Cardiology MCQ 77

Q. A 46 years old patient presented to you with history of chest pain for 3 hours duration. Initial ECG done at primary centre showed ST elevation in inferior leads which have completely resolved now. Patient is pain free at present. His vitals and clinical examination are completely normal. What should be the next appropriate strategy?
A. Discharge the patient since clinical examination is normal and patient does not have any chest pain
B. Observe him for at least 24 hours for recurrence of chest pain and then ask to follow in cardiology clinic
C. Arrange early coronary angiography preferably within 24 hours
D. Get the cardiac biomarkers done and if normal, discharge the patient to follow up in cardiology OPD

Answer: C. Arrange early coronary angiography preferably within 24 hours

High heart rate

The patient contacts the doctor over phone with this report. Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine. Should he be worried about this and come to emergency department as soon as possible? Correct answer- ECG machine has calculated his heart rate incorrectly. Heart rate is around 100 beats per minute. Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods. Now, should he come to emergency department? Not because of detection of high heart rate. But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist.

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Cardiology MCQ 77

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