AEMCA Cardiovascular Emergencies 3 — Questions and Answers
Question 1: A 58-year-old presents with intermittent palpitations. The rhythm strip shows a regular narrow-complex tachycardia at 160 bpm with no visible P waves. Which vagal maneuver should be attempted first?
- Carotid sinus massage
- Valsalva maneuver (Correct answer)
- Ice-water facial immersion
- Eyeball pressure
Correct answer: Valsalva maneuver
The Valsalva maneuver is the first-line vagal technique for stable SVT; it is safe, non-invasive, and has a reasonable conversion rate.
Question 2: Beck's Triad — hypotension, muffled heart sounds, and jugular venous distension — is the classic presentation of which emergency?
- Tension pneumothorax
- Massive hemothorax
- Cardiac tamponade (Correct answer)
- Acute aortic dissection
Correct answer: Cardiac tamponade
Beck's Triad describes the hallmarks of cardiac tamponade, where fluid compresses the heart and impairs filling.
Question 3: A patient on digoxin therapy presents with bradycardia, nausea, and yellow-green visual halos. Which electrolyte abnormality potentiates digoxin toxicity?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypercalcemia
- Hypermagnesemia
Correct answer: Hypokalemia
Hypokalemia increases myocardial sensitivity to digoxin by competing for the same Na⁺/K⁺-ATPase binding sites, potentiating toxicity.
Question 4: Which ECG change is an early indicator of right ventricular strain in a patient with massive pulmonary embolism?
- ST elevation in leads II, III, aVF
- S1Q3T3 pattern (Correct answer)
- Delta waves in precordial leads
- Prominent U waves in V2-V4
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is a classic, though non-specific, ECG sign of acute right heart strain from PE.
Question 5: A patient with stable angina reports chest pain that begins with exercise and resolves with rest within 5 minutes. This is BEST described as which type of angina?
- Prinzmetal's (variant) angina
- Unstable angina
- Classic (stable) angina (Correct answer)
- Microvascular angina
Correct answer: Classic (stable) angina
Classic stable angina is predictably triggered by exertion or stress and consistently relieved by rest or nitrates within a few minutes.
Question 6: When using a manual defibrillator on an adult in ventricular fibrillation, what is the initial recommended energy setting for a biphasic device?
- 100–120 J
- 120–200 J (Correct answer)
- 300 J
- 360 J
Correct answer: 120–200 J
AHA guidelines recommend 120–200 J for the initial biphasic defibrillation shock, following the manufacturer's recommended dose.
Question 7: A patient in 3rd-degree (complete) AV block is hemodynamically unstable with a rate of 30 bpm. What is the correct initial treatment?
- Amiodarone 300 mg IV bolus
- Transcutaneous pacing (Correct answer)
- Adenosine 6 mg rapid IV push
- Synchronized cardioversion at 50 J
Correct answer: Transcutaneous pacing
Transcutaneous pacing is the immediate treatment for hemodynamically unstable symptomatic bradycardia including complete heart block.
AEMCA Cardiovascular Emergencies 3
A 58-year-old presents with intermittent palpitations.
The rhythm strip shows a regular narrow-complex tachycardia at 160 bpm with no visible P waves.
Which vagal maneuver should be attempted first?