Cardiology and Cardiovascular Emergencies
Focus on rapid recognition and time-critical decisions. For acute coronary syndrome, know the distinction between STEMI (immediate reperfusion) and NSTEMI/unstable angina (risk-stratify, early invasive strategy for high-risk features). Understand the ECG patterns that mimic or mask ischemia: left bundle branch block, hyperkalemia, early repolarization, and posterior MI (ST depression in V1-V3). For acute decompensated heart failure, distinguish warm/dry, warm/wet, cold/dry, and cold/wet profiles and match diuresis or inotropy accordingly. Know the management of atrial fibrillation with rapid ventricular response in the unstable patient (synchronized cardioversion) versus stable (rate control first).
Traps
Questions test whether you recognize when a patient is unstable enough for electricity rather than drugs. Do not cardiovert a stable AF patient before rate control. Do not give nitrates to a patient with right ventricular infarction (inferior STEMI with hypotension) or recent PDE-5 inhibitor use. Recognize that a normal troponin does not exclude unstable angina, and that a widened QRS with hemodynamic compromise may need magnesium (torsades) or sodium bicarbonate (TCA/Na-channel blockade).
Rule of thumb
In any wide-complex tachycardia with hemodynamic instability, treat as ventricular tachycardia and cardiovert. In suspected ACS with a nondiagnostic ECG, serial troponins and clinical risk scores drive the decision, not a single normal value.