A 87-year-old male presents to the emergency department after collapsing. Upon arrival, an ECG reveals complete heart block with a heart rate of 35 bpm. The patient reports feeling dizzy. Despite receiving 500 micrograms of IV atropine, there is no improvement. This is repeated five more times, but the heart rate remains below 40 bpm even after transcutaneous pacing is attempted. What is the next recommended step according to the Resuscitation Council (UK) guidelines?
A 67-year-old man arrives at the emergency department with a history of severe chest pain, scoring 9 out of 10, that began an hour ago. He is a smoker and is currently taking amlodipine for his hypertension. Following an ECG and troponin testing, he is diagnosed with NSTEMI. Using the GRACE score, his predicted 6-month mortality is 2%, and he is not at high risk of bleeding. However, the nearest primary percutaneous intervention unit is over an hour away. What is the appropriate management plan for this patient?
A 72-year-old man presents to the cardiology clinic with symptomatic aortic stenosis. Despite his overall good health, he is eager for intervention. What intervention is most likely to be recommended for him?
A 55-year-old man with no significant medical history presents to the hospital with severe chest pain. Upon arrival, an ECG reveals anterior ST elevation, and he is promptly treated with thrombolysis, resulting in the resolution of symptoms and ECG changes. What combination of medications should he be prescribed four weeks after the event?
A 70-year-old man is rushed to the hospital due to severe chest pain and nausea. His ECG reveals ST elevation in leads V1, V2, V3, and V4. Following angiography and percutaneous coronary intervention, his left anterior descending coronary artery is stented. The patient admits to avoiding doctors and not seeing his GP for more than two decades. He has been smoking 15 cigarettes daily since he was 18. What are the recommended medications for secondary prevention?
A 63-year-old woman with no significant medical history presents with chest pain and an ECG showing anterolateral T wave inversion. Her troponin I level at 12 hours is 300 ng/L (reference range < 50 ng/L). She is managed conservatively and discharged on aspirin, atorvastatin, bisoprolol, and ramipril. What is the appropriate use of ticagrelor in this case?
A 55-year-old man presents with a daytime-average ABPM reading of 162/100 mmHg and a calculated QRISK-3 score of 13.8%. He has no significant past medical history and is of Pakistani background. What initial pharmacological management should be offered, in addition to lifestyle advice?
A 56-year-old male with no previous medical history presents with a sprained ankle and is incidentally found to be in atrial fibrillation. He denies any symptoms of palpitations or shortness of breath. Despite discussing treatment options, he declines cardioversion. Cardiovascular examination is otherwise normal, with a blood pressure of 118/76 mmHg. As per the most recent NICE guidelines, what is the recommended treatment for this patient if he remains in chronic atrial fibrillation?
A 55 year old woman presents to the Emergency Department complaining of a cough with green sputum and palpitations. She reports feeling very sick, feverish, and tired. Upon examination, she exhibits bronchial breathing at her right base, with a respiratory rate of 25 breaths per minute and oxygen saturation of 95% on room air. Her heart sounds are normal, but her heartbeat is irregularly irregular, with a heart rate of 120 beats per minute and blood pressure of 90/40 mmHg. An ECG reveals atrial fibrillation with a fast ventricular rate. The patient has no prior history of atrial fibrillation. What is the initial treatment that should be administered?
A 65-year-old woman is brought to the emergency department by ambulance due to worsening shortness of breath and palpitations. Upon examination, bilateral crepitations are heard in her lungs and she has bilateral ankle edema. An ECG shows atrial fibrillation with a fast ventricular response, with a heart rate of 157 bpm. A chest x-ray reveals pulmonary edema. Blood tests show normal levels of Hb, platelets, WBC, Na+, K+, urea, creatinine, CRP, magnesium, troponin, and TSH. What is the most appropriate next step in managing this patient?