MRCEM 2 Category: Cardiology

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A 67 year old female attends the emergency department complaining of palpitations. The patient reports experiencing brief episodes of palpitations over the past few weeks, but they usually resolve themselves after 5-10 minutes. However, today’s episode has been ongoing for 30 minutes. The patient denies any chest pain or shortness of breath. She is currently taking aspirin 75mg once daily as her only medication. Blood tests are conducted, and the results are as follows:

Hemoglobin (Hb): 115 g/l
Platelets: 155 * 109/l
White blood cells (WBC): 6.4 * 109/l
Sodium: 138 mmol/l
Potassium: 3.8 mmol/l
Urea: 4.1 mmol/l
Creatinine: 74 µmol/l
Glomerular filtration rate (GFR): 68 mL/min/1.73m2

An electrocardiogram (ECG) is performed, revealing atrial fibrillation. You decide to assess the patient’s bleeding risk using the ORBIT tool. What is this patient’s ORBIT score?

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You are asked to assess an older patient who has fainted. They have a bradyarrhythmia evident on their ECG, and you determine to administer a dose of atropine.
Which ONE statement about the use of atropine is accurate?

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A 58 year old male presents to the emergency department after experiencing dizziness and fainting. An ECG reveals bradycardia with a pulse rate of 44 bpm. His blood pressure is 90/60. The resident physician administers atropine. Which of the following conditions would be a contraindication for giving atropine?

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You are managing a 68-year-old woman who has been brought to the resuscitation bay by the ambulance team. The patient experienced sudden dizziness and difficulty breathing while at home. The ambulance crew presents the patient’s ECG for your review. Your plan includes administering atropine to address the patient’s arrhythmia. Which of the following conditions would contraindicate the use of atropine?

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A 22 year old female comes to the emergency department complaining of pleuritic chest pain that has been present for 2 days. She is not currently taking any medications. A chest X-ray reveals no abnormalities and her D-dimer test is negative. An ECG shows sinus rhythm, but a prolonged QTc of 500 ms is observed. The patient is diagnosed with costochondritis and an incidental finding of long QT syndrome (LQTS). What is the primary treatment approach for LQTS?

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A 28-year-old woman presents after experiencing a syncopal episode earlier in the day. She fainted while jogging on the treadmill at her local gym. She regained consciousness quickly and currently feels completely fine. Upon examination, she has a slim physique, normal heart sounds without any additional sounds or murmurs, clear lungs, and a soft abdomen. She is originally from Thailand and mentions that her mother passed away suddenly in her 30s.

Her ECG reveals:
– Right bundle branch block pattern
– Downward-sloping ‘coved’ ST elevation in leads V1-V3
– Widespread upward-sloping ST depression in other leads

What is the SINGLE most likely diagnosis?

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A 45 year old female comes to the emergency department with abrupt onset tearing chest pain that spreads to the throat and back. You contemplate the likelihood of aortic dissection. What is the predominant risk factor observed in individuals with aortic dissection?

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A 60-year-old woman presents with worsening symptoms of shortness of breath. Upon examination of her cardiovascular system, you find a collapsing pulse. Her apex beat is hyperkinetic and displaced to the side. During auscultation, you detect an early diastolic murmur that is most pronounced when the patient is sitting forward and exhaling.

What is the SINGLE most probable diagnosis?

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While examining a 68-year-old man, you detect an ejection systolic murmur. The murmur does not radiate, and his pulse character is normal.
What is the SINGLE most likely diagnosis?

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You assess a 60-year-old woman who has a confirmed diagnosis of aortic stenosis.
Which ONE statement accurately describes aortic stenosis?