Cardiology Practice Questions

Q: What does the following ECG show?

Ventricular bigeminy. ***Ventricular bigeminy*** - The ECG shows a repeating pattern of a **normal QRS complex** followed by a **premature ventricular contraction (PVC)**, which is characteristic of bigeminy. - The premature beats are wide and bizarre, indicating their **ventricular origin**, and occur every second beat. - This is a **regular coupling pattern**, distinguishing it from other PVC patterns. *Ventricular trigeminy* - This rhythm would show a PVC occurring every **third beat**, meaning two normal beats followed by one PVC. - The presented ECG consistently shows a PVC after every normal beat, not every third beat. *Atrial premature contraction* - An APC typically results in a **narrow QRS complex** because the signal originates in the atria and conducts normally through the ventricles. - The premature beats in this ECG are wide and abnormal, consistent with a ventricular origin, not an atrial one. *Atrial bigeminy* - Atrial bigeminy involves an **atrial premature contraction (APC)** following every normal beat. - An APC would typically have a **narrow QRS complex** and a P wave that looks different from the sinus P waves, which is not seen here. *Multifocal PVCs* - Multifocal PVCs refer to PVCs with **different morphologies** arising from multiple ventricular foci. - While this ECG shows frequent PVCs, they occur in a **regular bigeminal pattern** rather than irregularly with varying morphologies characteristic of multifocal PVCs.

Q: Comment on the ECG findings.

Atrial premature complexes. ***Atrial premature complexes*** - The ECG shows a **normal sinus rhythm** interspersed with **premature P waves** not followed by a QRS complex, indicated by the arrows. - This suggests an **ectopic atrial focus** firing prematurely, causing an atrial depolarization that is not conducted to the ventricles (blocked APCs). *Atrial fibrillation* - This rhythm is characterized by **irregularly irregular R-R intervals** and the **absence of distinct P waves**, replaced by fibrillatory waves. - The tracing clearly shows distinct P waves and a generally regular rhythm, ruling out atrial fibrillation. *PSVT* - Paroxysmal supraventricular tachycardia (PSVT) is a **fast, regular rhythm** originating above the ventricles, typically with a **narrow QRS complex**. - While there are premature beats, the overall rhythm is not tachycardic and does not fit the typical pattern of sustained PSVT. *WPW* - Wolff-Parkinson-White (WPW) syndrome is characterized by a **short PR interval** and a **delta wave** (slurring of the initial part of the QRS complex). - These characteristic findings are not present on the ECG, specifically the PR interval is not short, and there is no delta wave. *Ventricular premature complexes* - Ventricular premature complexes (VPCs) would show **wide QRS complexes** (>0.12 seconds) with **bizarre morphology** and no preceding P wave. - The premature beats on this ECG have **identifiable P waves** preceding them and occur without wide QRS complexes, distinguishing them from VPCs.

Q: A 70-year-old hypertensive woman presents with dyspnea, nausea and feeling of impending doom. ECG shows:

Myocardial infarction. ***Myocardial infarction*** - The ECG shows **ST-segment elevations** in leads V1, V2, V3, and V4, indicating an anterior myocardial infarction. - The patient's symptoms of dyspnea, nausea, and a feeling of impending doom are classic for an **acute coronary syndrome**, especially in an older hypertensive woman. - The ST elevation is **localized to contiguous leads** (precordial leads V1-V4), which is characteristic of **acute MI** rather than diffuse changes. *PSVT* - **Paroxysmal supraventricular tachycardia (PSVT)** is characterized by a narrow complex tachycardia with a regular rhythm and typically absent or retrograde P waves. - The ECG clearly shows **sinus rhythm** with visible P waves and significant ST changes, which are not features of PSVT. *Prinzmetal angina* - **Prinzmetal angina** (variant angina) is characterized by transient **ST-segment elevation** due to coronary artery spasm, occurring at rest. - While it can cause ST elevation, the persistent and widespread nature of the ST elevation in multiple precordial leads makes an **acute myocardial infarction** more likely, especially with the patient's severe symptoms. *Normal tracing* - A **normal ECG** would not show any significant ST-segment changes, T-wave inversions, or pathological Q waves. - The presented ECG clearly demonstrates significant **ST-segment elevations** in several leads, indicating an acute cardiac event. *Pericarditis* - **Acute pericarditis** can cause ST-segment elevation, but typically presents with **diffuse ST elevations** across multiple leads (including limb leads) with **PR depression**. - The ST elevations in pericarditis are typically **concave upward** (saddle-shaped), whereas MI shows **convex ST elevations**. - The **localized ST elevation** in the precordial leads without widespread changes makes MI more likely than pericarditis.

Q: Comment on the ECG given below:

Extensive anterior wall MI. ***Extensive anterior wall MI*** - The ECG shows significant **ST elevation** in leads **V1, V2, V3, V4, V5, and V6**, indicating an extensive area of myocardial injury. Leads V1-V4 typically represent the anterior wall, while V5-V6 also include the lateral wall. - The presence of ST elevation across such a broad range of precordial leads, extending into the lateral leads, points to an **extensive anterior myocardial infarction**. Leads I and aVL also show ST elevation, corroborating lateral involvement and the extensive nature of the MI. *Anterior wall MI* - While there is clear evidence of an anterior wall MI (V1-V4), the term "extensive" is more appropriate due to the involvement of leads **V5, V6, I, and aVL**, which suggests a larger territory of ischemia than just the anterior wall. - Simply stating "anterior wall MI" would not fully capture the scope and severity of the myocardial involvement seen in this ECG. *Anterolateral MI* - While this term correctly identifies involvement of both anterior (V1-V4) and lateral (V5-V6, I, aVL) territories, the term **"extensive anterior wall MI"** is more precise and clinically preferred. - "Extensive anterior wall MI" better captures the **contiguous nature** of the ST elevation across the entire anterior and lateral precordial leads, indicating a large left anterior descending (LAD) artery territory infarction. *Inferior wall MI* - An inferior wall MI is characterized by ST elevation in leads **II, III, and aVF**. - In this ECG, leads II, III, and aVF do not show ST elevation; instead, they exhibit **reciprocal changes** (ST depression), which can be seen in extensive anterior MIs. *Septal MI* - A septal MI is typically indicated by ST elevation in leads **V1 and V2**. - While V1 and V2 show ST elevation, suggesting septal involvement, the ST elevation extends significantly into V3-V6, I, and aVL, indicating involvement beyond just the septum.

Q: A patient collapsed while waiting for boarding an aircraft and was rushed to the medical room. Which of the following is correct regarding the ECG?

Inferior wall MI with ST elevation in lead II, III and AVF. ***Inferior wall MI with ST elevation in lead II, III and AVF*** - The ECG shows significant **ST segment elevation** in leads **II, III, and aVF**, which are the characteristic leads for an **inferior myocardial infarction**. - There are also reciprocal ST depressions in aVL and lead I, further supporting the diagnosis of an acute inferior MI. *Inferior wall MI with T-wave inversion in precordial leads* - While T-wave inversions can occur in myocardial infarction, especially in later stages, the most striking and acute finding here is **ST elevation**, not T-wave inversion as the primary indicator for inferior MI. - T-wave inversions in precordial leads would usually indicate an **anterior or anterolateral ischemia/infarction**, not directly an inferior one, although they can be seen as remote changes. *Anterior wall MI with hyperacute T waves in lead II, III and AVR* - An **anterior wall MI** would be characterized by changes in V1-V6 leads, not II, III, and aVF. - **Hyperacute T waves** are an early sign of MI, but they are clearly visible in **inferior leads (II, III, aVF)** along with ST elevation, not just T waves in AVR. Hyperacute T waves in aVR are not a specific indicator of anterior MI. *Anterior wall MI with ST depression in AVL* - An **anterior wall MI** would typically show ST elevation in precordial leads (V1-V6). - While ST depression in aVL can be a reciprocal change to inferior MI, it does not suggest an anterior wall MI as the primary event in this ECG. *Right ventricular MI with ST elevation in V1 and V4R* - While **right ventricular MI** often accompanies inferior MI (especially with RCA occlusion), it requires right-sided leads (V4R) for diagnosis. - The primary findings shown are in the **inferior leads (II, III, aVF)**, not specifically V1 or right-sided leads, making inferior MI the more accurate interpretation based on standard 12-lead ECG findings.

Question 1

In the ECG shown below, which drug will not be given?

Accepted Answer

Adenosine

Answer

Verapamil

Answer

Diltiazem

Answer

Flecainide

Answer

Amiodarone

Question 2

What does the following ECG show?

Accepted Answer

Ventricular bigeminy

Answer

Ventricular trigeminy

Answer

Atrial premature contraction

Answer

Atrial bigeminy

Answer

Multifocal PVCs

Question 3

Comment on the ECG findings.

Accepted Answer

Atrial premature complexes

Answer

Atrial fibrillation

Answer

PSVT

Answer

WPW

Answer

Ventricular premature complexes

Question 4

A 35-year-old lady has been diagnosed with anxiety neurosis by her psychiatrist. She came to you for second opinion. Comment on the diagnosis based on ECG.

Accepted Answer

WPW syndrome

Answer

Sinus tachycardia

Answer

Multifocal atrial tachycardia

Answer

Atrial fibrillation

Answer

Supraventricular tachycardia

Question 5

A 46-year-old man presents with diffuse chest pain at rest and recent history of cough, fever and rhinorrhea lasting for 3 days. ECG shows diffuse ST-segment elevation with PR-segment depression. What is the most likely diagnosis?

Accepted Answer

Acute pericarditis

Answer

Constrictive pericarditis

Answer

Takotsubo-cardiomyopathy

Answer

Cor pulmonale

Answer

Acute myocardial infarction (STEMI)

Question 6

A 70-year-old hypertensive woman presents with dyspnea, nausea and feeling of impending doom. ECG shows:

Accepted Answer

Myocardial infarction

Answer

PSVT

Answer

Prinzmetal angina

Answer

Normal tracing

Answer

Pericarditis

Question 7

Comment on the ECG given below:

Accepted Answer

Extensive anterior wall MI

Answer

Anterior wall MI

Answer

Inferior wall MI

Answer

Septal MI

Answer

Anterolateral MI

Question 8

ECG of a patient had ST segment elevation in V1-V6, lead I and AVL. Which of the following branches is involved?

Accepted Answer

1

Answer

2

Answer

3

Answer

4

Answer

5

Question 9

A 65-year-old diabetic lady complains of bloating for 3 hours. What is the diagnosis?

Accepted Answer

Anterior wall MI

Answer

Takotsubo cardiomyopathy

Answer

Early repolarization variant

Answer

Artifact in V3-V4

Answer

Pericarditis

Question 10

A patient collapsed while waiting for boarding an aircraft and was rushed to the medical room. Which of the following is correct regarding the ECG?

Accepted Answer

Inferior wall MI with ST elevation in lead II, III and AVF

Answer

Inferior wall MI with T-wave inversion in precordial leads

Answer

Anterior wall MI with hyperacute T waves in lead II, III and AVR

Answer

Anterior wall MI with ST depression in AVL

Answer

Right ventricular MI with ST elevation in V1 and V4R

Cardiology — MCQs

Cardiology — MCQs

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