A 16-year-old male presents to the cardiologist after passing out during a basketball practice. An echocardiogram confirmed the diagnosis of hypertrophic cardiomyopathy. The cardiologist advises that a pacemaker must be implanted to prevent any further complications and states the player cannot play basketball anymore. Unfortunately, the coach objects to sidelining the player since a big game against their rivals is next week. The coach asks if the pacemaker can be implanted after the game, which of the following steps should the physician take?
APostpone the procedure so the patient can play
BAllow the patient to play and schedule a follow up after the game
CRecommend to the legal guardian that the player stop playing and have the procedure performed
DPerform the procedure immediately so that both the physician and coach's wishes may be fulfilled
EAllow the patient to make the decision regarding his health
A 66-year-old female with hypertension and a recent history of acute ST-elevation myocardial infarction (STEMI) 6 days previous, treated with percutaneous transluminal angioplasty (PTA), presents with sudden onset chest pain, shortness of breath, diaphoresis, and syncope. Vitals are temperature 37°C (98.6°F), blood pressure 80/50 mm Hg, pulse 125/min, respirations 12/min, and oxygen saturation 92% on room air. On physical examination, the patient is pale and unresponsive. Cardiac exam reveals tachycardia and a pronounced holosystolic murmur loudest at the apex and radiates to the back. Lungs are clear to auscultation. Chest X-ray shows cardiomegaly with clear lung fields. ECG is significant for ST elevations in the precordial leads (V2-V4) and low-voltage QRS complexes. Emergency transthoracic echocardiography shows a left ventricular wall motion abnormality along with a significant pericardial effusion. The patient is intubated, and aggressive fluid resuscitation is initiated. What is the next best step in management?
AImmediate cardiac catheterization
BImmediate transfer to the operating room
CEmergency pericardiocentesis
DIntra-aortic balloon counterpulsation
EAdminister dobutamine 5-10 mcg/kg/min IV
A 67-year-old man presents to the emergency department for squeezing and substernal chest pain. He states that he was at home eating dinner when his symptoms began. The patient has a past medical history of diabetes, hypertension, and dyslipidemia. He is currently taking atorvastatin, lisinopril, insulin, metformin, metoprolol, and aspirin. Six days ago he underwent percutaneous coronary intervention. His temperature is 99.5°F (37.5°C), blood pressure is 197/118 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam reveals an uncomfortable elderly man who is sweating. An ECG is ordered. Which of the following is the best next step in management for this patient?
AStress testing
BAngiography
CCardiac troponins
DCreatine kinase-MB
EMyoglobin
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