MI Practice Questions

Q: A 58-year-old woman with diabetes and hypertension presents with acute chest pain. ECG shows ST-segment elevation in leads II, III, and aVF. She is taken for emergent cardiac catheterization which reveals 100% occlusion of the right coronary artery. After successful stent placement, her blood pressure drops to 85/50 mmHg and heart rate is 48/min. Physical examination reveals jugular venous distention and clear lung fields. What is the most appropriate next step?

Immediate fluid resuscitation with normal saline bolus. ***Immediate fluid resuscitation with normal saline bolus*** - This patient presents with an **inferior wall myocardial infarction** and a **right ventricular (RV) infarction**, characterized by the triad of **hypotension**, **jugular venous distention (JVD)**, and **clear lung fields**. - RV failure leads to decreased **preload** for the left ventricle; therefore, aggressive **intravenous fluid resuscitation** is the first-line treatment to improve cardiac output. *Emergent echocardiography to assess left ventricular function* - While an echocardiogram can confirm RV dysfunction, it should not delay life-saving **volume resuscitation** in an unstable patient. - The **clear lung fields** already clinicaly suggest that the primary issue is not left ventricular failure or pulmonary edema. *Administer intravenous atropine* - Although the patient is bradycardic, the primary driver of hypotension in RV infarction is usually **decreased preload** rather than heart rate alone. - Atropine may be useful if bradycardia persists, but it does not address the **volume-dependent** state of the infarcted right ventricle. *Place intra-aortic balloon pump* - An IABP is typically used for **cardiogenic shock** resulting from left ventricular failure or mechanical complications like mitral regurgitation. - It is not the initial treatment for RV infarction and is generally ineffective for isolated right-sided heart failure. *Start inotropic support with dobutamine* - Inotropic support should only be considered if the patient remains hypotensive **after adequate fluid loading**. - Starting inotropes before ensuring adequate **preload** can be ineffective and potentially worsen the clinical status.

Question 1

A 58-year-old woman with diabetes and hypertension presents with acute chest pain. ECG shows ST-segment elevation in leads II, III, and aVF. She is taken for emergent cardiac catheterization which reveals 100% occlusion of the right coronary artery. After successful stent placement, her blood pressure drops to 85/50 mmHg and heart rate is 48/min. Physical examination reveals jugular venous distention and clear lung fields. What is the most appropriate next step?

Accepted Answer

Immediate fluid resuscitation with normal saline bolus

Answer

Emergent echocardiography to assess left ventricular function

Answer

Administer intravenous atropine

Answer

Place intra-aortic balloon pump

Answer

Start inotropic support with dobutamine

Question 2

A 62-year-old man presents to the emergency department with crushing substernal chest pain radiating to his left arm for 45 minutes. ECG shows ST-segment elevation in leads V1-V4. Blood pressure is 110/70 mmHg, heart rate 92/min. The nearest cardiac catheterization facility is 90 minutes away by ambulance. What is the most appropriate immediate management?

Accepted Answer

Arrange immediate transfer for primary percutaneous coronary intervention

Answer

Administer fibrinolytic therapy and transfer for catheterization

Answer

Administer nitroglycerin and delay transfer until pain resolves

Answer

Administer aspirin, heparin, and observe in emergency department

Answer

Perform emergent coronary artery bypass grafting

MI — MCQs

MI — MCQs

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