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Acute limb ischaemia from AF — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsAcute limb ischaemia from AFSCE Acute Medicine

A 42-year-old man presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show painful pale pulseless paraesthetic limb with motor deficit. What is the most appropriate next step in management?

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Correct answer: B — Give intravenous unfractionated heparin and call vascular surgery urgently

The key discriminator is that painful pale pulseless paraesthetic limb with motor deficit, which makes Give intravenous unfractionated heparin and call vascular surgery urgently the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Vascular Society guidance