Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1581: Which of the following statements regarding hypertensive crisis is false?

A. Hypertensive urgencies may be managed without extensive monitoring on an outpatient basis.
B. Hypertensive emergencies require immediate reduction of blood pressure over hours to prevent end-organ damage. (Correct Answer)
C. Hypertensive urgency is characterized by marked elevation of blood pressure without rapidly evolving end organ damage.
D. None of the options.

Explanation: ***Hypertensive emergencies require immediate reduction of blood pressure over hours to prevent end-organ damage.*** - This statement is **false** because in a **hypertensive emergency**, blood pressure must be reduced gradually over **minutes to hours** (not over multiple hours) to prevent rapid drops in pressure that could lead to organ hypoperfusion and ischemia. [1] - The goal is to reduce the mean arterial pressure by no more than **25% within the first hour**, followed by a more gradual reduction to 160/100 mmHg over the next 2-6 hours. *Hypertensive urgencies may be managed without extensive monitoring on an outpatient basis.* - This statement is **true** because **hypertensive urgencies** lack acute end-organ damage, allowing for a more gradual reduction in blood pressure, often with oral medications. [1] - Patients can frequently be managed safely in an **outpatient setting** without the need for intensive monitoring or intravenous medications. *Hypertensive urgency is characterized by marked elevation of blood pressure without rapidly evolving end organ damage.* - This statement is **true** and precisely defines a **hypertensive urgency** where blood pressure readings are typically >180/120 mmHg but without acute signs of damage to organs like the brain, heart, or kidneys. - The absence of **acute end-organ damage** differentiates it from a hypertensive emergency. *None of the options.* - This option is incorrect because the first statement (regarding the management of hypertensive emergencies) is indeed **false**, making it the correct answer to the question. - There is a false statement identified among the given options, so "None of the options" cannot be the correct answer.

Question 1582: Which of the following statements about atherosclerosis is MOST accurate?

A. Hypercholesterolemia is a significant risk factor for atherosclerosis. (Correct Answer)
B. Atherosclerosis primarily affects veins rather than arteries.
C. Thoracic aorta is more commonly involved than abdominal aorta in atherosclerosis.
D. Intake of saturated fatty acids is associated with decreased atherosclerosis risk.

Explanation: **Hypercholesterolemia is a significant risk factor for atherosclerosis.** - **Hypercholesterolemia**, particularly elevated **LDL-cholesterol**, is a primary driver of **atherosclerosis** as it promotes the accumulation of lipids in the arterial walls [1]. - This accumulation leads to the formation of **atherosclerotic plaques** which can narrow arteries and impede blood flow [1]. *Atherosclerosis primarily affects veins rather than arteries.* - **Atherosclerosis** is a disease of **arteries**, not veins, characterized by plaque buildup in the **intimal lining** of large and medium-sized arteries [1]. - The high pressure and turbulent flow in arteries contribute to **endothelial damage**, which is a critical initial step in atherogenesis, unlike the lower pressure system of veins [1]. *Thoracic aorta is more commonly involved than abdominal aorta in atherosclerosis.* - The **abdominal aorta** is much more commonly affected by **atherosclerosis** than the thoracic aorta. - This predilection is due to factors like increased **hemodynamic stress** and branching patterns in the abdominal segment [1]. *Intake of saturated fatty acids is associated with decreased atherosclerosis risk.* - Intake of **saturated fatty acids** is associated with an **increased risk** of **atherosclerosis**, as it can raise **LDL-cholesterol** levels [1]. - Diets high in saturated fats contribute to **dyslipidemia**, which accelerates the formation and progression of atherosclerotic plaques.

Question 1583: What is an electrical storm?

A. Electromechanical dissociation
B. Electrical alternans
C. 3 episodes of atrial tachycardia within 24 hours
D. 3 episodes of ventricular tachycardia within 24 hours (Correct Answer)

Explanation: ***3 episodes of ventricular tachycardia within 24 hours*** - An **electrical storm**, also known as **arrhythmia storm**, is defined by the occurrence of **three or more distinct episodes of ventricular tachycardia (VT)**, ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within a 24-hour period [1]. - This condition signifies **severe myocardial electrical instability** and is associated with increased morbidity and mortality [1]. *Electromechanical dissociation* - **Electromechanical dissociation (EMD)**, or pulseless electrical activity (PEA), describes a situation where there is organized electrical activity on an electrocardiogram but **no palpable pulse**. - It is a form of cardiac arrest and is distinct from an arrhythmia storm, which specifically refers to recurrent ventricular arrhythmias. *Electrical alternans* - **Electrical alternans** is an electrocardiographic phenomenon characterized by **beat-to-beat alterations in the QRS complex amplitude or axis**. - It is often associated with **pericardial effusion with cardiac tamponade** and is not indicative of recurrent ventricular tachyarrhythmias. *3 episodes of atrial tachycardia within 24 hours* - While recurrent **atrial tachycardia** indicates electrical instability in the atria, an "electrical storm" specifically refers to **ventricular arrhythmias** [1]. - Atrial arrhythmias, though potentially serious, do not meet the diagnostic criteria for an electrical storm.

Question 1584: Positive hepatojugular reflux is found in all of the following conditions except -

A. Tricuspid regurgitation
B. Increased capillary bed pressure
C. Decreased afterload (Correct Answer)
D. Right heart failure

Explanation: ***Decreased afterload*** - **Hepatojugular reflux** is a sign of **right-sided heart dysfunction** [1] where compressing the liver increases jugular venous pressure due to impaired right ventricular filling [2]. - **Decreased afterload** would typically improve cardiac output and reduce intracardiac pressures, making hepatojugular reflux less likely. *Tricuspid regurgitation* - **Tricuspid regurgitation** leads to increased right atrial pressure [2], which can cause engorgement of the liver and an exaggerated hepatojugular reflux. - This condition directly impacts the ability of the right ventricle to empty effectively, contributing to systemic venous congestion. *Right heart failure* - **Right heart failure** is a common cause of hepatojugular reflux due to elevated right atrial and central venous pressures [1]. - The failing right ventricle is unable to handle increased venous return, leading to reflux. *Increased capillary bed pressure* - **Increased capillary bed pressure** in the systemic circulation, often secondary to **right heart failure** [2] or **volume overload**, contributes to elevated venous pressures. - This increased pressure can be transmitted back to the right atrium, leading to a positive hepatojugular reflux.

Question 1585: Sine wave pattern in an ECG is seen in which of the following conditions?

A. Hypokalemia
B. Hyperkalemia (Correct Answer)
C. Hyponatremia
D. Hypernatremia

Explanation: ***Hyperkalemia*** - As **hyperkalemia** worsens, the ECG may show a loss of P waves, widening of the QRS complex, and tall, peaked T waves that merge with the QRS complex, creating a **sine wave pattern** [1]. - This pattern indicates severe electrical instability, often progressing to **ventricular fibrillation** [2] or **asystole** if not urgently treated. *Hypokalemia* - **Hypokalemia** typically manifests on ECG with U waves, T wave flattening or inversion, and prolongation of the QT interval [3]. - It does not cause a **sine wave pattern**, which is characteristic of severe hyperkalemia. *Hyponatremia* - While severe **hyponatremia** can affect cardiac function, it does not typically produce a specific **sine wave pattern** on the ECG [1]. - ECG changes in hyponatremia are often non-specific and may include bradycardia or arrhythmias due to altered nerve conduction. *Hypernatremia* - **Hypernatremia** can lead to various cardiac effects, but a **sine wave pattern** is not a characteristic ECG finding of this condition. - ECG changes in hypernatremia are often non-specific and are more related to volume status and associated electrolyte imbalances.

Question 1586: Accelerated idioventricular rhythm (AIVR) is most characteristically seen in?

A. Myocardial reperfusion (Correct Answer)
B. Digitalis therapy
C. Atrioventricular nodal block
D. Electrolyte imbalance

Explanation: ***Myocardial reperfusion*** - **Accelerated idioventricular rhythm (AIVR)** is a common reperfusion arrhythmia, often seen after successful restoration of blood flow to the ischemic myocardium following a myocardial infarction. - The sudden influx of oxygen and nutrients can trigger **automaticity** in the ventricular myocardium, leading to this rhythm. *Atrioventricular nodal block* - While AV nodal block can lead to escape rhythms from lower pacemakers, **AIVR** is a specific ventricular rhythm typically associated with **reperfusion injury**, not primarily with AV block itself. - AV nodal block often results in a slower **junctional or ventricular escape rhythm**, rather than an *accelerated* ventricular rhythm. *Electrolyte imbalance* - Severe electrolyte imbalances, such as **hyperkalemia** or **hypokalemia**, can cause various arrhythmias, including ventricular tachycardias or bradycardias. - However, **AIVR** has a much stronger and more characteristic association with **myocardial reperfusion** than with general electrolyte derangements. *Digitalis therapy* - **Digitalis toxicity** can cause a wide range of arrhythmias, including ventricular ectopy, bigeminy, and even ventricular tachycardia. - While it can increase ventricular automaticity, **AIVR** is not the *most characteristic* arrhythmia specifically linked to digitalis toxicity; other arrhythmias like **bidirectional ventricular tachycardia** are more classic.

Question 1587: What is the immediate treatment modality for a patient presenting with acute anterior wall myocardial infarction and hypotension?

A. Anticoagulation
B. Thrombolytic therapy
C. Intra-aortic balloon counterpulsation
D. Primary Percutaneous Coronary Intervention (Primary PCI) (Correct Answer)

Explanation: ***Primary Percutaneous Coronary Intervention (Primary PCI)*** - **Primary PCI**, guided by coronary angiography, is the **gold standard** for treating ST-elevation myocardial infarction (STEMI) because it directly restores blood flow to the *ischemic* myocardium. - In a patient with **acute anterior wall MI and hypotension**, immediate revascularization via Primary PCI is crucial to improve cardiac output and stabilize hemodynamics, as hypotension often implies significant myocardial damage and *cardiogenic shock*. - Guidelines recommend Primary PCI within **90 minutes** of first medical contact (door-to-balloon time) when available. *Thrombolytic therapy* - While thrombolysis can restore blood flow, it is considered a **second-line treatment** if PCI is unavailable or significantly delayed (>120 minutes from first medical contact). - It carries a higher risk of bleeding complications and may not achieve complete reperfusion, especially in patients with **hypotension** or *cardiogenic shock*. *Anticoagulation* - Anticoagulation is an **adjunctive therapy** used to prevent further clot formation and maintain coronary artery patency after reperfusion. - It is **not a definitive revascularization strategy** on its own and does not immediately address the acute coronary occlusion causing the MI and hypotension. *Intra-aortic balloon counterpulsation (IABP)* - **IABP** is a mechanical circulatory support device used to reduce *afterload* and increase *coronary perfusion*, primarily in patients with **cardiogenic shock** awaiting or recovering from revascularization. - While beneficial for hemodynamic support, it is **not the primary reperfusion treatment** and should be used in conjunction with immediate PCI, not as a substitute.

Question 1588: What is the most common site of acute aortic dissection?

A. Arch of aorta
B. Suprarenal abdominal aorta
C. Infrarenal abdominal aorta
D. Ascending aorta (Correct Answer)

Explanation: ***Ascending aorta*** - The **ascending aorta** is the most common site for **acute aortic dissection**, particularly within a few centimeters of the **aortic valve** [1]. - This region is under the highest **hemodynamic stress**, making it more susceptible to intimal tear and dissection. *Arch of aorta* - While dissections can propagate into or originate in the **arch of the aorta**, it is a less common primary site compared to the ascending aorta [1]. - Involvement of the arch often occurs as an extension of a more proximal dissection. *Suprarenal abdominal aorta* - The **abdominal aorta** is less commonly affected by acute dissection compared to the thoracic aorta [1]. - When dissection does occur in the abdominal aorta, it is generally an extension from a thoracic dissection and rarely originates primarily here. *Infrarenal abdominal aorta* - The **infrarenal abdominal aorta** is the most common site for **abdominal aortic aneurysms**, but it is an infrequent primary site for acute aortic dissection [2]. - Dissections originating here are rare, though dissections can extend to this segment.

Question 1589: Duration of pain in angina is:

A. 2-5 mins (Correct Answer)
B. 5-30 mins
C. 30-60 mins
D. > 1 hour

Explanation: **2-5 mins** - **Stable angina** chest pain typically lasts for a few minutes, usually 2 to 5 minutes, and is precipitated by exertion or stress [1]. - Pain is **relieved by rest** or nitroglycerin within minutes [1]. *5-30 mins* - This duration is longer than typical stable angina and could indicate **unstable angina** or another cardiac event, requiring immediate medical evaluation [1]. - While an myocardial infarction (MI) is a possibility, pain lasting this specific duration is not the hallmark of stable angina [1]. *30-60 mins* - This duration is characteristic of prolonged cardiac ischemia, such as an **acute myocardial infarction (heart attack)**, rather than stable angina [1]. - Such prolonged pain signals serious heart damage and requires urgent medical intervention [2]. *> 1 hour* - Pain lasting over an hour is atypical for angina and strongly suggests an **acute myocardial infarction (MI)** or other non-cardiac causes like pericarditis or aortic dissection. - **Angina pain is generally brief** and resolves quickly [1].

Question 1590: Post-myocardial infarction on the 10th day, which of the following enzyme levels is raised?

A. LDH
B. CPK
C. Troponin (Correct Answer)
D. Myoglobin

Explanation: ***Troponin*** - **Cardiac troponins (cTnI and cTnT)** are highly sensitive and specific biomarkers for myocardial injury. - They typically remain elevated for **10-14 days** after an acute myocardial infarction, making them detectable on day 10 [2], [3]. *LDH* - **Lactate dehydrogenase (LDH)** is a non-specific enzyme and its levels begin to rise later than troponin, peaking around 3-4 days. - While elevated in MI, it usually returns to normal within **7-14 days**, making its elevation less reliable or prominent on day 10 compared to troponin [1]. *CPK* - **Creatine phosphokinase (CPK)**, particularly the MB isoenzyme (CK-MB), rises within 3-12 hours after MI [2]. - However, CK-MB levels typically return to normal within **2-3 days**, making it unlikely to be significantly elevated on day 10. *Myoglobin* - **Myoglobin** is one of the earliest markers to rise, appearing within 1-4 hours after MI. - Due to its rapid clearance, myoglobin levels also normalize quickly, usually within **24 hours**, and would not be elevated on day 10.

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Coronary Artery Disease and Angina

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Acute Coronary Syndromes

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Heart Failure

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Cardiac Arrhythmias

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Valvular Heart Diseases

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Cardiomyopathies

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Pericardial Diseases

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Congenital Heart Disease in Adults

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Hypertension and Hypertensive Emergencies

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Pulmonary Hypertension

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Non-invasive Cardiac Diagnostics

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Preventive Cardiology

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Cardiology — MCQs

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