AEMCA Cardiovascular Emergencies 5 — Questions and Answers
Question 1: A patient presents with a BP of 210/120 mmHg, severe headache, and blurred vision. This is classified as a hypertensive:
- Urgency with no end-organ damage
- Emergency with end-organ damage (Correct answer)
- Crisis requiring immediate defibrillation
- Response requiring oral antihypertensives only
Correct answer: Emergency with end-organ damage
Hypertensive emergency is defined by severely elevated BP with acute end-organ damage (neurological symptoms here), requiring IV antihypertensive therapy.
Question 2: Which ECG finding differentiates Wolff-Parkinson-White (WPW) syndrome from other causes of SVT?
- Prolonged PR interval and wide QRS
- Short PR interval and delta wave (Correct answer)
- Absent P waves and irregular rhythm
- ST depression in lateral leads
Correct answer: Short PR interval and delta wave
WPW is characterized by a short PR interval (<120 ms) and slurred upstroke of the QRS (delta wave) due to accessory pathway pre-excitation.
Question 3: A patient is found in cardiac arrest. The first responder has been performing CPR for 8 minutes. The monitor shows fine ventricular fibrillation. What is the MOST appropriate action?
- Continue CPR for 2 more minutes, then defibrillate
- Immediately deliver a defibrillation shock (Correct answer)
- Administer epinephrine first, then defibrillate
- Administer amiodarone 300 mg before shocking
Correct answer: Immediately deliver a defibrillation shock
Fine VF is still a shockable rhythm and should be defibrillated immediately; CPR has already been ongoing and a perfusing rhythm may be restored with defibrillation.
Question 4: ST-segment elevation in leads II, III, and aVF with reciprocal changes in leads I and aVL indicates an MI in which cardiac territory?
- Anterior wall
- Lateral wall
- Inferior wall (Correct answer)
- Posterior wall
Correct answer: Inferior wall
Leads II, III, and aVF face the inferior wall of the left ventricle, so ST elevation in these leads with lateral reciprocal changes indicates an inferior MI.
Question 5: A patient taking warfarin presents with sudden severe tearing chest pain radiating to the back. BP is 190/100 in the right arm and 150/85 in the left arm. What is the most likely diagnosis?
- Acute MI with pericarditis
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with tearing back pain and a blood pressure differential between arms due to the dissection flap occluding the subclavian artery.
Question 6: During transcutaneous pacing for symptomatic bradycardia, how do you confirm mechanical capture?
- Observe a pacer spike on the ECG for each impulse
- Palpate a pulse corresponding to the paced rate (Correct answer)
- Note an increase in the patient's heart rate on the monitor
- Confirm that the patient reports chest discomfort
Correct answer: Palpate a pulse corresponding to the paced rate
Mechanical capture is confirmed by palpating a pulse that corresponds to the set pacing rate, distinguishing true capture from electrical artifact.
Question 7: A patient with an acute MI develops new-onset atrial fibrillation with rapid ventricular response at 140 bpm and is hemodynamically stable. Which is the BEST initial management?
- Immediate unsynchronized defibrillation at 200 J
- Synchronized cardioversion at 200 J
- Rate control with a beta-blocker or calcium channel blocker IV (Correct answer)
- Adenosine 6 mg rapid IV push
Correct answer: Rate control with a beta-blocker or calcium channel blocker IV
In stable AF with rapid ventricular response, the priority is rate control using IV beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem).
AEMCA Cardiovascular Emergencies 5
A patient presents with a BP of 210/120 mmHg, severe headache, and blurred vision.
This is classified as a hypertensive: