Sample interview questions: How do you approach the management of patients with cardiac involvement in hematological malignancies, such as lymphoma or leukemia?
Sample answer:
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History and Physical Examination:
- Obtain a detailed medical history, including prior cardiac conditions, risk factors, and symptoms suggestive of cardiac involvement.
- Perform a thorough physical examination, paying attention to signs of heart failure, arrhythmias, and pericardial effusion.
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Cardiac Biomarkers:
- Obtain cardiac biomarkers, such as troponin and B-type natriuretic peptide (BNP), to assess myocardial injury and heart failure.
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Echocardiography:
- Transthoracic echocardiography (TTE) is the initial imaging modality of choice to evaluate cardiac structure and function, detect abnormalities such as valvular dysfunction, cardiomyopathy, and pericardial effusion, and estimate pulmonary artery pressure.
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Additional Imaging Modalities:
- In selected cases, additional imaging tests may be needed, such as transesophageal echocardiography (TEE) for better visualization of cardiac structures, cardiac magnetic resonance imaging (MRI) for tissue characterization and assessment of myocardial fibrosis, and coronary angiography to evaluate for coronary artery disease.
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Management of Cardiac Complications:
- Heart failure: Initiate appropriate heart failure therapy, including diuretics, ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists.
- Arrhythmias: Manage arrhythmias according to standard guidelines, including antiarrhythmic medications, catheter ablation, or implantable cardioverter-defibrillator (ICD) placement.
- Pericarditis: Treat pericarditis with anti-inflammatory medications, su… Read full answer
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