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Old 05-31-2011
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Emergency Why this woman died in the ambulance?

A 55 years old woman with severe chest pain awoke at 6 o'clock AM and came to clinic on 6:30 AM. Her EKG showed II, III, aVF ST elevation. I, aVL, V1, V2, V3, V4, ST depression. IV line and sublingual TNG pearl were done in ambulance during in it's way to specialized hospital, but unfortunately she died at 7 o'clock in ambulance. What is the most probable cause of her death?

A. Myocardial wall rupture and tamponade
B. VFib
C. Heart failure
D. Complete heart block


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Old 05-31-2011
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looks like an inferior wall MI, and in any case MCC of death after MI is fatal arrythmia - Vfib?
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Old 05-31-2011
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ECG shows inferior wall MI as well as ST segment depression in the anterior chest leads so i guess in d ambulance if u have vfib and complete heart block they can defibrillate wheras in myocardial wall rupture nothing can be done but if u look at it in general, inferior wall MI most likely leads to Vfib so assumingly my guess is a or b
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Old 05-31-2011
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Quote:
Originally Posted by ricko335 View Post
ECG shows inferior wall MI as well as ST segment depression in the anterior chest leads so i guess in d ambulance if u have vfib and complete heart block they can defibrillate wheras in myocardial wall rupture nothing can be done
Interesting , i had a question like this once in the kaplan Qbank with a kid having a head trauma and "no witness present" - they asked what to do . i said ct scan coz he "might have been unconcious" - it was wrong.

the guys at kaplan say that we dont need to assume ANYthing unless its mentioned specifically in the question stem. In this case they say thve just done an iv line and given her some gTN..

i hate these CK ques....
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Old 05-31-2011
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the answer is not A . Myocardial wall rupture and tamponade because it taked several days post mi for the wall to scar and weaken to rupture

but B. VFib CAN CAUSE sudden death so it is the choice
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Old 05-31-2011
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Originally Posted by drarnab View Post
Interesting , i had a question like this once in the kaplan Qbank with a kid having a head trauma and "no witness present" - they asked what to do . i said ct scan coz he "might have been unconcious" - it was wrong.

the guys at kaplan say that we dont need to assume ANYthing unless its mentioned specifically in the question stem. In this case they say thve just done an iv line and given her some gTN..

i hate these CK ques....
The most common cause of immediate death after an MI is Vfib and it is possible in this patient. So I will go with B. Wall rupture, tamponade and mechanical complications take time (5-6 days)
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Old 05-31-2011
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This patient has inferior STEMI which is RCA teritorry infarction. Conducting system above AV nodes are supplied by RCA and so I would pick complete heart block which is not easy to treat in ambulance after giving some drug like atropine! I'm not sure if paramedics are equipped with external pacer-which can be an option for ambulance intervention for CHB!

I agree VF is common, and lethal. But shockable in ambulance!

Let us know the correct answer aghammoud85. Thanks
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Old 05-31-2011
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Inferior MI always gives suspicion of Heart Block, but the most common cause of death in the first few hours is V-Fib .... this step 2 is an abomination
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Old 06-01-2011
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Quote:
Originally Posted by 1TA2B View Post
This patient has inferior STEMI which is RCA teritorry infarction. Conducting system above AV nodes are supplied by RCA and so I would pick complete heart block which is not easy to treat in ambulance after giving some drug like atropine! I'm not sure if paramedics are equipped with external pacer-which can be an option for ambulance intervention for CHB!

I agree VF is common, and lethal. But shockable in ambulance!

Let us know the correct answer aghammoud85. Thanks
Yes, now heart block makes sense. So it could be D or B?
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Cardiology-, Emergency-Medicine, Internal-Medicine-, Step-2-Questions

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