1) Which of the following IS NOT an absolute contraindication to cardiac exercise testing?
B) Recent pulmonary embolism.
D) Left bundle branch block.
The correct answer is "D." An LBBB is a relative—not absolute—contraindication to exercise stress testing. In the setting of LBBB, there are already repolarization abnormalities that limit the usefulness of the stress test. For the most effective test, one should add an imaging modality, such as myocardial perfusion scanning or echocardiogram, in cases of LBBB. Unstable angina, recent pulmonary embolism, and active pericarditis are all absolute contraindications to exercise stress testing. Other absolute contraindications to exercise stress testing include acute myocardial infarction (MI) within 2 days, dissecting aneurysm, BP > 200/120 mm Hg, severe heart failure, severe aortic stenosis, inability to complete the test, and hemodynamically significant arrhythmias. See question 2.2.2.
2) Which of the following is the preferred antiplatelet drug for treating chest pain in the emergency department?
D) Clopidogrel 300 mg PO.
E) 2B/IIIA glycoprotein inhibitor.
The correct answer is "B." Immediate therapy for a patient presenting with chest pain to the ED requires ASA 325 mg orally (preferably chewed). Aspirin 81 mg daily is a maintenance or prophylactic dose for coronary artery disease and is not the preferred choice for immediate therapy. Since we are not sure if this patient is experiencing acute coronary syndrome (ACS), there is no indication for glycoprotein IIb/IIIa inhibitor or clopidogrel (Plavix) at this time. These therapies would be reasonable in addition to ASA 325 mg if the patient had ACS. See question 2.1.4.
3) This ECG, shown in Figure 30-1, represents a(n):
The correct answer is "A." This is an inferior wall MI. Note the ST elevations in leads II and III, and aVF with reciprocal changes in leads V1–V2. Anterior wall MI would have ST elevations in the anterior leads (V2–V4). Inferolateral wall MI ...