ECC Risk Assessment & Management 3 — Questions and Answers
Question 1: A patient on warfarin presents with NSTEMI. Which bleeding risk score is most commonly applied in this setting before antithrombotic therapy?
- CHADS2 score
- CRUSADE score (Correct answer)
- HASBLED score
- HCM Risk-SCD score
Correct answer: CRUSADE score
The CRUSADE score was developed specifically to estimate in-hospital major bleeding risk in NSTEMI patients receiving antithrombotic therapy.
Question 2: Which ECG finding in the context of chest pain represents the highest immediate risk for adverse outcomes?
- Isolated T-wave flattening in V4-V6
- New left bundle branch block (LBBB) (Correct answer)
- Sinus bradycardia at 52 bpm
- First-degree AV block
Correct answer: New left bundle branch block (LBBB)
New LBBB in the setting of chest pain is treated as a STEMI equivalent because it obscures ischemic changes and indicates large territory at risk.
Question 3: In the Wellens syndrome pattern on ECG, what does the characteristic T-wave morphology indicate about risk?
- Low risk; the patient has resolved their ischemia
- High risk; critical LAD stenosis with recent near-occlusion (Correct answer)
- Moderate risk; myocarditis is more likely
- Indeterminate; requires stress testing immediately
Correct answer: High risk; critical LAD stenosis with recent near-occlusion
Wellens pattern (biphasic or deeply inverted T-waves in V2-V3 during pain-free period) signals critical proximal LAD stenosis at high risk for massive MI.
Question 4: Which patient characteristic MOST significantly increases the risk of adverse outcomes during cardiac arrest resuscitation?
- Female sex
- Non-shockable initial rhythm (PEA or asystole) (Correct answer)
- Age under 60
- Arrest occurring in the hospital
Correct answer: Non-shockable initial rhythm (PEA or asystole)
Non-shockable rhythms (PEA/asystole) have far lower survival rates than shockable rhythms (VF/pVT) because they lack the depolarization amenable to defibrillation.
Question 5: A post-ROSC patient has a MAP of 55 mmHg and SpO2 of 91%. Which post-cardiac arrest risk factor is being poorly managed?
- Hyperthermia
- Hypotension and hypoxia (Correct answer)
- Hyperglycemia only
- Hypercapnia only
Correct answer: Hypotension and hypoxia
Post-ROSC hypotension (MAP <65) and hypoxia (SpO2 <94%) are both independently associated with worse neurological outcomes and must be corrected urgently.
Question 6: In acute heart failure risk stratification, which tool integrates BNP, vital signs, and BUN to estimate 30-day mortality?
- TIMI score
- GRACE score
- ADHERE risk tree (Correct answer)
- HEART score
Correct answer: ADHERE risk tree
The ADHERE (Acute Decompensated Heart Failure National Registry) risk tree uses BUN, systolic BP, and creatinine to stratify in-hospital mortality.
Question 7: A patient presents with syncope. Which feature on evaluation MOST increases the likelihood of a cardiac (vs. vasovagal) etiology?
- Prodrome of nausea and diaphoresis before the event
- Syncope occurring during exertion or without warning (Correct answer)
- Prolonged loss of consciousness over 10 minutes
- Syncope in a warm crowded environment
Correct answer: Syncope occurring during exertion or without warning
Exertional syncope or abrupt loss of consciousness without prodrome strongly suggests a cardiac cause such as arrhythmia or structural disease.
ECC Risk Assessment & Management 3
A patient on warfarin presents with NSTEMI.
Which bleeding risk score is most commonly applied in this setting before antithrombotic therapy?