CCS Emergency Procedures & Response 3 — Questions and Answers
Question 1: A patient in the ICU develops acute cardiac tamponade. Which hemodynamic triad is characteristic?
- Hypotension, bradycardia, elevated CVP
- Hypotension, muffled heart sounds, elevated JVP (Correct answer)
- Hypertension, tachycardia, low CVP
- Wide pulse pressure, hypotension, S3 gallop
Correct answer: Hypotension, muffled heart sounds, elevated JVP
Beck's triad of cardiac tamponade includes hypotension, muffled heart sounds, and elevated jugular venous pressure.
Question 2: Which antiarrhythmic drug is preferred for stable wide-complex tachycardia of uncertain etiology?
- Verapamil
- Adenosine
- Amiodarone (Correct answer)
- Digoxin
Correct answer: Amiodarone
Amiodarone is the preferred agent for stable wide-complex tachycardia of uncertain origin because it is safe in both VT and SVT with aberrancy.
Question 3: What is the recommended energy for synchronized cardioversion of unstable atrial flutter?
- 50–100J biphasic (Correct answer)
- 200J biphasic
- 150J biphasic
- 360J monophasic
Correct answer: 50–100J biphasic
Atrial flutter often converts with low energy; 50–100J biphasic is the recommended starting dose for synchronized cardioversion.
Question 4: A patient with known Wolff-Parkinson-White syndrome develops rapid atrial fibrillation. Which drug is CONTRAINDICATED?
- Procainamide
- Ibutilide
- Verapamil (Correct answer)
- Flecainide
Correct answer: Verapamil
Verapamil (and other AV nodal blockers) are contraindicated in WPW with AFib because they can accelerate conduction via the accessory pathway, precipitating VF.
Question 5: During a STEMI alert, door-to-balloon time should ideally be achieved within:
- 60 minutes
- 90 minutes (Correct answer)
- 120 minutes
- 30 minutes
Correct answer: 90 minutes
The AHA/ACC guideline target for door-to-balloon time in primary PCI for STEMI is ≤90 minutes.
Question 6: Which finding on bedside echocardiography best confirms cardiac tamponade physiology?
- Left ventricular hypertrophy
- Right ventricular diastolic collapse (Correct answer)
- Dilated aortic root
- Mitral valve prolapse
Correct answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse on echocardiography is the most specific sign of hemodynamically significant cardiac tamponade.
Question 7: A patient receives thrombolytics for STEMI but shows no reperfusion at 90 minutes. What is the next recommended step?
- Repeat thrombolytic infusion
- Emergent rescue PCI (Correct answer)
- Intra-aortic balloon pump placement
- Increase heparin infusion rate
Correct answer: Emergent rescue PCI
Failed thrombolysis (no reperfusion by 90 minutes) requires emergent rescue PCI to restore coronary flow and reduce mortality.
CCS Emergency Procedures & Response 3
A patient in the ICU develops acute cardiac tamponade.
Which hemodynamic triad is characteristic?