Case 1Case 1

37-year old male comes to the hospital 37-year old male comes to the hospital complaining of palpitation for 8 months, no complaining of palpitation for 8 months, no other symptoms: no sweating, wt other symptoms: no sweating, wt loss,ischaemic chest pain, anxiety or loss,ischaemic chest pain, anxiety or pleuretic chest pain.pleuretic chest pain.

On examination, BP is 100/70, normal On examination, BP is 100/70, normal heart sounds, no murmurs/gallops. heart sounds, no murmurs/gallops.

1.1. What is the most commonly encountered What is the most commonly encountered “premature contraction?”“premature contraction?”

a. a ventricular premature beata. a ventricular premature beat

b. an atrial premature beatb. an atrial premature beat

c. atrial flutterc. atrial flutter

d. atrial fibrillationd. atrial fibrillation

e. I do not knowe. I do not know

2. Most atrial premature beats discovered on 2. Most atrial premature beats discovered on clinical examination are:clinical examination are:a. associated with COPDa. associated with COPDb. completely benignb. completely benignc. associated with valvular heart diseasec. associated with valvular heart diseased. associated with an increase in d. associated with an increase in cardiovascular mortalitycardiovascular mortalitye. I do not knowe. I do not know

Case 2Case 2

A 40 year old female comes to the ER C/O A 40 year old female comes to the ER C/O of palpitations. Denies chest pain or SOB. of palpitations. Denies chest pain or SOB. No known history of CAD . There is history No known history of CAD . There is history of weight loss and anxiety.of weight loss and anxiety.

On physical examination, BP is 130/60 On physical examination, BP is 130/60 and heart rate is 160 irregular. and heart rate is 160 irregular.

Strip ECG: show this rhythm

What is the diagnosis, investigation and treatment?

A 50 year old male is brought to the A 50 year old male is brought to the emergency department c/o of severe emergency department c/o of severe substernal chest pain, nausea, substernal chest pain, nausea, diaphoresis. BP is 90mm Hg systolic, HR diaphoresis. BP is 90mm Hg systolic, HR 120 bpm. Pulse disappears on arrival . 120 bpm. Pulse disappears on arrival . Venous access is established and he has Venous access is established and he has O2 via mask. ECG was doneO2 via mask. ECG was done

Case 3Case 3

What is your favorable diagnosis?

The appropriate management at this time The appropriate management at this time includes:includes:

1.1. Lidocaine 1 mg/kg IV bolusLidocaine 1 mg/kg IV bolus

2.2. Procainamide, 20mg/min IV infusionProcainamide, 20mg/min IV infusion

3.3. DefibrillationDefibrillation

4.4. Transvenous pacemakerTransvenous pacemaker

5.5. Oral beta- blockersOral beta- blockers

His rhythm stabilizes and you note His rhythm stabilizes and you note evidence of acute MI on ECG. Which of evidence of acute MI on ECG. Which of the following should be taken into the following should be taken into account when considering thrombolytic account when considering thrombolytic therapy?therapy?

1.1. Degree of coronary occlusionDegree of coronary occlusion

2.2. Whether the patient has a hx of strokeWhether the patient has a hx of stroke

3.3. Time interval from onset of sxsTime interval from onset of sxs