ECC Cardiovascular Evaluation & Monitoring 3 — Questions and Answers
Question 1: A patient presents with sudden-onset chest pain radiating to the back, BP 190/110 in the right arm and 145/88 in the left arm. What diagnosis should be considered first?
- STEMI
- Pulmonary embolism
- Aortic dissection (Correct answer)
- Hypertensive urgency
Correct answer: Aortic dissection
Inter-arm blood pressure discrepancy combined with severe chest pain radiating to the back is a classic presentation of aortic dissection.
Question 2: Which waveform on a pulmonary artery catheter tracing represents right ventricular pressure?
- A waveform with systolic pressure 15-25 mmHg and diastolic pressure 0-8 mmHg (Correct answer)
- A waveform with systolic pressure 15-25 mmHg and diastolic pressure 8-15 mmHg
- A waveform with mean pressure 2-6 mmHg
- A waveform with systolic pressure 100-140 mmHg and diastolic pressure 60-90 mmHg
Correct answer: A waveform with systolic pressure 15-25 mmHg and diastolic pressure 0-8 mmHg
Normal right ventricular pressure is 15-25 mmHg systolic and 0-8 mmHg diastolic, distinguishing it from pulmonary artery pressures which have higher diastolic values.
Question 3: On a 12-lead ECG, ST-segment elevation in leads V1-V4 with reciprocal changes in the inferior leads is most consistent with:
- Inferior STEMI
- Lateral STEMI
- Anterior STEMI (Correct answer)
- Posterior STEMI
Correct answer: Anterior STEMI
ST elevation in V1-V4 corresponds to the anterior wall of the left ventricle, typically caused by LAD occlusion.
Question 4: A patient's continuous SpO2 monitoring shows sudden drop from 98% to 78% with a normal waveform on the plethysmograph. What is the most appropriate next action?
- Immediately intubate the patient
- Recheck the probe placement and consider arterial blood gas (Correct answer)
- Administer 100% oxygen via NRB mask and recheck in 10 minutes
- Call a code blue
Correct answer: Recheck the probe placement and consider arterial blood gas
A sudden dramatic drop with preserved waveform quality suggests probe artifact or displacement; repositioning and confirming with ABG is appropriate before escalating.
Question 5: Which finding on physical exam is the most specific indicator of elevated left ventricular filling pressure?
- Peripheral pitting edema
- Jugular venous distension
- Crackles at the lung bases (Correct answer)
- Hepatojugular reflux
Correct answer: Crackles at the lung bases
Bilateral basilar crackles indicate pulmonary edema from elevated left-sided filling pressures causing fluid transudation into the alveoli.
Question 6: In a patient with suspected right heart failure, which hemodynamic finding would you expect?
- Elevated pulmonary capillary wedge pressure with normal CVP
- Elevated CVP with low or normal pulmonary capillary wedge pressure (Correct answer)
- Low CVP with elevated systemic vascular resistance
- Elevated cardiac output with low systemic vascular resistance
Correct answer: Elevated CVP with low or normal pulmonary capillary wedge pressure
Right heart failure causes blood to back up into the systemic venous system, elevating CVP while left-sided filling pressures may remain normal or low.
Question 7: A 12-lead ECG shows delta waves, short PR interval, and wide QRS complexes. This pattern is most consistent with:
- Brugada syndrome
- Wolff-Parkinson-White syndrome (Correct answer)
- Left bundle branch block
- Hyperkalemia
Correct answer: Wolff-Parkinson-White syndrome
The triad of delta waves, short PR interval, and wide QRS is the classic ECG presentation of Wolff-Parkinson-White syndrome due to ventricular pre-excitation via an accessory pathway.
ECC Cardiovascular Evaluation & Monitoring 3
A patient presents with sudden-onset chest pain radiating to the back, BP 190/110 in the right arm and 145/88 in the left arm.
What diagnosis should be considered first?