A 39-year-old woman comes to the emergency department with substernal chest pressure and palpitations

A 39-year-old woman comes to the emergency department with substernal chest pressure and palpitations. She was diagnosed with systemic lupus erythematosus 7 years ago and has had renal involvement. The patient was recently discharged from the hospital for an exacerbation of lupus nephritis. Her medications include prednisone and hydroxychloroquine. She does not use tobacco, alcohol, or illicit drugs. Her temperature is 37.2 C (99 F), blood pressure is 150/90 mm Hg, pulse is 128/min, and respirations are 26/min. During her visit to the emergency department, she sustains cardiac arrest with documented ventricular fibrillation and expires despite resuscitative efforts. Which of the following is the most likely cause of her death?

  • A. Aortic dissection r
  • B. Cardiac tamponade r
  • C. Coronary atherosclerosis r
  • D. Coronary vasculitis r
  • E. Non-Hodgkin lymphoma

0 voters

A 55-year-old man comes to the emergency department with palpitations that started earlier this morning. He has no chest pain or shortness of breath. The patient has hypertension that is well controlled with valsartan and amlodipine. He does not use tobacco, alcohol, or illicit drugs. His blood pressure is 140/80 mm Hg and respirations are 19/min. Jugular venous pressure is estimated at 2 em H20 . Cardiac auscultation shows no murmurs. Lungs are clear to auscultation. The abdomen is soft, nontender, and non-distended. Neurologic examination shows no abnormalities. The patient is placed on a telemetry monitor, and a 12-lead electrocardiogram is performed and shown in this exhibit.
What is the most appropriate next step in management of this patient?

  • A. Adenosine r
  • B. Amiodarone r
  • C. Clopidogrel r
  • D. Digoxin r
  • E. Metoprolol

0 voters