Acute Medical Presentations — Flashcards

Flashcard 71: What is the appropriate treatment for Torsades de Pointes?

Answer: • IV magnesium sulfate

Flashcard 72: If a patient treated with PCI for MI experiences persistent pain or hemodynamic instability, what surgical intervention is recommended?

Answer: Coronary artery bypass graft (CABG) surgery

Extra: Emergency CABG is recommended if Percutaneous Coronary Intervention (PCI) fails or if there are complications like coronary artery perforation, persistent ischemia/pain, or hemodynamic instability that cannot be managed percutaneously post-PCI.

Flashcard 73: What is contraindicated in VT?

Answer: • Verapamil

Flashcard 74: What should be considered during CPR if a PE is suspected?

Answer: • Thrombolytic drugs

Flashcard 75: 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 76: What are the ECG findings in hypokalaemia?

Answer: U have no Pot (K+) and no T, but a long PR and a long QT (small or absent T waves) - U waves - Small or absent T waves - Long PR - ST Depression - Long QT

Flashcard 77: What MI presents with tall R waves V1-2

Answer: • Posterior MI

Flashcard 78: 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 79: Which patient group can present without Chest Pain during an MI ?

Answer: • Elderly • Diabetics • Women

Flashcard 80: 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.