A 48yo presents with severe chest pain since the last 40mins. In the ED he is given oxygen, GTN,
morphine. ECG=ST elevation. Bloods=increased troponin levels. What is the next step of
a. Beta blockers
b. Percutaneous angiography
c. Anticoagulant & heparin
Next step is apsirin , after that PCI
A 50yo man with DM suddenly develops persistent crushing central chest pain radiating to the
neck. What is the single most appropriate dx?
b. Costochondritis (tietz’s disease)
c. Dissecting aneurysm
e. Pulmonary embolism
A 45yo manual worker presented with a 2h hx of chest pain radiating to his left arm. His ECG is
normal. What is the single most appropriate inv?
a. Cardiac enzymes
e. V/Q scan
Normal ECG + Normal Enzymes = Excludes MI
A man was brought to the ED from a shopping mall after collapsing there. He is conscious and
answering questions now. His ECG shows irregular rhythm. Your choice of inv:
c. 24h ECG
24h ECG is for when you find a normal ECG but suspect an intermittently evident ECG abnormality, here the abnormality of rhythm has already been found.
A 65yo male presents with dyspnea and palpitations. Exam: pulse=170bpm, BP=120/80mmHg.
Carotid massage has been done as first instance. What is the next step of the management?
c. DC cardioversion
e. Beta blocker
answer: A, adenosine if carotid massage failed
A 29yo lady came to the ED with complaints of palpitations that have been there for the past 4
days and also feeling warmer than usual. Exam: HR=154bpm, irregular rhythm. What is the tx for
b. Beta blockers
answer: B: heat intolerance, tachycardia, palpitations point to thyroxicosis, irregular pulse could be due to AF