The Challenge Cardiology. Week 1

A 75-year-old female presents to the hospital complaining of shortness of breath and requiring 3-4 pillow to be able to sleep at night, which has been progressively worsening over the last week. She has a past medical history of hypertension and cancer. She states that he was recently started on a new chemotherapy agent one month ago for a newly diagnosed lymphoma. Which of the following agents was this patient most likely started on by his care provider?

72 yo F PMHx significant for HTN, atrial fibrillation (on apixaban), HF (EF 30%), presents to the ED after a motor vehicle collision (car vs. pole). In the trauma bay she is mentating well and her vitals are as follows: HR 90, BP 88/62, RR 20, 95% O2 saturation on room air. FAST exam positive for intraperitoneal fluid, concerning for hemorrhage secondary to a blunt injury.  Which intervention should be prioritized for this patient?

A 45 year old woman, B.L., is brought in by ambulance to the ED. She is in cardiac arrest and her rhythm is asystole. Her sister states they were walking around the neighborhood when she suddenly collapsed and went unresponsive. She recently had surgery on her foot about a month ago and this was the first day she felt well enough to take a short walk. The nurses are unable to get any vital signs on the patient and CPR is started. The ED physician is concerned for a pulmonary embolism and wants to give a dose of alteplase. The patient is 70 kg. Which of the following is the correct dose of alteplase to give?

RK is a 59yo female (101kg) who is brought to the ED as a post-cardiac arrest patient. Paramedics report she has an extensive cardiac history with previous CABG. She was eating dinner with her family when she suddenly grabbed her chest and lost consciousness. Her daughter is in nursing school and immediately began performing CPR. Once EMS arrived, they noted the patient to be in ventricular fibrillation, and obtained ROSC after 1 shock. Their post-ROSC EKG shows a ST segment elevation in the lateral leads, with reciprocal changes in the septal leads, which is confirmed with in-house EKG prompting the ED physician to call a STEMI alert. Upon presentation RK looks visibly ill, she is pale and diaphoretic, HR 98, BP 104/52, RR 24, O₂ saturation 88% on 15L non-rebreather. The ED team is concerned that she may go into cardiac arrest again. Unfortunately, the cath lab calls back saying that they have cases ongoing in both of their rooms, so there will be a delay in taking RK up. Due to her critical presentation, the ED physician decides to proceed with alteplase administration due to the delay in catheterization. Which of the following is the most appropriate dosing of alteplase for RK?

47-year-old male presenting to the emergency department (ED) via emergency medical services (EMS) transport from home for altered mental status and new onset palpitations. The patient has a past medical history of hypertension taking amlodipine. Her presenting vital signs include BP 120/62 mm Hg, HR 161 beats/min, RR 21 breaths/min, and temperature 38.9oC.  A 12-lead ECG reveals a wide complex tachycardia with a irregular rhythm with prolonged QT internal that is identified as polyomorphic ventricular tachycardia. Which of the following interventions would be the best initial option for acute management in this patient?

1. Which of the following is the earliest electrocardiogram (EKG) finding in acute myocardial infarction (MI)?

1. The ED provider is deciding on which pharmacological agent to use for hypertensive emergency. She wants to know what is the maximum duration of clevidipine?

1. What intervention should be prioritized in patients presenting aortic dissection with hypotension secondary to aortic rupture or pericardial tamponade?

1. A 42-year-old man is brought to the emergency room by ambulance after a syncopal episode. He doesn’t respond. A review of the patient’s medical records indicates that he was recently treated for a bacterial respiratory infection; however, the specific antibiotic was not noted. He has a complicated medical history characterized by severe diabetes mellitus and chronic kidney disease. On examination he is pale and sweating with a rapid but weak pulse. An electrocardiogram is obtained and the results displays torsades de pointes. A baseline metabolic panel is pending. Which of the following medications could patient been taking to precipitate torsades de pointes?

   

1. A 60-year-old woman with a history of atrial arrhythmia comes to the emergency department with complaints of tinnitus, headache, visual disturbances, and severe diarrhea. The patient is given oxygen through a nasal cannula. ECG electrodes, a pulse oximeter and an automated blood pressure cuff are applied. The patient suddenly faints. Her ECG shows the presence of multifocal ventricular tachycardia with a smooth change in the QRS electrical axis. Which of the following medications is most likely responsible for this patient’s symptoms?