CEN Cardiovascular Emergencies 1 — Questions and Answers
Question 1: A patient presents with crushing chest pain, diaphoresis, and ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior MI, which is most commonly caused by occlusion of the right coronary artery.
Question 2: Which medication is the first-line treatment for symptomatic bradycardia with hypotension in a stable patient?
- Epinephrine
- Dopamine
- Atropine (Correct answer)
- Amiodarone
Correct answer: Atropine
Atropine 0.5 mg IV is the first-line treatment for symptomatic bradycardia according to ACLS guidelines.
Question 3: A patient is in pulseless ventricular tachycardia. After the second defibrillation attempt, which medication should be given?
- Lidocaine 1.5 mg/kg
- Amiodarone 300 mg IV push (Correct answer)
- Magnesium sulfate 2g IV
- Adenosine 6 mg IV
Correct answer: Amiodarone 300 mg IV push
Per ACLS protocol, amiodarone 300 mg IV push is the preferred antiarrhythmic after the second shock in pulseless VT/VF.
Question 4: A patient with known heart failure presents with severe dyspnea, pink frothy sputum, and an SpO2 of 82%. What is the priority intervention?
- Administer furosemide 40 mg IV
- Apply CPAP or BiPAP (Correct answer)
- Obtain 12-lead ECG
- Insert Foley catheter
Correct answer: Apply CPAP or BiPAP
Non-invasive positive pressure ventilation (CPAP/BiPAP) rapidly improves oxygenation in acute pulmonary edema and reduces the need for intubation.
Question 5: Which finding on a 12-lead ECG is most consistent with cardiac tamponade?
- ST elevation in all leads
- Electrical alternans (Correct answer)
- Right bundle branch block
- Prolonged QT interval
Correct answer: Electrical alternans
Electrical alternans, where the QRS complex alternates in height with each beat, is a classic ECG finding in cardiac tamponade due to the heart swinging within the pericardial fluid.
Question 6: A patient presents with a suspected aortic dissection. Which combination of findings is most classic?
- Tearing chest pain radiating to the jaw and left arm
- Sudden tearing back pain with unequal blood pressures in both arms (Correct answer)
- Gradual onset chest pressure with diaphoresis
- Sharp pleuritic chest pain with a pleural friction rub
Correct answer: Sudden tearing back pain with unequal blood pressures in both arms
A sudden tearing or ripping pain radiating to the back with a blood pressure differential greater than 20 mmHg between arms is the classic presentation of aortic dissection.
CEN Cardiovascular Emergencies 1
A patient presents with crushing chest pain, diaphoresis, and ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?