Mukherjee_Interventional Cardiology Board Review, 4e

67

7 Antiarrhythmics, Inotropes, Sedatives, and Lipid-Lowering Agents

A. Low thyroid-stimulating hormone (TSH); high T4

100 mg daily, sacubitril/valsartan 24/26 mg twice daily, and torsemide 20 mg twice daily. In this patient, which medication is best to suppress re current, appropriate ICD shocks? A. Lidocaine B. Amiodarone C. Sotalol D. Ranolazine 7.8 Which of the following is TRUE regarding medi cation administration during cardiac arrest sec ondary to pulseless ventricular tachycardia? A. Epinephrine should be administered as soon as possible to facilitate return of spontane ous circulation (ROSC) B. Amiodarone is superior to lidocaine for achievement of ROSC C. Antiarrhythmic medications should be ad ministered after initial defibrillation attempts fail to achieve ROSC D. Procainamide is superior to amiodarone to facilitate ROSC 7.9 A 53-year-old man presents to the ED via ambu lance with complaints of progressive shortness of breath over the past week. During his transfer, he received a single defibrillation for ventricular fibrillation. Upon arrival, vital signs include BP 98/60 mm Hg and HR 100 bpm. His extremities are cool to the touch. A transthoracic echocar diogram reveals an LVEF of 15%. A right heart catheterization is performed with the following findings: pulmonary capillary wedge pressure (PCWP) 32 mm Hg and cardiac index 1.6 L/min/ m 2 . Which medication is most appropriate in this patient? 7.10 A 57-year-old patient presents with cardiogenic shock following an acute right coronary artery occlusion. A transthoracic echocardiogram con firms right ventricular (RV) dysfunction. Fol lowing reperfusion therapy, the patient remains hypotensive with central venous pressure 10 mm Hg. Which vasoactive agent is most appropriate in this patient? A. Phenylephrine B. Dobutamine C. Milrinone D. Epinephrine A. Dobutamine B. Epinephrine C. Milrinone D. Vasopressin

B. Elevated TSH; low T4 C. Abnormal chest x-ray D. Low vitamin D level

7.5 A 47-year-old woman presents to the ED with new-onset atrial flutter. Vital signs include BP 102/66 mm Hg and HR 135 bpm. On ECG, her QTc is measured at 320 ms. A transthoracic echo cardiogram is obtained, and her estimated LVEF is 45%. Pertinent laboratory values include serum creatinine 0.9 mg/dL, potassium 2.9 mEq/L, and magnesium 2.1 mg/dL. The decision to adminis ter ibutilide is made. Which of the following in creases the risk of torsades de pointes (TdP) in this patient? A. Corrected QT B. Left ventricular ejection fraction 7.6 An 80-year-old woman presents with altered mental status and vomiting. Her daughter reports that the patient has had decreased oral intake over the past week. Current vital signs include BP 82/52 mm Hg and HR 42 bpm. An ECG demon strates second-degree atrioventricular (AV) nodal block and bigeminy. Pertinent laboratory values include serum creatinine 3.6 mg/dL (baseline 1.2 mg/dL), potassium 5.7 mEq/L, and digoxin 3.5 ng/mL. Which of the following is most appro priate to recommend at this time? A. Phenylephrine B. Digoxin-specific antibody fragment C. Dopamine D. Calcium gluconate defibrillator (ICD) shocks. She has a history of nonischemic cardiomyopathy (LVEF 20%), cardiac resynchronization therapy-defibrillator (CRT-D) device placement, stage 4 chronic kidney dis ease, and hypothyroidism. Interrogation of the ICD reveals sustained ventricular tachycardia that persisted despite antitachycardia pacing and re quired three defibrillations before the arrhythmia was terminated. Relevant laboratory parameters include serum potassium 4.1 mEq/L, magnesium 2.0 mg/dL, serum creatinine 2.5 mg/dL (estimated CrCl 21 mL/min), and TSH 3.42 mIU/L. Current medications include empagliflozin 10 mg daily, levothyroxine 25 µg daily, metoprolol succinate 7.7 A 61-year-old female is admitted to the hos pital for recurrent implantable cardioverter-­ C. Serum potassium level D. Serum magnesium level

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.