Acute Medical Presentations — Flashcards

Flashcard 71: Management of a peri-arrest tachycardia with any of the following adverse signs: shock (hypotension, confusion, cold extremities), syncope, MI, heart failure?

Answer: • Synchronised DC shocks Up to 3 shocks can be given; if unsuccessful, expert help should be sought.

Flashcard 72: Management for Broad-complex tachycardia?

Answer: • If unstable (shock, syncope, MI): Synchronized DC cardioversion\n• If stable: IV Amiodarone (300mg over 20-60 mins)

Flashcard 73: What is the appropriate treatment for Torsades de Pointes?

Answer: • IV magnesium sulfate

Flashcard 74: Difference between presentation of Myocarditis and Pericarditis?

Answer: • **Pericarditis:** Pleuritic chest pain (relieved by sitting forward), pericardial friction rub, and diffuse ST-elevation on ECG. • **Myocarditis:** Features of heart failure (dyspnea, edema), arrhythmias, and **elevated cardiac enzymes (Troponin)** with global/regional wall motion abnormalities on Echo.

Extra: Clinical Note: In practice, these often overlap as **myopericarditis**. The presence of elevated troponins or new ventricular dysfunction (HF symptoms) is the key clinical indicator that the myocardium is involved, rather than just the pericardial sac.

Flashcard 75: What is the first-line management of SVT?

Answer: 1. Vagal maneuvers (e.g., Valsalva maneuver or unilateral carotid sinus massage) 2. Adenosine (if vagal maneuvers fail)

Extra: In unstable patients (hypotension, heart failure, ischemia), the first-line management is synchronized DC cardioversion.

Flashcard 76: What MI presents with tall R waves V1-2

Answer: • Posterior MI

Flashcard 77: What can reduce BNP levels?

Answer: • ACE inhibitors • ARBs • Diuretics

Flashcard 78: What is this?

Answer: • Wellen's syndrome *high-grade stenosis in the LAD *Pt pain may have resolved at the time, and trop = normal/minimially elevated **Biphasic or deep T wave inversion in Leads V2-3 Minimal ST Elevation • no Q waves

Flashcard 79: What is the first-line drug treatment for symptomatic Sinus bradycardia?

Answer: Atropine (0.5 - 1 mg IV) ⟗ repeat every 3-5 mins (Max 3mg)

Extra: If Atropine is ineffective, second-line treatments include: • Transcutaneous pacing • Dopamine infusion (5-20 mcg/kg/min) • Epinephrine infusion (2-10 mcg/min) Note: ACLS 2020 updates increased the initial dose of Atropine to 1 mg for bradycardia, though 0.5 mg is still commonly cited in many guidelines (like ALS UK). The previous dose was 0.5 mg.

Flashcard 80: Which patient group can present without Chest Pain during an MI ?

Answer: • Elderly • Diabetics • Women