Case 1

58-year-old female patient entered the emergency room due to sudden palpitations from 5 hours ago. history of only THA and taking bendroflumethiazide. at heart rate 170 bpm, BP 135/75 mmHg, breathing 18 / min and sp02 97%. outside of the fast circuit, she is fine now. Her ECG is below (Figure 3.1).

a Name 3 abnormalities on the ECG and diagnosis?

b 4 common causes leading to this diagnosis.

c 3 medications, dose and route are used to control frequency in this patient

d 4 blood tests you need to do emergency care to find the cause of this ECG abnormality

e Outline approach to rhythm control in this patient

Case 2

A 67-year-old male patient with a history of diet-controlled diabetes and taking high blood pressure medication 15 minutes before having left chest pain spreading to his left arm after evening exercise. he has nausea and sweats in pain, easing when he sits down to rest at home. In the emergency department, he had chest pain while resting. nurse gave oxygen and had ECG (Figure 3.2).

a Name 3 ECG abnormalities and diagnosis

b You treat it with aspirin and clopidogrel. platelet inhibitory pathways of these [3] What is this drug like?

c Name the 4 drugs of primary treatment for acute coronary syndrome (ACS) in this patient

d You consult with an expert who recommends you provide 4 TIMI risk factors. lists four risk factors for calculating the TIMI score [4]

e Despite treatment, the patient still had severe chest pain with changes in her kinetics during ECG resumption. What are your treatment options at this time? [2]

Case 3

62-year-old male patient enters the emergency room for sudden chest pain. he describes pain as a tearing of his chest and spreading to his shoulder blades. history of hypertension and smoking addiction. on pulse 115 bpm, BP: 205/110 mmHg, breathing 26 / min and sp02 95%. ECG had left ventricular hypertrophy (LVH) but no change suggesting ischemia

a Is the diagnosis possible in this patient and its pathophysiological description?

b Provides 2 clinical signs to support the diagnosis of busyness [2]

c With the diagnosis you think of. Give 4 immediate treatment items you do with this patient [4]

d Offer 3 diagnostic imaging techniques that confirm your diagnosis. [3]

e How do you classify this cause and how to deal with it?

Case 4

A 72-year-old male patient with a history of rheumatic fever as a child goes to the emergency room due to unconsciousness and loss of consciousness while walking in the morning. on pulse 72 bpm evenly, blood pressure 100/85 mmHg, breathing 22 / min and sp02 96%. hear the heart have systolic murmur on the left bank of the sternum

a Given the 3 differential diagnoses that could cause this condition with the given information, what is the most likely diagnosis of this patient?

b Classic trilogy in the diagnosis you give? [4]

c In addition to the information obtained from hearing the heart, what clinical signs support your diagnosis (2 signs)? [3]

d Name two of the ECG abnormalities involved in this diagnosis

e The patient at this time complains of chest pain. Name the medicine you are going to take, the 1 drug you will avoid to manage this patient’s chest pain [2]

Case 5

38-year-old female patient, 32 weeks pregnant, enters the emergency room with chest pain spreading to her left arm. She has a history of idiopathic hypertension and a family history of ischemic heart disease. The ECG below (Figure 3.3):

Figure 3.3

a Name 4 causes of chest pain that are more likely in a pregnant patient than in a nonpregnant person of the same age [4]

b What are the 2 leading cardiovascular causes of maternal death? [2]

c Point out 2 abnormalities on the ECG (Figure 3.3) and based on the ECG, what is your final diagnosis? [3]

d Which management was best suited to the final diagnosis you gave?

e Provide 4 next management steps in your emergency room with this patient. [4]

Case 6

A 24-year-old male patient went to the emergency room for chest pain 2 hours ago and is increasingly having difficulty breathing. His girlfriend said he had hit cocaine at the Bar late at night, but did use it occasionally. In patient agitation, ECG is noted below (Figure 3.4).

Figure 3.4

a ECG analysis (Figure 3.4) depicts the anomalies you see.

b Physiological description of cocaine chest pain in this patient

c What was the primary drug for this patient?

d Names of 3 drugs can be used in this situation.

e What cardiovascular medications should be avoided and why?

Case 7

A 27-year-old male patient entered the emergency room with fever 1 week ago, chills, and persistent pleuritic chest pain. smelling the patient has an alcoholic odor and a lot of needles on the elbows and wrists. examine patient with fever 38.8 ° C. You wonder if this is a case of infectious endocarditis (IE).

a Name the 3 groups of patients most at risk of IE? [3]

b What are the most common names in IE related to injecting?

c Which heart valve is most likely to be affected in this patient and what are the 2 symptoms of IE that characterize this valve?

d Name the intervention you will do with a suspected IE patient. [3]

e After sampling the patient, the initial antibiotic you used with the patient IE immediately was?

Case 8

The 42-year-old male patient was taken to the emergency room by his wife because his eyes were naturally blurred 6 hours ago. his wife said he had complained of a headache since yesterday and is currently a bit confused. He does not take any drugs but smokes and drinks alcohol. at circuit 110, HA 230/130 and sp02 96%, 37.4 ° C.

a Definition of high blood pressure in terms of blood pressure? [1]

b Name the 4 symptoms of encephalopathy caused by THA [2]

c In addition to encephalopathy caused by hypertension, name 3 other emergency hypertension cases. Tests to determine each type?

d What are the main steps in managing hypertensive encephalopathy in this patient? [6]

e Name 4 recommended lifestyle advice by NICE for hypertensive patients

Case 9

A 26-year-old male patient went to the emergency room for 3 days of chest pain spreading to the side of the neck. patients describe more pain with morning walks with shortness of breath. at circuit 110, HA 110/65, sp02 96%, 38.2 ° C. Recorded ECG below (Figure 3.5).

a Describe an ECG abnormality and possible diagnosis in this patient (Figure 3.5) [3]

b What clinical signs do you want to look for when examining this patient? [1]

c Name the 3 blood tests you did with this patient? why?

d What was your initial treatment with this patient? [3]

e If this patient complains of difficulty breathing, what complications may be present? Name the 3 clinical signs and 3 tests you used to detect this complication? [4]

Case 10

A 70-year-old male patient with a history of heart failure in the emergency department because of dyspnea increased 2 days ago. family members said that he did not adhere to the medication and felt that he was urinating a lot. when looking at the patient with acute dyspnea. irregular 130 bpm, HA 170/95 mmHg, breathing 28 / min, sp02 86%. Chest X-ray in the picture

Figure 3.6.

a Description of abnormality on the film (Figure 3.6). [2]

b Tell the 4 clinical signs of heart failure you will look for on your exam

c Name 4 causes of decompensation in heart failure patients [2]

d How would you manage this patient level? 3 drugs (with route of administration)

e ECG of patients with atrial fibrillation at frequency of 130−150. What frequency will you control?

f You give blood gas after 1 hour of treatment:

pH 7.28

pO2 7.4 kPa

pCO2 6.0 kPa

HCO3 13.5 mEq / L

BE −9.2

What treatment are you going to do now?

Case 11

The 30-year-old man went to the emergency room because he was suddenly nervous with difficulty breathing. The patient’s sister said she had a history of ‘Wolff-Parkinson-White Syndrome’ (WPW) syndrome. patient sensation of discomfort, pulse 180 bpm, blood pressure 135/75 mmHg.

a Are there any ECG abnormalities you have seen in a patient with WPW?

b Description of cardiac abnormalities due to WPW syndrome. [2]

c When you have an ECG, you see atrial fibrillation with a ventricular rate of 180−200 bpm. Name 2 antiarrhythmic drugs to avoid in this case and why?

d How would you treat this patient? Name 2 antiarrhythmic drugs that are safe to use?

e Even with treatment, the pulse spikes to 240 bpm and blood pressure drops to 85/50 mmHg. what will you do now

Case 12

The 35-year-old female patient went to the emergency room because 2 hours ago, continuous palpitations. She has a 20-year history of depression and is on medication, the rest is no problem. at entry, pulse 200 bpm, blood pressure 95/60 mmHg, sp02 96%. The following span ranges are recorded (Figure3.7):

Figure 3.7

a Diagnosis of this ECG (Figure 3.7)? [2]

b First-hand handling this situation? [2]

c Name the 3 drugs and the 3 non-drug causes that can lead to this condition. [6]

d How would you calculate the normal resting QT interval in ECG? [2]

e If initial treatment is ineffective, what are your next 2 treatment steps? [2] [14]

Case 1

a ECG (Figure 3.1) tachycardia at 120−160 frequency. Frequency is irregular and P waves are absent. The diagnosis here is atrial fibrillation (AF) with rapid ventricular response.

b There are many causes of AF, but a number of causes are seen in emergency patients such as

Table 3.1

Cardiovascular causes AF The cause is not cardiovascular AF
Ischemic heart disease Hyperthyroidism
Heart failure PE
Heart valve disease (mitral valve) Alcoholism or alcohol withdrawal
Sinus node failure syndrome Lowering potassium
Pericarditis Hypothermia
Cardiomyopathy Drug-induced (cocaine)

c The ALS recommends the following medication for frequency control in atrial fibrillation (NICE recommends similar5):

● B-blockers are usually first-line (eg, metoprolol 5 mg IV or bisoprolol 5 mg PO)

● CCB (eg, verapamil 5 mg IV) if b-blockers are contraindicated or poorly tolerated (eg, asthma)

● Digoxin 500−750 mcg IV or amiodarone 300 mg IV for 30−60 minutes followed by 900 mg infusion over 24 hours when evidence of heart failure is present.

d Blood tests for new onset atrial fibrillation include:

● U & Es rated electrolyte disturbance

● Thyroid functions such as hyperthyroidism

● Ca2 + and Mg2 + (both decrease causes acute arrhythmias)

● The FBC / CRP find the cause of the infection

e Management of atrial fibrillation targeted for rhythm control (bringing back sinus rhythm) when atrial fibrillation started less than 48 hours in this female patient, symptoms of tachycardia occurred less than 5 hours, should manage pacing. Newly initiated AF will automatically switch back to sinus rhythm, assisted by fluid compensation if dehydration and correction of electrolyte disturbances in case of electric shock, electric shock when using sedation is an option for AF patients. If the patient has no heart disease or structural abnormalities, when the patient has a contraindication to flecainide, amiodarone is an alternative to switching with a drug such as flecainide.

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