Study guides
Cardiology
2 guides for this subject — how to prepare, what to practise, and how to know it has gone in.
A practice question
Choose an answer and it is marked, with the explanation. From Cardiology Practice Questions: 10 Cases With Answers.
A 58-year-old presents with 50 minutes of central chest pressure and diaphoresis. ECG shows ST elevation in leads II, III and aVF. He is haemodynamically stable. What is the most appropriate next step?
The symptoms and regional ST elevation indicate acute STEMI. Reperfusion should be organised urgently; do not delay for a troponin result when the ECG establishes the diagnosis. An outpatient test is not appropriate in an acute presentation.
A spoken answer, marked
An examiner's question, answered out loud and marked criterion by criterion. From Cardiology Viva Questions: Cases and Model Answers.
Examiner
A 62-year-old has crushing chest pain, sweating and nausea. The ECG shows ST elevation in II, III and aVF with reciprocal depression in I and aVL. His blood pressure is 92/60 mmHg and pulse 48/min. Talk me through your immediate assessment and management.
You prioritised monitoring, repeat observations and urgent senior/catheter-laboratory involvement.
ImproveSay explicitly that you would assess airway, breathing and circulation and obtain IV access while escalating.
You identified an inferior STEMI and recognised that bradycardia and hypotension raise concern for right-ventricular involvement.
ImproveState that you would obtain right-sided leads, particularly V4R, and assess for heart block.
You named aspirin and urgent primary PCI, but did not link the hypotension to avoiding nitrates.
ImproveState that nitrates may worsen hypotension and should be avoided here; use local ACS protocol for antithrombotic treatment.
You planned continuous monitoring but gave limited detail on reassessment and explaining the urgent plan.
ImproveMention frequent observations, response to treatment and a clear handover to the receiving cardiac team.
A strong answerI would assess airway, breathing and circulation, attach continuous ECG and oxygen-saturation monitoring, obtain IV access and call for urgent senior and interventional cardiology support. The ECG is an inferior STEMI; with hypotension and bradycardia I would consider right-ventricular infarction and conduction block, obtain right-sided leads including V4R, and reassess haemodynamics. I would give an aspirin loading dose according to local ACS protocol if there is no contraindication, and arrange immediate reperfusion by the local primary PCI pathway. I would avoid nitrates because he is hypotensive, and would not give oxygen routinely if he is not hypoxaemic. I would monitor closely, treat deterioration promptly and hand over the ECG, observations and treatments already given.
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Guides
- Cardiology Practice Questions: 10 Cases With AnswersWork through 10 cardiology practice questions on acute care, arrhythmias, heart failure and valve disease, with explanations for each answer.
- Cardiology Viva Questions: Cases and Model AnswersPractise three cardiology viva cases in acute coronary syndrome, atrial fibrillation and heart failure, with structured answers and feedback.
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