Acute Coronary Syndromes: Pathophysiology and Presentation – Post Test

A 62-year-old man presents with ischaemic chest pain of three hours duration. He has a previous history of myocardial infarction (MI). He takes aspirin, simvastatin and atenolol.

On examination he is haemodynamically stable and his chest pain is resolving with opiate analgesia, GTN and aspirin. His ECG shows ST segment depression in an anterior distribution. Posterior leads reveal no ST segment elevation. Troponin assay is awaited.

Which one of the following statements is most appropriate?

A 65-year-old man presents to the emergency department complaining of chest pain onset at rest. He describes it as a ‘pressure’ and it is associated with sweating and nausea. He reports that it radiates to his left arm.

Which one of the following historical factors is most likely to be associated with acute myocardial infarction?

A 55-year-old woman presents with an ongoing chest pain of duration approximately three hours. She describes it as retrosternal and burning in nature. It radiates to her left arm. She is a smoker and has hypertension but is otherwise well. On examination her pulse is 95, BP is 105/60, SaO2 is 93% on air and she has evidence of pulmonary odema.

Which one of the following would not increase her likelihood of having an acute myocardial infarction?

A 70-year-old man presents to the emergency department with ischaemic sounding chest pain and shortness of breath of three hours duration. He has a history of hypertension and non insulin dependent diabetes. He is haemodynamically stable. His blood glucose is 18mmol/l. He is given aspirin, diamorphine and GTN. He tells you that his pain is settling.

An ECG is performed and is as shown (click on the image to enlarge).

What is the most appropriate next course of action for the emergency physician?

Which one of the following ECG abnormalities is least likely to be associated with acute myocardial infaction?

A 69-year-old lady presents to the emergency department (ED) with ongoing retrosternal chest pain with radiation to both arms. Examination reveals no diagnostic features. ECG reveals ST segment depression in an anteroseptal distribution.

Which one of the following statements is least appropriate?

An 81-year-old lady arrives by ambulance to the emergency department having had an unwitnessed collapse at home at some point over the preceding 24 hours. She has a history of previous myocardial infarction and has had a transient ischaemic attack (TIA) in the past. On examination her pulse is 95, BP is 105/80, respiratory rate 28, her oxygen saturation is 89% on air and her temperature is 35.9ºC. She has a third heart sound and bilateral basal crackles.

ECG is shown (click on image to enlarge) and the chest x-ray shows bilateral basal infiltrates.

Which one of the following statements is most appropriate?

Which one of the following statements, about performing additional ECG leads to the standard 12 lead ECG, is incorrect?

Which one of the following statements about LBBB on the ECG in the setting of acute ischaemic chest pain is the most appropriate?

Which one of the following statements about cardiac markers is the most appropriate?