapid.  ECG shows atrial flutter with a ventricular rate of approximately 150/min.  The estimated atrial rate based on ECG flutter waves is 300/min.  Which of the following is most likely responsible for the rate difference between the atria and the ventricles?

A 20-year-old, previously healthy woman is brought to the emergency department after a motor vehicle collision.  The patient was a restrained, rear-seat passenger when another car struck the side door.  There was extensive damage to the vehicle, resulting in a prolonged extrication time.  On arrival at the emergency department, blood pressure is 90/60 mm Hg and pulse is 120/min.  On physical examination, the patient is alert but appears anxious, pale, and diaphoretic.  There is no obvious head or neck injury.  The lungs are clear bilaterally and cardiac auscultation reveals tachycardia.  The abdomen is soft.  Several actively bleeding lacerations are present on the lower extremities.  X-rays show pelvic and left femoral shaft fractures.  Which of the following findings are most likely present in this patient?

A 24-year-old woman participates in a study of changes in blood pressure during aerobic exercise.  She is healthy and takes no medications.  During the study she is asked to run on a treadmill at incrementally increasing speed until her heart rate reaches 90% of her expected maximum heart rate.  Compared to at rest, which of the following changes in blood pressure are expected during this time?

A 63-year-old man with peptic ulcer disease comes to the emergency department after several bouts of melena followed by large hematemesis.  He reports nausea and feels faint.  Temperature is 34.5 C (94.1 F), blood pressure is 90/46 mm Hg, pulse is 126/min, and respirations are 28/min.  Physical examination reveals a lethargic man with cold extremities and sluggish capillary refill.  Type O, Rh-D negative red blood cells are given as rapidly as possible via intravenous access.  However, the blood transfusion rate is unacceptably slow, and the patient remains hypotensive.  Which of the following will lead to the greatest improvement in flow rate?

A 52-year-old man comes to the office with a 2-week history of shortness of breath and dry cough.  The patient has noticed decreased exercise tolerance that limits his daily activities.  A Doppler probe placed at the cardiac apex reveals the following blood flow pattern across the patient’s mitral valve.

Item 1 of 2

The point marked by the arrow would best correspond to which of the following auscultation findings?

Item 2 of 2

On physical examination, jugular venous pressure is elevated, breath sounds are decreased at the right lung base with dullness to percussion, and 2+ bilateral lower extremity pitting edema is present.  Chest x-ray shows cephalization of the blood vessels, Kerley B lines, and a right pleural effusion.  Thoracentesis is performed for pleural fluid analysis.  In comparison to plasma fluid, which of the following pleural fluid findings is most likely to be observed?