CEN Cardiovascular Emergencies 2 — Questions and Answers
Question 1: A patient arrives in rapid atrial fibrillation with a rate of 160 bpm and is hemodynamically unstable. What is the most appropriate immediate intervention?
- Administer diltiazem 0.25 mg/kg IV
- Administer amiodarone 150 mg IV over 10 minutes
- Perform synchronized cardioversion (Correct answer)
- Initiate rate control with metoprolol
Correct answer: Perform synchronized cardioversion
An unstable patient with tachyarrhythmia requires immediate synchronized cardioversion rather than pharmacological management.
Question 2: Which serum biomarker is most specific for myocardial necrosis and is elevated within 3–6 hours of an acute MI?
- CK-MB
- Myoglobin
- Troponin I (Correct answer)
- LDH
Correct answer: Troponin I
Cardiac troponin I is the most specific biomarker for myocardial necrosis, rising within 3–6 hours and remaining elevated for up to 14 days.
Question 3: A patient with chest pain has a 12-lead ECG showing ST depression in V1–V4. Which condition should be considered first?
- Anterior STEMI
- Posterior MI (Correct answer)
- Right ventricular infarction
- Pericarditis
Correct answer: Posterior MI
ST depression in V1–V4 can represent a posterior MI, which appears as a mirror image; applying posterior leads (V7–V9) will reveal ST elevation.
Question 4: What is the initial energy setting for defibrillation of ventricular fibrillation using a biphasic defibrillator?
- 100 J
- 200 J (Correct answer)
- 360 J
- 50 J
Correct answer: 200 J
For biphasic defibrillators, the initial energy for defibrillation of VF is 120–200 J (commonly 200 J), while monophasic uses 360 J.
Question 5: Which sign is associated with cardiac tamponade in addition to hypotension and muffled heart sounds?
- Kussmaul's sign
- Jugular venous distension (Correct answer)
- Pulsus alternans
- Tracheal deviation
Correct answer: Jugular venous distension
Beck's triad for cardiac tamponade includes hypotension, muffled heart sounds, and jugular venous distension (JVD) due to impaired venous return.
Question 6: A patient converts from VF to a normal sinus rhythm after resuscitation. Which post-cardiac arrest intervention has the strongest evidence for improving neurological outcomes?
- Immediate coronary angiography
- Targeted temperature management (32–36°C) (Correct answer)
- High-dose epinephrine infusion
- Prophylactic anticonvulsants
Correct answer: Targeted temperature management (32–36°C)
Targeted temperature management (TTM) at 32–36°C for 24 hours post-cardiac arrest has strong evidence for improving neurological outcomes in comatose survivors.
CEN Cardiovascular Emergencies 2
A patient arrives in rapid atrial fibrillation with a rate of 160 bpm and is hemodynamically unstable.
What is the most appropriate immediate intervention?