Practice Cases Arrythmias/Stroke/ACS Exam 4

What is the mechanism of ticagrelor’s benefit in a STEMI patient that has already received ASA, oxygen, nitrates, and morphine?

• Ticagrelor improves myocardial oxygen supply.

• Ticagrelor opens up the infarct-related artery.

• Ticagrelor reduces myocardial oxygen demand.

• Ticagrelor prevents myocardial reinfarction.

Which of the following medications given during the treatment of VF or pulseless VT has no dose maximum?

• Vasopressin

• Epinephrine

• Lidocaine

• Amiodarone

A 63-year-old African American man with a PMH significant for dyslipidemia presented to the emergency department several days ago with symptoms of an acute stroke. The physician you are working with wants your recommendations on what to send this patient home on for blood pressure control. Current vitals are as follows: BP 138/88 mm Hg, HR 86 beats/min What do you recommend?

• β-Blocker

• Nondihydropyridine calcium channel blocker

• Angiotensin-converting enzyme inhibitor plus a diuretic

• No blood pressure medication. The patient’s blood pressure is at goal.

Which of the following is an appropriate fibrinolytic dosing regimen for a 78-kg person with STEMI?

• Streptase 1 million units intravenously over 20 minutes

• Reteplase or rPA 10 units IV bolus twice 30 minutes apart

• Tenecteplase or TNK 80 mg IV bolus once

• Alteplase 100 mg IV over 2 hours

What is the initial step in therapy for a stable patient presenting with monomorphic VT?

• Epinephrine

• Adenosine

• Lidocaine

• Immediate DCC

KE presents with chest pain, nausea, vomiting, and diaphoresis. He is diagnosed with an NSTEMI. Current blood pressure is 92/56 mm Hg and HR is 105 beats/min. Which of these medications should be given to this patient?

• ASA EC 325 mg orally once

• ASA 81 mg two tablets chewed once

• NTG IV drip at 20 mcg/min

• IV metoprolol 5 mg IV once

A 79-year-old man weighing 80 kg presents to your hospital emergency room with newly discovered AF with rapid ventricular response and is symptomatic with little rate control achieved after initiation of a diltiazem drip. It is decided by the attending physician to proceed with electrical cardioversion. The patient’s wife reports that he underwent a cardiac workup the day before for routine knee replacement surgery. The ECG from that workup is retrieved and shows normal sinus rhythm. What is the next appropriate step in this patient’s care?

• Proceed with synchronized direct cardioversion after receiving enoxaparin 80 mg.

• Anticoagulate with warfarin for 3 weeks, target INR 2.0 to 3.0, then cardioversion.

• Obtain transesophageal ECHO to rule out thrombus then cardioversion.

• Proceed with synchronized direct current cardioversion without anticoagulation.

A patient experiencing chest pain for a few hours decides to take an SL tablet of NTG. The first tablet provides no pain relief, so EMS is contacted. The patient continued to take the NTG every 5 minutes. The third tablet she took provided relief. How do oral nitrates decrease chest pain?

• Vasoconstriction of venous vasculature

• Vasoconstriction of arterial vasculature

• Vasodilation of venous vasculature

• Decreased cardiac output

LC is a 76-year-old woman who presents to ED via EMS to a large academic medical center (with a coronary catheterization laboratory) complaining of sudden onset of diaphoresis and nausea. She states, “About 5 hours ago my chest started hurting and I just don’t feel well.” LC’s weight is 65 kg.

Past medical history: CAD and arthritis

Family history: Father died of acute myocardial infarction at 76 years of age and mother passed away at age 70 from pneumonia

Social history: Does not drink alcohol; smokes 1 pack of cigarettes per week

Medications: ASA 81 mg orally once daily, atorvastatin 40 mg orally at bedtime, conjugated estrogens 0.625 mg orally daily, and celecoxib 200 mg orally daily

Laboratory data: Serum creatinine (SCr) = 1.9 mg/dL, total cholesterol 250 mg/dL, triglycerides 150 mg/dL, high-density lipoprotein (HDL) 40 mg/dL, LDL 130 mg/dL, troponin I = 5.7 ng/mL

Electrocardiogram: ST-segment elevation

Which one of the following is the preferred approach to reperfuse this patient?

• Chew ASA 81 mg, clopidogrel 75 mg, UFH for 48 hours

• Reteplase 10 units IV for two doses 30 minutes apart and UFH for 48 hours

• Chew ASA 325 mg, administer ticagrelor 180 mg orally once, abciximab 16.25 mcg IV bolus and percutaneous intervention with coronary stent placement

• Streptokinase 1,500,000 units IV over 30 minutes, ASA 81 mg, clopidogrel 300 mg

CB is a 56-year-old woman who presents with palpitations, dyspnea, and presyncope. An ECG is performed and PVCs are found. CB has a past medical history of hypertension, hyperlipidemia, and postmyocardial infarction 2 years ago. What is the treatment of choice for CB?

• Flecainide

• Propafenone

• Metoprolol succinate

• Amiodarone