Q&A

1. What is the preferred preventive treatment for vasospastic (Prinzmetal) angina?

2. Classic ECG finding of diffuse ST elevation

3. What is the likely diagnosis in a patient with a recent URI that presents with CHF, dilated ventricles with diffuse
hypokinesia, and low ejection fraction on echocardiogram?

4. What is the likely diagnosis in a chronic atrial fibrillation patient taking furosemide, metoprolol, digoxin, and
warfarin who presents with diarrhea, nausea, decreased appetite, and arrhythmias?

5. What is the likely diagnosis in a patient with a recent URI that presents with JVD, hypotension, non-palpable
PMI, and clear lungs (CXR below)?
6. What is the recommended management for a hemodynamically stable Wolff-Parkinson-White syndrome patient
with atrial fibrillation?

7. What is the first-line therapy for conscious and stable patients with this ecg finding?

8. What anti-hypertensive medication is commonly associated with peripheral edema as an adverse effect?

9. What is the most effective non-pharmacologic measure to decrease blood pressure in an overweight, diabetic
patient with significant tobacco/alcohol use?

10. What is the preferred initial management for symptomatic patients with hypertrophic obstructive
cardiomyopathy?
 Answers
1. What is the preferred preventive treatment for vasospastic (Prinzmetal) angina?
Answer: Calcium Channel Blockers
2. Classic ECG finding of diffuse ST elevation

Answer: Acute Pericarditis

3. What is the likely diagnosis in a patient with a recent URI that presents with CHF, dilated ventricles with diffuse
hypokinesia, and low ejection fraction on echocardiogram?
Answer: Dilated Cardiomyopathy

4. What is the likely diagnosis in a chronic atrial fibrillation patient taking furosemide, metoprolol, digoxin, and
warfarin who presents with diarrhea, nausea, decreased appetite, and arrhythmias?
Answer: Digoxin toxicity

5. What is the likely diagnosis in a patient with a recent URI that presents with JVD, hypotension, non-palpable
PMI, and clear lungs (CXR below)?
 Answer: Pericardial Effusion

6. What is the recommended management for a hemodynamically stable Wolff-Parkinson-White syndrome patient
with atrial fibrillation?
Answer: IV Procainamide

7. What is the first-line therapy for conscious and stable patients with this ecg finding?
Answer: Diagnosis: Torsades de pointes,
Treatment: IV Magnesium

8. What anti-hypertensive medication is commonly associated with peripheral edema as an adverse effect?
Answer: Dihydropyridine CCBs
• amlodipine
• nifedipine
• felodipine

9. What is the most effective non-pharmacologic measure to decrease blood pressure in an overweight, diabetic
patient with significant tobacco/alcohol use?
Answer: Weight Loss

10. What is the preferred initial management for symptomatic patients with hypertrophic obstructive
cardiomyopathy?
Answer: Beta-blockers
Non-Dihydropiridine CCBs (ex. verapamil can be used as additional therapy in patients with persistent
symptoms; this ↓ HR and therefore prolong diastolic filling thus decreasing outflow obstruction.)
 CASES
1.

Answer:
B. Aortic Injury
Patients suffering rapid deceleration blunt chest trauma are at high risk for aortic injury Oftentimes in the setting of high
energy aortic injury secondary to blunt chest trauma, aortic transection, circulatory collapse, and death are immediate
sequelae
A minority of patients with aortic injury have an incomplete or contained rupture. There are no clinical findings specific
for aortic injury, but hypotension, external evidence of trauma and altered mental status are common.
Once stabilized with airway, breathing, and circulation secured, patients should be assessed with an upright chest x-ray_
Findings suggestive of aortic injury include a widened mediastinum, large left-sided hemothorax, deviation of the
mediastinum to the right and disruption of the normal aortic contour.
In these cases, the diagnosis can be confirmed via CT scanning.
Management of patients with established aortic injury includes antihypertensive therapy where appropriate and immediate
operative repair.

2.

Answer:
D. Intravenous Furosemide
This patient’s presentation (dyspnea, orthopnea, paroxysmal nocturnal dyspnea [PND], bibasilar crackles, hypoxemia) is
consistent with acute pulmonary edema, most likely due to acute decompensated heart failure (ADHF) ADHF is most
commonly due to left ventricular (LV) systolic or diastolic dysfunction with or without additional cardiac disease (acute
myocardial infarction, arrhythmias, and acute severe m1tral or aortic regurgitation).
Acute management of ADHF includes supplemental oxygen and intravenous loop diuretics (eg, furosemide). Intravenous
nitroglycerine is a possible adjunctive therapy in patients without hypotension. Intravenous nitroglycerin rapidly decreases
preload to relieve dyspnea and tachycardia associated with pulmonary edema.
3.

Answer: E. Prostaglandin E1

This infant has cyanosis and hypoxia that fail to improve with a trial of 100% oxygen (hyperoxia challenge}. These
findings are concerning for a congenital heart defect. Cyanotic congenital heart diseases are caused by deoxygenated
blood from the right ventricle being shunted to the systemic circulation.
In many cases, the pulmonary blood now comes not from the right ventricle itself but rather from left ventricular output
through the patent ductus arteriosus (PDA) As the PDA begins to close, the pulmonary blood now decreases and the
cyanosis becomes more apparent, as in this infant.
The exact nature of the malformation can be confirmed by echocardiogram, but the immediate first step is to administer
prostaglandin therapy. Prostaglandin E1 is a vasodilator and can prevent the PDA from closing, thereby maintaining
pulmonary blood flow.
Prompt prostaglandin administration can be life-saving and should not be delayed