CARDIO SLIDE
PROJECTION
1. A 67-year-old man presents to the emergency department with severe chest pain that is worse when lying supine. Three days ago he had a
pacemaker placed for symptomatic bradycardia. The patient is in moderate distress, slightly altered, and slow to respond. His vital signs are BP 76/60,
HR 110, RR 22, SpO2 96% on RA, and T 37.3°C. His ECG shows sinus tachycardia, not paced, with normal intervals and no significant ST or T-wave
abnormalities. Bedside point-of-care echocardiogram is performed. The parasternal long- and short-axis views are shown in Figure below .
A. Describe the picture below as to what view it was taken and describe the area focused?
B. What is your impression and management?
1. A 47-year-old man presents to the emergency department with severe chest pain that is worse when lying supine. Three days ago he had a pacemaker placed for
symptomatic bradycardia. The patient is in moderate distress, slightly altered, and slow to respond. His vital signs are BP 76/60, HR 110, RR 22, SpO2 96% on RA, and T
37.3°C. His ECG shows sinus tachycardia, not paced, with normal intervals and no significant ST or T-wave abnormalities. Bedside point-of-care echocardiogram is performed.
The parasternal long- and short-axis views are shown in Figure below .
A. Describe the picture below as to what view it was taken and describe the area focused?
Subcostal longitudinal view of the inferior vena cava with collapse index measured in M mode
B. What is your impression and management? Chapter 50
The patient presents to the emergency department with cardiac tamponade, as evidenced by positional chest pain, hypotension, and narrow pulse pressure. The
ultrasound also helps demonstrate tamponade with a pericardial effusion and hypotension in the setting of minimally collapsible IVC. Given that that patient is
hemodynamically unstable, an emergent pericardiocentesis is indicated.
2. A 60-old-man known hypertensive, diabetic and smoker presents to the emergency department with chest pain, nausea, vomiting, and shortness of breath. He takes a daily
aspirin and insulin. His blood pressure is 84/65 with a heart rate of 74. He appears diaphoretic and distressed. You obtain this ECG (Figure 5.3).
1. Which artery is occluded?
(A) Left circumflex artery
(B) Obtuse marginal artery
(C) Proximal left anterior descending artery
(D) Right coronary artery
2. What medicine is preferred to manage his chest pain? Give the dose, route and interval in giving the medication
2. A 60-old-man known hypertensive, diabetic and smoker presents to the emergency department with chest pain, nausea, vomiting, and shortness of breath. He takes a daily
aspirin and insulin. His blood pressure is 84/65 with a heart rate of 74. He appears diaphoretic and distressed. You obtain this ECG (Figure 5.3).
1. Which artery is occluded?
(A) Left circumflex artery
(B) Obtuse marginal artery
(C) Proximal left anterior descending artery
(D) Right coronary artery
2. What medicine is preferred to manage his chest pain? Give the dose, route and interval in giving the medication
Morphine 2–5 milligrams IV every 5–15 min PRN pain
The ECG demonstrates ST elevation in the inferior leads. The elevation is greater in lead III than in lead II with ST depression in the high
lateral leads of I and aVL. A left circumflex myocardial infarction (MI) will cause ST elevation in leads I, aVL, V5, and ST depression in leads
V1, V2, and V3. An obtuse marginal artery MI will cause similar findings to a circumflex MI given that it is a branch originating from the
circumflex artery. A left anterior descending artery MI will cause ST elevation in V1, V2, V3, and ST depression in leads II, III, and aVF
A 58-year-old female presents to the emergency department with sudden onset of shortness of breath, pleuritic chest pain, and a sense of
impending doom. She reports no history of trauma, but recently completed a long international flight. On examination, her vital signs are as
follows: BP 8065 mmHg, HR 120 bpm, RR 28 breaths/min, SpO2 88% on room air. On auscultation, breath sounds are clear bilaterally. There
is mild swelling and tenderness in her left calf. An ECG shows sinus tachycardia without acute ischemic changes, and a bedside
echocardiogram reveals signs of right ventricular strain. CT Scan revealed a filling defect in the upward white arrow.
A. What is your Impression?
B. What is the Original Well Score of the patient?
A 58-year-old female presents to the emergency department with sudden onset of shortness of breath, pleuritic chest pain, and a sense of
impending doom. She reports no history of trauma, but recently completed a long international flight. On examination, her vital signs are as
follows: BP 8065 mmHg, HR 120 bpm, RR 28 breaths/min, SpO2 88% on room air. On auscultation, breath sounds are clear bilaterally. There
is mild swelling and tenderness in her left calf. An ECG shows sinus tachycardia without acute ischemic changes, and a bedside
echocardiogram reveals signs of right ventricular strain. CT Scan revealed a filling defect in the upward white arrow.
A. What is your Impression? Acute Pulmonary Embolism
B. What is the Original Well Score of the patient? 4.5
A 70-year-old male with a history of hypertension and smoking presents to the emergency department with sudden onset of
severe, tearing abdominal and back pain. He is diaphoretic, pale, and reports feeling lightheaded. On examination, his blood
pressure is 85/55 mmHg, heart rate is 110 bpm, and he has a pulsatile abdominal mass on palpation. His peripheral pulses are
weak, and he appears to be in acute distress.
1, What are the indications of prompt follow up and possible surgical intervention in this case?
2. What is medical term of periumbilical ecchymosis seen in patient with this disease?
A 70-year-old male with a history of hypertension and smoking presents to the emergency department with sudden onset of
severe, tearing abdominal and back pain. He is diaphoretic, pale, and reports feeling lightheaded. On examination, his blood
pressure is 85/55 mmHg, heart rate is 110 bpm, and he has a pulsatile abdominal mass on palpation. His peripheral pulses are
weak, and he appears to be in acute distress.
1, What are the indications of prompt follow up and possible surgical intervention in this case? Abdominal aortic aneurysms
≥5 cm in diameter are at an increased risk of rupture (size is measured from outer wall to outer wall) and require prompt (days)
follow-up. Symptomatic aneurysms of any size are considered emergent.
2. What is medical term of periumbilical ecchymosis seen in patient with this disease (Cullen sign)
A 55-year-old male presents with a history of progressive dyspnea on exertion, fatigue, and occasional palpitations. Physical examination reveals aHigh-
pitched blowing diastolic murmur immediately after S2 , echocardiography confirms with left ventricular dilation but preserved systolic function. The
patient is currently asymptomatic at rest.
1. What is our impression based on PE findings and echo findings ?
2. What do you classical PE findings which is due to increase stroke volume followed by collapse from a rapid fall in diastolic pressure ?
A 55-year-old male presents with a history of progressive dyspnea on exertion, fatigue, and occasional palpitations. Physical examination reveals aHigh-pitched
blowing diastolic murmur immediately after S2 , echocardiography confirms with left ventricular dilation but preserved systolic function. The patient is currently
asymptomatic at rest.
1. What is our impression based on PE findings and echo findings ?
2, The classic “water hammer pulse” (Corrigan pulse) is a peripheral pulse with a quick rise in upstroke due to increased stroke volume followed by collapse
from a rapid fall in diastolic pressure
