Day 6 Flashcards
A 32-year-old male attends the Emergency department complaining of severe chest pain of one hour.
On examination he is 6’4” tall and of slim build.
His blood pressure is 135/80 mmHg and he has an early diastolic murmur.
Electrocardiogram shows 1 mm ST elevation in II, III, and aVF.
What is the likely diagnosis?
What is the most appropriate action?
In a suspected presentation of an atypical (an inferior) myocardial infarction and a diagnosis of aortic artery dissection must be excluded.
These features are consistent with Marfan’s syndrome and aortic dissection.
What is the rule of nines?
The ‘rule of nines’ is used to approximate the body surface area (BSA) burnt.
For adults
- The head is 9%
- Upper limbs 9% each
- Lower limbs 18% each
- Trunk 18% front
- Back 18% back and finally
- The perineum 1%.
What is the half-life of carboxyhemoglobin?
What is the half-life of carboxyhemoglobin on 100% oxygen?
The half-life of carboxyhemoglobin is four hours but this falls to 30 minutes when breathing 100% oxygen.
What is the mount Vernon formula?
The Mount Vernon formula uses colloid at 0.5 ml per Kg x %BSA of burn every four hours for the first 12 hours following injury, then every six hours for the next 12 hours.
At what point are IV fluids required in burn victims?
- Adults can compensate with oral fluids for up to a 15% burn
- but children can only compensate for a burn <10%.
A 27-year-old asthmatic who has been unwell for 24 hours with a productive cough, fever and episodic wheeze.
He initially managed it at home with his regular salbutamol inhaler but was having worsening shortness of breath so presented to the hospital.
Your colleague has clerked him and thus far prescribed four sets of back to back salbutamol nebulisers, one set of ipratropium nebulisers and intravenous hydrocortisone.
The patient is now tiring and speaking in words only, with a silent chest.
His respiratory rate is climbing and his saturations are 90% on 10 litres of oxygen.
What therapeutic intervention should be given next?
Magnesium sulphate 2 g
Oxygen
- if patients are hypoxaemic, it is important to start them on supplemental oxygen therapy
- if patients are acutely unwell they should be started on 15L of supplemental via a non-rebreathe mask, which can then be titrated down to a flow rate where they are able to maintain a SpO₂ 94-98%.
Bronchodilation with short-acting beta₂-agonists (SABA)
- high-dose inhaled SABA e.g. salbutamol, terbutaline
- in patients without features of life-threatening or near-fatal asthma, this can be given by a standard pressurised metered-dose inhaler (pMDI) or by an oxygen-driven nebulizer
- in patients with features of a life-threatening exacerbation of asthma, nebulised SABA is recommended
Corticosteroid
- all patients should be given 40-50mg of prednisolone orally (PO) daily, which should be continued for at least five days or until the patient recovers from the attack
- during this time, patients should continue their normal medication routine including inhaled corticosteroids.
ipratropium bromide
- in patients with severe or life-threatening asthma, or in patients who have not responded to beta₂-agonist and corticosteroid treatment, nebulised ipratropium bromide, a short-acting muscarinic antagonist
IV magnesium sulphate
- the BTS notes that the evidence base is mixed for this treatment that is now commonly given for severe/life-threatening asthma
IV aminophylline
- may be considered following consultation with senior medical staff
Management stages of acute asthma attack in ER
(6)
Oxygen
- if patients are hypoxaemic, it is important to start them on supplemental oxygen therapy
- if patients are acutely unwell they should be started on 15L of supplemental via a non-rebreathe mask, which can then be titrated down to a flow rate where they are able to maintain a SpO₂ 94-98%.
Bronchodilation with short-acting beta₂-agonists (SABA)
- high-dose inhaled SABA e.g. salbutamol, terbutaline
- in patients without features of life-threatening or near-fatal asthma, this can be given by a standard pressurised metered-dose inhaler (pMDI) or by an oxygen-driven nebulizer
- in patients with features of a life-threatening exacerbation of asthma, nebulised SABA is recommended
Corticosteroid
- all patients should be given 40-50mg of prednisolone orally (PO) daily, which should be continued for at least five days or until the patient recovers from the attack
- during this time, patients should continue their normal medication routine including inhaled corticosteroids.
ipratropium bromide
- in patients with severe or life-threatening asthma, or in patients who have not responded to beta₂-agonist and corticosteroid treatment, nebulised ipratropium bromide, a short-acting muscarinic antagonist
IV magnesium sulphate
- the BTS notes that the evidence base is mixed for this treatment that is now commonly given for severe/life-threatening asthma
IV aminophylline
- may be considered following consultation with senior medical staff
Mechanism of action of ipratropium
Ipratropium exhibits broncholytic action by reducing cholinergic influence on the bronchial musculature.
It blocks muscarinic acetylcholine receptors, without specificity for subtypes, and therefore promotes the degradation of cyclic guanosine monophosphate (cGMP), resulting in a decreased intracellular concentration of cGMP.
Most likely due to actions of cGMP on intracellular calcium, this results in decreased contractility of smooth muscle in the lung, inhibiting bronchoconstriction and mucus secretion. It is a nonselective muscarinic antagonist,
A 54-year-old female is admitted after suddenly collapsing in the street whilst out shopping with her friend. On examination she appears drowsy, has a pulse of 110 beats per minute and a temperature of 37.1°C.
She has nuchal rigidity which elicits a moan.
There is no eye opening to pressure over the sternum, but pressure over the nail bed elicits this withdrawal of the limb.
She is generally hyper-reflexic with bilateral extensor plantar responses.
What is her GCS?
What diagnosis do you suspect?
The 54-year-old female who collapses in the street sounds as if she may have had a subarachnoid haemorrhage.
Her GCS is E1, V2, M4 = 7.
A 19-year-old female is brought to the Emergency department following a car accident.
On examination she has a head wound, has a pulse of 110 beats per minute, smells of alcohol, is confused.
She shouts for her boyfriend while thrashing around on the couch and only partially co-operates with examination.
Her eyes are fully open, pupils appear slightly dilated and reflexes appear brisk with down going plantar responses.
Calculate her GCS
E4
V4 (as confused)
M6 (obeys commands) = 14
An 80-year-old male is admitted after being found collapsed at home.
No history is obtainable.
On examination he has a pulse of 45 beats per minute, a temperature of 34°C, no eye opening to pressure over the eyebrows and he makes no audible sounds.
No movements can be elicited and he has generally brisk reflexes with bilateral extensor plantar responses.
What is his GCS?
The 80-year-old male with what sounds like raised intracranial pressure has E1, V1, M1 = 3, suggesting a grave prognosis.
Which virus is associated with hepatocellular carcinoma?
Approximately 2% of those with cirrhosis from hepatitis C develop hepatocellular carcinoma.
A 10-year-old boy attends the Emergency department with a scalp laceration he sustained playing football.
Examination confirms a superficial clean incised wound approximately 2 cm in length.
Which would be the best way of managing this wound?
Tissue adhesive glue is very useful for scalp wounds particularly in children.
Wounds must be clean and less than about 3 cm in length. Glue should not be used to close wounds around the eyes or over joints.
A 58-year-old dairy farmer attends the Emergency department following a fall at work. He slipped in the cowshed cutting his leg on some metal fencing.
On examination he has a severely contaminated deep wound on the lateral aspect of his thigh.
After completing the examination and obtaining an x ray to exclude a foreign body you would like to clean the wound.
Which cleaning agent is the best to use?
- Sterile 0.9% saline
- Hydrogen peroxide is generally not recommended and carries a risk of oxygen embolism.
On examination he has abdominal swelling, guarding and numerous audible bowel sounds.
What is the diagnosis?
Sigmoid volvulus
A 3-year-old boy is brought to the Emergency department with onset of stridor in the last few hours.
Over the past three days he has been unwell with coryzal symptoms and ear temperature of 38.2°C.
What is the diagnosis?
What is the infective agent?
Croup may be caused by different viruses although most commonly as a result of infection with parainfluenza.
Typically it occurs in young children a few days after a coryzal illness with symptoms of a barking cough, a low grade fever and an inspiratory stridor.
Symptoms are worse at night.
A 9-month-old boy is referred to ENT as he has been noted to have stridor.
He sometimes chokes when drinking or feeding.
His head circumference has risen from the 50% at birth to the 98% and he has short limbs.
What is the diagnosis?
This child has achondroplasia, which is often associated with hydrocephalus (Arnold-Chiari malformation).
This in turn can be associated with vocal cord palsy.
A 22-year-old male is admitted wheezing with a respiratory rate of 35/min, a pulse of 120 beats per min, blood pressure 110/70 mmHg, peak expiratory flow rate <50% predicted.
He has been given back-to-back nebulisers of salbutamol 5 mg and ipratroprium 0.5 mg for the last 45minutes and is on face mask oxygen. He has been given hydrocortisone 100 mg IV.
The intensive care team are aware of the patient.
What is the next stage in this patient’s treatment?
- oxygen
- Salbutamol
- steroids
- ipratropium
- magnesium sulphate
- amenophyleline
Which criteria must be met for asthma to be life threatening?
(6)
- PEFR < 33% best or predicted
- Oxygen sats < 92%
- ‘Normal’ pC02 (4.6-6.0 kPa)
- Silent chest, cyanosis or feeble respiratory effort
- Bradycardia, dysrhythmia or hypotension
- Exhaustion, confusion or coma
A 62-year-old male presented with an eight hour history of double vision.
He has generally been well but has a history of hypertension for which he takes amlodipine and atenolol.
He also has a four year history of diet controlled type 2 diabetes.
On examination he has some watering of the right eye, there is a slight droop of the eyelid and the eye is displaced to the right.
Pupil size is the same as on the left and the left eye appears to have a full range of movements.
What is the likely cause of his symptoms?
Which cranial nerve is being affected?
Diabetes
- third nerve palsy
- This man has a painless partial third nerve palsy which affects his eye but there is pupil sparing.
- The most likely cause is diabetes mononeuropathy and is thought to be due to a microangiopathy with occlusion of the vasa nervorum.
- Aneurysm of the posterior communicating artery is associated with an often painful third nerve palsy with pupillary dilatation being typical.
Features of toxicity to lithium
(6)
Features of toxicity
- coarse tremor (a fine tremor is seen in therapeutic levels)
- hyperreflexia
- acute confusion
- polyuria
- seizure
- coma
A 56-year-old fit and well man presented to the hand trauma clinic with a one week history of pain and swelling to his right ring finger. He recalls lifting a garden pot and feeling a sudden pain in his finger.
A photograph of his hand is shown below; radiographs were normal.
What is the deformity and what is the diagnosis?
Boutonniere deformity due to central slip rupture
Which anti-depressant class overdose presents with prolonged QRS complex?
Prolonged QRS complex is consistent with TCA overdose.
On examination she has a temperature of 39°C, has neck stiffness and is drowsy.
What is the most likely diagnosis?
The patient’s symptoms are important here in establishing the diagnosis as she has a temperature and signs of meningeal irritation suggesting infection.
The CT head scan shows a frontal space occupying lesion with rim enhancement suggesting tumour/metastasis or abscess.
Thus with her presentation the likely diagnosis is abscess.
Which abnormals result of CSF analysis would confirm bacterial meningitis?
(4)
Raised neutrophil count
raised WBC
turbid appearance
Gram stain
During lumbar puncture, the needle can be inserted between which two vertebrae?
(3)
L4 & L5
L3 & L4
L5 & S1
What are the most important contraindications to performing a lumbar puncture?
(4)
- Increased intracranial pressure
- bleeding diathesis
- cardiorespiratory compromise
- infection at site of needle insertion
List four specific complications of a lumbar puncture.
(4)
Post-LP/post-spinal tap headache
nerve root trauma
CSF infection
intraspinal haematoma
“coning” (herniation)
A 24-year-old man with a past medical history of asthma is admitted to hospital with a left lower lobe pneumonia. He is treated with amoxicillin.
Within two minutes of the antibiotic being administered, the patient complains of feeling unwell. There is a rapidly developing, erythematous, macular rash over his trunk and limbs and there are large wheals on his torso. He is noted to have lip and tongue swelling. Harsh wheeze is heard on auscultating the chest.
Observations show a blood pressure of 84/39 mmHg and a heart rate of 167 bpm, shown to be a sinus tachycardia when connected to cardiac monitoring. Oxygen saturations are 90% on air so he is put onto high flow oxygen.
Which drug would be the next most appropriate to administer?
Adrenaline 1:1000 0.5 ml (500 mcg equivalent) intramuscular
A 62-year-old man presents to the rural medical clinic in India with a non-healing wound on the volar aspect of the right arm four weeks after incision and drainage of an abscess.
He now has restricted movement of the right arm and shoulder.
What is the diagnosis?
Upper limb ischaemia is rare, and age, alone, is not a risk factor in wound healing.
This patient has chronic tuberculous osteomyelitis
A 2-year-old boy is seen in the Emergency department 30 minutes after ingesting 150 ml of amitriptyline syrup.
He is fully conscious.
Which clinical signs might you anticipate? (5)
How would this child be managed? (3)
Which clinical signs might you anticipate?
- Pupil constriction
- Coma
- Myoclonic twitches
- Choreoathetosis, and
- Pyramidal tract signs
How would this child be managed?
- ABC resuscitation as necessary
- Gastric lavage followed by activated charcoal in severe poisoning, and
- Treatment of the arrhythmias and seizures as necessary.
A 72-year-old woman is admitted unconscious with a core temperature of 35.6°C. She has a heart rate of 42 beats per minute and slowly relaxing reflexes.
Which test should be ordered?
TFT
Drowsiness, bradycardia and slowly relaxing reflexes would suggest the diagnosis of hypothyroid coma.
Urgent thyroid function tests will confirm the diagnosis.
A healthy female is scheduled for laparoscopic sterilization.
Suitable muscle relaxation will be provided by which drug? (1)
Which alternatives wouldn’t be used? (2)
Muscle relaxation is required during the creation of a pneumoperitoneum, which provides a clear view and access to the fallopian tubes.
The anticipated duration of surgery is 20 to 30 minutes, thus atracurium is the best choice.
Suxamethonium is too short acting and pancuronium lasts too long.
A 21-year-old-male presents for dental extractions under general anaesthesia.
He has epilepsy but has been seizure free for nine months on his current medication.
Select an appropriate intravenous induction agent.
Which agents would be contra-indiciated?
Thiopentone is a barbiturate and has anticonvulsant properties thus it the correct answer.
Diazepam is an anticonvulsant but it is not used to induce anaesthesia.
Propofol and etomidate have both been known to cause movement resembling convulsions thus are best avoided.
A young male is due to have a large lipoma excised from his forearm.
Which agent would be a suitable intravenous induction agent to allow placement of an LMA?
Propofol is the best induction agent when planning to use an LMA.
It inhibits the pharyngeal and laryngeal reflexes faster than thiopentone or etomidate, providing optimal conditions for inserting the device.
A 64-year-old male presents for a cystoscopy.
A hiatus hernia was diagnosed six months ago.
His current medication is Gaviscon and he has been nil by mouth since midnight.
Select a suitable muscle relaxant to allow placement of the endotracheal tube.
Patients with a hiatus hernia must have their airway protected as quickly as possible following induction of anaesthesia.
Failure to protect the airway with a cuffed endotracheal tube may lead to soiling of the trachea from regurgitation of residual gastric fluid.
Thus a rapid sequence induction should be considered.
Suxamethonium is the correct choice as it provides optimum intubating conditions in 30 to 45 seconds.
24-year-old female non-smoker; pleuritic chest pain and hemoptysis; a normal chest radiograph
What is the next investigation?
CTPA
These clinical features suggest pulmonary embolism and CTPA is regarded as the best test to diagnose this condition.
4-day-old male; convulsions and bulging fontanelles
What is the most appropriate next investigation?
Transcranial ultrasound is an useful tool in the assessment of brain injury in the newborn.
65-year-old male hypertensive; acute central chest pain; a widened superior mediastinum on his chest radiograph
What is the next most appropriate investigation?
The presumed diagnosis here must be aortic dissection, and this will be revealed using a CT of the thorax and aorta.
In the past, aortic arch angiography was considered the optimal diagnostic tool but this has been superseded by imaging with CT or MRI.
22-year-old female, unable to conceive; history of pelvic inflammatory disease
What is the most appropriate next investiation?
The hysterosalpingogram will investigate the anatomy of the uterus and fallopian tubes. Pelvic inflammatory disease is associated with infertility, due to scarring in the fallopian tubes secondary to salpingitis.
You are asked to assess a 56-year-old woman in the emergency department using the Glasgow coma scale.
When you pinch the patient’s arm she opens her eyes and withdraws the limb by normal flexion. She does not open her eyes to any stimulus other than pain and she is unable to speak or provide any verbal response.
List the patient’s scores for eye opening, best motor response and verbal response.
What is the patient’s total score?
Using the Glasgow coma sale definition, is the patient in a coma?
List the patient’s scores for eye opening, best motor response and verbal response.
E2V1M4
What is the patient’s total score?
7
Using the Glasgow coma sale definition, is the patient in a coma?
Yes
A 56-year-old female presents with a five day history of fever, cough and malaise.
She returned from a holiday in southern Spain one week ago and has since developed a non-productive cough with chills which have deteriorated.
She has no previous medical history but is a smoker of 10 cigarettes per day.
Examination reveals a temperature of 40°C, with a blood pressure of 118/72 mmHg with a pulse of 106 bpm.
Chest examination reveals some inspiratory crackles at the left base only, with a respiratory rate of 28/min. She has oxygen saturations of 94% on air.
Baseline investigations reveal:
What is the most likely diagnosis?
What is the causative organism?
What is the treatment?
This history together with symptoms suggest a community-acquired pneumonia.
The investigations show a relatively normal white cell count, despite the obvious infection and would therefore suggest an atypical pneumonia.
The travel to Spain and the hyponatraemia would suggest a diagnosis of Legionnaire’s disease.
This is due to infection with the organism Legionella pneumophila.
The disease is spread through infected water supplies, usually air conditioning systems.
It is most readily diagnosed through the detection of urinary antigen prior to any rise in serum antibody titres.
The organism is sensitive to macrolides and ciprofloxacin.
A 28-year-old Zimbabwean man presents with severe constant abdominal pain. He has not opened his bowels for three days and is not passing flatus. He has had two previous similar episodes but has never seen a doctor before. The pain is now much worse.
On examination, he is pale and sweaty. He is dehydrated, his pulse is 100 beats per minute, blood pressure 100/70 mmHg and temperature is 38°C. The abdomen is distended and diffusely tender.
You begin to resuscitate the patient and arrange an urgent supine abdominal x ray.
There is small and large bowel distension on this x ray but the appearance is of the classic ‘coffee bean’ of sigmoid volvulus.
Sigmoid volvulus as a cause of large bowel obstruction is not uncommon in sub-Saharan Africa and if not decompressed urgently, may result in ischaemia and perforation of the colon.
This patient has constant, severe pain and is likely to have ischaemia resulting in peritonitis.
He needs resuscitation, urgent laparotomy, and sigmoid colectomy.
Neuroleptic malignant syndrome
What is the tetrad? (4)
What is the typical cause?
What is the treatment?
A potentially life-threatening complication of treatment with antipsychotic drugs, or abrupt withdrawal of dopamine agonists.
Characterised by a tetrad of
- altered mental status
- muscle rigidity
- autonomic instability
- hyperthermia
A diagnosis of exclusion. Common differential diagnoses are sepsis and drug reactions.
NMS is a medical emergency. Treatment consists of immediate cessation of the offending medication and provision of supportive measures (hydration and cooling).
A delay of at least 2 weeks in restarting antipsychotic treatment is advised following full resolution of an NMS episode.
A 77-year-old man presents with his fourth episode of acute rectal bleeding.
The blood is a mixture of fresh blood and clots.
On this occasion the bleeding has been severe enough to require a 4 unit blood transfusion.
A barium enema is undertaken and is normal.
The differential diagnosis is diverticular disease or angiodysplasia.
Both can produce a significant gastrointestinal blood loss which is painless.
In contrast a sigmoid carcinoma would not usually bleed enough to require a transfusion but would be associated with chronic blood loss causing anaemia.
Angiodysplasia is only diagnosed by colonoscopy. Diverticulae would be seen on a barium enema.
What is the name given to this physical sign?
What is the most likely diagnosis?
Name four initial investigations that you would request?
List one long term complication of this condition.
What is the name given to this physical sign?
- Cullen’s sign
- Ecchymoses
What is the most likely diagnosis?
- Acute pancreatitis
- Bleeding aortic aneurysm
Name four initial investigations that you would request?
- Serum amylase
- Abdominal ultrasound
- Arterial blood gas analysis
- Full blood count
- Urea and electrolytes
- Calcium
- Glucose
List one long term complication of this condition.
- Psuedocyst of pancreas
- Diabetes mellitus
- Pancreatic insufficiency/malabsorption
What is this sign?
What does it represent?
Grey Turner sign
Classically it correlates with severe acute necrotizing pancreatitis
A 76-year-old woman presented with an acute myocardial infarction.
The ECG showed ST segment elevation in leads II, III, and a VF.
Which coronary artery is most likely to be occluded?
Which area of the heart is affected?
A 76-year-old woman presented with an acute myocardial infarction.
The ECG showed ST segment elevation in leads V1-V2
Which area of the heart is affected?
Which coronary artery is most likely to be occluded?
A 76-year-old woman presented with an acute myocardial infarction.
The ECG showed ST segment elevation in leads V3-V4
Which area of the heart is affected?
Which coronary artery is most likely to be occluded?
A 76-year-old woman presented with an acute myocardial infarction.
The ECG showed ST segment elevation in leads V5-V6
Which area of the heart is affected?
Which coronary artery is most likely to be occluded?
A 76-year-old woman presented with an acute myocardial infarction.
The ECG showed ST segment elevation in leads I, aVL
Which area of the heart is affected?
Which coronary artery is most likely to be occluded?
A 76-year-old woman presented with an acute myocardial infarction.
The ECG showed ST segment elevation in V7, 8, 9
Which area of the heart is affected?
Which coronary artery is most likely to be occluded?
Define each term
HbSAg
Anti-HBs
IgM anti-HBc
IgG anti-HBc
HBeAg
Anti-HBe
HbSAg
- HBsAg (Hepatitis B surface antigen) - A “positive” or “reactive” HBsAg test result means that the person is infected with hepatitis B
Anti-HBs
- A “positive” or “reactive” anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus.
IgM anti-HBc
- Anti-HBc (IgG and IgM) antibodies are the body’s first response to a hepatitis B virus (HBV) infection.
IgG anti-HBc
- Anti-HBc (IgG and IgM) antibodies are the body’s first response to a hepatitis B virus (HBV) infection.
HBeAg
- HBeAg stands for hepatitis B e-antigen. This antigen is a protein from the hepatitis B virus that circulates in infected blood when the virus is actively reproducing
Anti-HBe
- Positive anti-HBe results usually indicate inactivity of the virus and low infectivity.
Which pattern is often seen on PE patient’s ECG?
The S-I Q-III T-III ECG pattern
A 30-year-old woman develops a right sided facial weakness very quickly over 24 hours. You think that the most likely diagnosis is Bell’s palsy and you carry out an examination to confirm this.
Which findings are in keeping with a diagnosis of Bell’s palsy?
Right sided facial paralysis
with weakness of right-side (occipito-)frontalis
A 14-year-old boy is referred by his GP to the hospital’s Emergency department.
The boy complains of headache, neck stiffness and photophobia.
What does the picture show?
What is the most likely diagnosis?
Which organism is the most likely cause for this patient’s presentation?
What haematological abnormality may underlie this rash?
What does the picture show?
- Petechiae
- purpura
- septicaemic rash
What is the most likely diagnosis?
- Meningococcal meningitis
- meningococcal septicaemia
Which organism is the most likely cause for this patient’s presentation?
- Meningococcus/Neisseria meningitidis
What haematological abnormality may underlie this rash?
- Disseminated intravascular coagulation (DIC)
Which of the following agents is the most appropriate to treat this lesion?
What is the causative agent?
What is the lesion called?
Which of the following agents is the most appropriate to treat this lesion?
- acyclovir
What is the causative agent?
- Herpes simplex
What is the lesion called?
- Dendritic Ulcer
You are the foundation year doctor on ward cover and have been asked to review a 70-year-old male who has been admitted to the cardiac care unit with chest pain five hours ago.
He has been treated with morphine, aspirin, clopidogrel, enoxaparin and metoprolol. He has just developed a further worsening of chest pain and his heart rate has suddenly dropped to 30 beats per minute. His other observations are: BP 140/85 mmHg, O2 98%, RR 18.
An ECG is performed and demonstrates complete heart block.
What is the most likely precipitating factor?
Which artery has most likely been affected?
Which leads in an ECG would they represent?
Inferior myocardial infarction
Patients presenting with myocardial infarctions are at higher risks of associated arrhythmias.
Inferior MIs in particular can have associated transient complete heart block, due to the right coronary artery supplying the AV node.
