Cardiovascular Practice Questions

Correct Answer: B) IV furosemide 40-80 mg push

Rationale: In acute decompensated heart failure with pulmonary congestion (evidenced by crackles), IV diuretics provide rapid symptom relief. IV administration provides faster onset than oral medications. ACE inhibitors and beta-blockers are important for long-term management but won't provide immediate symptom relief. Oral diuretics are appropriate for maintenance therapy but not acute decompensation.

Key Concept: Acute vs. chronic heart failure management requires different approaches. Acute symptoms require immediate relief (diuretics), while chronic management focuses on disease modification (ACE-I, beta-blockers, aldosterone antagonists).

Correct Answer: B) Evidence of end-organ damage (stroke, MI, pulmonary edema)

Rationale: Hypertensive emergency is defined by elevated BP WITH end-organ damage (neurological, cardiovascular, renal manifestations). Hypertensive urgency is elevated BP without end-organ damage. The presence of visual disturbances and severe headache combined with hypertension suggests potential cerebral edema or hypertensive encephalopathy—signs of emergency requiring immediate treatment.

Key Concept: The distinction between urgency and emergency is based on presence/absence of end-organ damage, not just the BP number. Emergency requires rapid controlled reduction in BP (minutes to hours), while urgency allows gradual reduction (24 hours).

Correct Answer: B) Causes vasodilation, reducing preload and afterload

Rationale: Nitrates work by dilating coronary arteries AND peripheral veins/arteries. By reducing preload (venous return) and afterload (systemic vascular resistance), the heart's workload and oxygen demand decrease. This supply-demand mismatch is what causes angina—nitrates help by reducing demand. While nitrates do cause some coronary vasodilation, their therapeutic benefit in stable angina is primarily through reducing cardiac workload.

Key Concept: Angina occurs when myocardial oxygen demand exceeds supply. Nitrates relieve symptoms by decreasing oxygen demand, not necessarily by increasing supply to narrowed vessels.

Correct Answer: B) Rapid rise and fall of troponin within 48 hours

Rationale: When coronary blood flow is restored (successful reperfusion), cardiac biomarkers rise rapidly and peak within 24-48 hours, then decline. This rapid rise-and-fall pattern indicates myocardial injury followed by reperfusion and recovery. In patients without reperfusion, troponin rises more slowly and remains elevated longer. High troponin values alone don't indicate successful reperfusion—the kinetics matter.

Key Concept: Troponin is a marker of myocardial injury, not ischemia. The pattern of rise and fall helps assess reperfusion status. Successful reperfusion may actually cause a higher peak due to washout from damaged myocardium.

Correct Answer: B) IV beta-blocker (metoprolol) or calcium channel blocker (diltiazem)

Rationale: For hemodynamically stable A-fib with RVR, rate control is the priority. IV beta-blockers and non-dihydropyridine calcium channel blockers are first-line agents for rate control. Cardioversion is reserved for hemodynamically unstable patients. Amiodarone and digoxin are alternatives when beta-blockers/CCBs are contraindicated. The goal is to slow the ventricular response rate to <110 bpm at rest.

Key Concept: Management of A-fib depends on hemodynamic stability. Stable patients need rate control; unstable patients need immediate cardioversion. Long-term management also requires consideration of rhythm control vs. rate control strategy and anticoagulation.