Cardiology Practice Questions

Q: Which condition is suggested by the 'spade-shaped left ventricle' on ECHO?

Hypertrophic cardiomyopathy. ***Hypertrophic cardiomyopathy*** - A **spade-shaped left ventricle** is a classic echocardiographic finding in **hypertrophic cardiomyopathy (HCM)**, specifically apical HCM [3]. - This shape results from focal **hypertrophy of the left ventricular apex**, leading to a distinctive narrowing towards the apex [3]. *Aortic regurgitation* - Causes **left ventricular volume overload** and often leads to **left ventricular dilation**, not typically a spade shape [1]. - **Diastolic retrograde flow** across the aortic valve is the characteristic echocardiographic finding. *Pulmonary embolism* - Primarily affects the **right side of the heart**, leading to **right ventricular dilation** and **dysfunction** [1]. - Does not directly cause a **spade-shaped left ventricle**. *Dilated cardiomyopathy* - Characterized by **enlargement and thinning of all four heart chambers**, particularly the left ventricle [2]. - The left ventricle typically appears globally dilated and spherical, not spade-shaped [2].

Q: A 55-year-old male presents to the emergency department with chest pain. An ECG shows ST-segment depression in leads V2 and V3. Troponin levels are elevated. What is the most likely diagnosis?

NSTEMI. ***NSTEMI*** - Elevated **troponin levels** confirm myocardial infarction (myocardial cell necrosis), while **ST-segment depression** (and absence of ST elevation) indicates it is a non-ST elevation myocardial infarction [1]. - This condition is characterized by **ischemia** severe enough to cause myocardial damage, but not a complete transmural infarction. *Unstable angina* - Characterized by **chest pain at rest** or with minimal exertion, which is a new onset or worsening pattern of angina [1]. - Unlike NSTEMI, **troponin levels** would not be elevated, indicating no myocardial cell necrosis has occurred yet [1]. *STEMI* - Defined by **ST-segment elevation** in two contiguous leads on an ECG, indicating acute transmural myocardial ischemia [2]. - While troponin levels are elevated in STEMI, the absence of **ST elevation** on the ECG rules out this diagnosis [2]. *Posterior wall MI* - Often diagnosed by **ST-segment depression in leads V1-V3** and prominent R waves in those same leads, which are reciprocal changes for a posterior infarct. - The given information only states ST-segment depression in V2 and V3, and while a posterior MI can present this way, the most direct and overarching diagnosis given the troponin elevation and ST depression is NSTEMI.

Q: All of the following are features of hyperkalemia on ECG, EXCEPT:

U waves. ***U waves*** - **U waves** are typically associated with **hypokalemia**, not hyperkalemia. They are small deflections immediately following the T wave. - Their presence suggests an abnormality in myocardial repolarization due to low potassium levels. *Shortened QT interval* - A **shortened QT interval** is *not* a typical finding in hyperkalemia; hyperkalemia usually causes a **prolonged PR interval** and QRS widening, which can make QT measurement difficult but does not inherently shorten it. - A shortened QT interval is more commonly seen in conditions like **hypercalcemia** or inherited short QT syndrome. *Peaked T waves* - **Peaked T waves** (also known as "tenting" of the T waves) are one of the earliest and most classic ECG signs of hyperkalemia [1]. - This occurs due to abnormally rapid repolarization of the ventricles. *Wide QRS complex* - As hyperkalemia progresses, the **QRS complex widens** due to a slowing of intraventricular conduction [1]. - This widening can eventually lead to a **sine wave pattern** if not treated, indicating severe hyperkalemia and impending cardiac arrest.

Q: Which of the following findings is seen in pericardial tamponade?

Pulsus paradoxus. ***Pulsus paradoxus*** - This is an **abnormally large decrease** in systolic blood pressure (>10 mmHg) and pulse wave amplitude during inspiration. - It occurs due to compromised ventricular filling caused by **increased pericardial pressure** in tamponade [1]. *Beck's triad* - Beck's triad (hypotension, jugular venous distention, and muffled heart sounds) are **signs/symptoms** of pericardial tamponade, not a finding in the same way pulsus paradoxus is [1]. - This clinical triad points towards the diagnosis but does not describe a physiological finding as specifically as pulsus paradoxus. *Kussmaul sign* - The Kussmaul sign is a paradoxical **increase** in jugular venous pressure (JVP) during inspiration. - While it indicates impaired right ventricular filling, it is classically seen in **constrictive pericarditis** and severe right heart failure, not typically in pericardial tamponade [2]. *All of the options* - This option is incorrect because Kussmaul sign is typically associated with **constrictive pericarditis** rather than pericardial tamponade [2]. - While Beck's triad is characteristic of tamponade, pulsus paradoxus is a specific hemodynamic finding seen in this condition [1].

Q: A patient presents with palpitations, chest pain, and irregular pulse. ECG shows irregular RR intervals with no P waves. Diagnosis?

Atrial fibrillation. Atrial fibrillation - Irregularly irregular RR intervals on ECG, combined with the absence of discernible P waves, are hallmark features of atrial fibrillation [2]. - The symptoms of palpitations and chest pain are common presentations due to the rapid and disorganized atrial electrical activity. Atrial flutter - Characterized by a "sawtooth" pattern of P waves (flutter waves), particularly prominent in leads II, III, aVF, which are absent here [3]. - While it can cause palpitations and an irregular pulse, the RR intervals often show a fixed block ratio, giving it a more regular rhythm unless conducted variably. SVT (Supraventricular Tachycardia) - Typically presents with a narrow QRS complex tachycardia and a regular rhythm, although some forms can be irregular. - P waves are often hidden within the QRS complex or appear retrograde, but the irregular RR intervals with no P waves are not characteristic. Ventricular tachycardia - Characterized by wide QRS complexes (typically >0.12 seconds) due to ventricular origin [1]. - While it causes palpitations and chest pain and can be irregular, the ECG description of no P waves with irregular RR intervals specifically points away from this diagnosis, which usually involves a rapid ventricular rhythm [1].

Q: A 55-year-old diabetic presents with chest pain, shortness of breath, and diaphoresis. ECG shows ST elevation. What is the next best step?

PCI. ***PCI (Percutaneous Coronary Intervention)*** - The patient's symptoms (chest pain, shortness of breath, diaphoresis) combined with **ST elevation on ECG** indicate an **ST-segment elevation myocardial infarction (STEMI)**. - **PCI** is the preferred and most effective treatment for STEMI when available within **90 minutes of first medical contact**, as it directly opens the occluded coronary artery and restores blood flow. *Nitroglycerin* - While nitroglycerin can help alleviate chest pain by causing **vasodilation**, it does not address the underlying coronary artery occlusion in STEMI. - It is typically used for symptomatic relief in **angina** or NSTEMI, but not as the primary reperfusion therapy for STEMI. *Thrombolysis* - **Thrombolysis** is an alternative reperfusion strategy for STEMI when PCI is not readily available or cannot be performed within the recommended timeframes (e.g., within 120 minutes of first medical contact to PCI-capable hospital). - However, **PCI is superior to thrombolysis** in terms of revascularization success and clinical outcomes when available in a timely manner. *Heparin* - **Heparin** is an anticoagulant used as an adjunct therapy in STEMI to prevent further clot formation and propagation. - It is part of the overall management strategy but does not directly open the occluded artery and is not a primary reperfusion therapy on its own.

Q: A 55-year-old diabetic presents with chest pain, shortness of breath, and diaphoresis. ECG shows ST elevation. What is the next best step?

PCI. ***PCI*** - Percutaneous coronary intervention (PCI) is the **preferred reperfusion strategy** for ST-elevation myocardial infarction (STEMI) if it can be performed within 90 minutes (door-to-balloon time) at a PCI-capable hospital, or within 120 minutes if requiring transfer [1]. - This patient's symptoms (chest pain, shortness of breath, diaphoresis) and **ST elevation on ECG** indicate an acute STEMI, making PCI the most effective and definitive treatment [1]. *Nitroglycerin* - While nitroglycerin can help alleviate chest pain by causing **vasodilation** and reducing cardiac preload and afterload, it does not address the underlying coronary artery occlusion in STEMI. - It is often used as an adjunct, but not as the primary or definitive treatment for **reperfusion** in STEMI. *Thrombolysis* - Thrombolysis is an alternative reperfusion strategy for STEMI, primarily used when **primary PCI is not available** within the recommended timeframes [1]. - Given that PCI is typically available and preferred for STEMI, thrombolysis is considered a second-line option due to higher risks of bleeding and potential for re-occlusion compared to PCI [1]. *Heparin* - Heparin is an **anticoagulant** used in STEMI management to prevent further clot formation and propagation. - It is an important adjunctive therapy, but it does not directly restore blood flow to the ischemic myocardium by dissolving or mechanically removing the occluding thrombus like PCI or thrombolysis.

Q: A 30-year-old female presents with exertional dyspnea and a loud P2 on auscultation. What is the most likely diagnosis?

Pulmonary hypertension. ***Pulmonary hypertension*** - **Exertional dyspnea** is a common symptom due to increased pulmonary vascular resistance leading to right heart strain [1]. - A **loud P2** (second heart sound, pulmonary component) indicates elevated pulmonary artery pressure [1]. *Mitral regurgitation* - Characterized by a **holosystolic murmur** best heard at the apex and radiating to the axilla. - While it can cause dyspnea, a loud P2 is not a primary or specific finding. *Aortic stenosis* - Presents with a **systolic ejection murmur** heard best at the right upper sternal border, radiating to the carotids [2]. - Symptoms include dyspnea, angina, and syncope, but a loud P2 is not typically associated [2]. *Pericarditis* - Typically causes **sharp chest pain** that improves with leaning forward and a **pericardial friction rub**. - Dyspnea may occur but is usually related to pain or tamponade, and a loud P2 is not a characteristic sign.

Q: Which condition is indicated by 'Q waves' and 'ST elevation' in leads II, III, and aVF?

Inferior myocardial infarction. Current ECG leads II, III, and aVF reflect the electrical activity of the inferior wall of the left ventricle [2]. Inferior myocardial infarction is typically indicated by ST elevation and subsequent Q wave formation in these leads [2], [3]. Q waves indicate necrosis (infarction), and ST elevation signifies acute ischemia in the myocardial territory often supplied by the right coronary artery (RCA) [3]. Lateral myocardial infarction typically manifests with changes in leads I, aVL, V5, and V6, which correspond to the lateral ventricular wall [2]. In contrast, an anterior myocardial infarction is characterized by changes, including Q waves and ST elevation, in leads V1, V2, V3, and V4 [1]. Pericarditis typically presents with diffuse ST elevation across multiple leads and does not typically involve the formation of pathological Q waves.

Question 1

Which condition is suggested by the 'spade-shaped left ventricle' on ECHO?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Aortic regurgitation

Answer

Pulmonary embolism

Answer

Dilated cardiomyopathy

Question 2

A 55-year-old male presents to the emergency department with chest pain. An ECG shows ST-segment depression in leads V2 and V3. Troponin levels are elevated. What is the most likely diagnosis?

Accepted Answer

NSTEMI

Answer

Unstable angina

Answer

STEMI

Answer

Posterior wall MI

Question 3

All of the following are features of hyperkalemia on ECG, EXCEPT:

Accepted Answer

U waves

Answer

Shortened QT interval

Answer

Peaked T waves

Answer

Wide QRS complex

Question 4

Which of the following findings is seen in pericardial tamponade?

Accepted Answer

Pulsus paradoxus

Answer

Beck's triad

Answer

Kussmaul sign

Answer

All of the options

Question 5

A patient presents with palpitations, chest pain, and irregular pulse. ECG shows irregular RR intervals with no P waves. Diagnosis?

Accepted Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

SVT

Answer

Ventricular tachycardia

Question 6

A 55-year-old diabetic presents with chest pain, shortness of breath, and diaphoresis. ECG shows ST elevation. What is the next best step?

Accepted Answer

PCI

Answer

Nitroglycerin

Answer

Thrombolysis

Answer

Heparin

Question 7

A 55-year-old diabetic presents with chest pain, shortness of breath, and diaphoresis. ECG shows ST elevation. What is the next best step?

Accepted Answer

PCI

Answer

Nitroglycerin

Answer

Thrombolysis

Answer

Heparin

Question 8

A 30-year-old female presents with exertional dyspnea and a loud P2 on auscultation. What is the most likely diagnosis?

Accepted Answer

Pulmonary hypertension

Answer

Mitral regurgitation

Answer

Aortic stenosis

Answer

Pericarditis

Question 9

Which condition is indicated by 'Q waves' and 'ST elevation' in leads II, III, and aVF?

Accepted Answer

Inferior myocardial infarction

Answer

Lateral myocardial infarction

Answer

Pericarditis

Answer

Anterior myocardial infarction

Question 10

Which of the following statements about atrial fibrillation is correct?

Accepted Answer

Discrepancy in pulse rate and heart rate are reliable for diagnosis

Answer

Rarely seen in heart with normal morphology

Answer

Cardioversion is used for all cases of atrial fibrillation

Answer

Only digoxin used for rate control

Cardiology — MCQs

Cardiology — MCQs

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