Dr. Usman's Cardiology Notes

 Here are multiple choice questions (MCQs) in cardiology with detailed answers: 1. Which of the following is the most common cause of acute myocarditis?    A) Coxsackievirus B) Streptococcus pneumoniae C) Staphylococcus aureus D) Mycobacterium tuberculosis    Answer: A) Coxsackievirus    Explanation: Coxsackievirus is the most common viral cause of acute myocarditis, leading to inflammation of the heart muscle. 2. What is the characteristic ECG finding in patients with Brugada syndrome?    A) Prolonged QT interval B) ST-segment elevation in leads V1-V3 C) Tall peaked T waves D) Presence of Osborn waves    Answer: B) ST-segment elevation in leads V1-V3    Explanation: Brugada syndrome is characterized by ST-segment elevation in leads V1-V3, often resembling a coved-type pattern. 3. Which of the following is NOT a major criterion for the diagnosis of infective endocarditis according to the modified Duke criteria?  ...

A 67-year-old woman with a past medical history of paroxysmal atrial fibrillation for the last 10 years is brought to the hospital with episodes of syncope. Her medications include metoprolol, flecainide, and rivaroxaban. Baseline electrocardiogram showing sinus bradycardia with heart rate 40/min. Which of the following is the next best step in the management of this patient? A. Hold metoprolol and flecainide B. Permanent pacemaker placement C. Observation only D. Switch flecainide to dofetilide Click the button below to view answer: Show Answer

A 67-year-old man presents to the clinic for a follow-up appointment after being treated for an ST-elevation myocardial infarction. He developed ventricular arrhythmia while he was admitted to the intensive care unit and was twice defibrillated and received an amiodarone infusion. The patient also has mild persistent asthma and is on albuterol and fluticasone. He also just completed a 5-day course of oral azithromycin for community-acquired pneumonia. He is concerned about the bluish discoloration of his lips that was first noticed by his wife a few days ago. Which of the patient's recent medications is mot likely to have caused this clinical condition? A. Albuterol B. Fluticasone C. Azithromycin D. Amiodarone Click the button below to view answer: Show Answer

A 71-year-old woman with a past medical history of poorly controlled diabetes and coronary artery disease presents to the hospital with chest pain, diaphoresis, and hypotension. He is found to have anterolateral ST-elevation myocardial infarction (STEMI). Emergent percutaneous coronary intervention (PCI) is performed and Impella 2.5 is placed in the cath lab due to cardiogenic shock. 2 hours later, her urine noticed to be bloody in the urine bag. Which of the following indices is most likely to be elevated in this patient? A. Hematocrit B. Haptoglobin C. Chloride D. HCO3 Click the button below to view answer: Show Answer

An asymptomatic 20-year-old woman is incidentally found to have a bicuspid aortic valve. Fusion of the left and right coronary cusps is noted and there is moderate stenosis with a peak echocardiogram gradient of 3.2 meters/second. There is also mild aortic insufficiency. The left ventricular size is normal and the ejection fraction is 62%. The ascending aorta measures 3.8 cm. Her past history is significant for hypothyroidism and short stature. Which of the following is the next best step in the management of this patient? A. Cardiac MRI B. Exercise testing C. Chromosome analysis with a karyotype D. Cardiac catheterization Click the button below to view answer: Show Answer

A 67-year-old male presents to the emergency department with substernal chest pain. After initial investigations, the medical team decides whether to proceed with angioplasty or thrombolytics. Based on the results of the PAMI-1 (Primary Angioplasty in Myocardial Infarction) trial, when compared to thrombolytics in ST-segment elevation myocardial infarction (STEMI), percutaneous balloon angioplasty was associated with which of the following? A. Higher in-hospital mortality B. Similar rates of cerebral vascular accidents C. Similar rates of repeat re-vascularization D. Higher event-free survival Click the button below to view answer: Show Answer

A 65 year old woman with history of COPD and mild hypertension, now presented with CHF. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi and Dobutamine. Images representing myocardial perfusion were obtained at rest and peak stress. Stress protocol is Dobutamine Duration of stress is 7 min 57 sec Peak heart rate (basal --> peak) is 92 --> 100 (85%=131) Systolic BP (basal --> peak) is 130 --> 134 --> 92 Double product (peak rate x BP) is 13,400 Reason for termination is Typical chest pain ECG findings are ST-T abnormality at rest, No additional changes Echocardiography: Moderate LV and RV enlargement with moderate-to- severe generalized contractile dysfunction. LVEF=20-30% Mild mitral regurgitation (2+) without structural valve abnormality Tricuspid regurgitation (2+) Figure 1 Figure 2: Labelled for easy identification Click the button below to view answer: Show Answer

Name the structure shown Click the button below to view answer: Show Answer

Comment on the origin of Left and Right coronary artery Click the button below to view answer: Show Answer

Comment on Aortic Valve of this patient Click the button below to view answer: Show Answer

A Cyanotic Neonate presented with rapid breathing, lethargy, and poor feeding. What abnormality is seen in these CT Scan images? Click the button below to view answer: Show Answer

A 55 year old man presented with chest pain on exertion, What is the main finding in above images? Click the button below to view answer: Show Answer

What is the prominent finding in this case? Click the button below to view answer: Show Answer

Comment on Aorta Click the button below to view answer: Show Answer

What is the key finding in these cardiac CT images suggesting diagnosis of a life threatening problem? Click the button below to view answer: Show Answer

A 53-year-old man with family history of coronary artery disease presented with CHF and ECG evidence of silent anterior wall MI. We have to evaluate for extent and severity of ischemia. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi. Images representing myocardial perfusion were obtained at rest and peak stress. Stress protocol used is Treadmill / Bruce Duration of exercise is 5 min 25 sec Peak heart rate (85%) is 84 -- 131 (85%=142) Systolic BP (basal -- peak) is 115 -- 155 Double product (peak rate x BP) is 20,300 Reason for termination is Dyspnea. Fatigue. No chest pain ECG findings are ST-T abnormalities at rest, pseudo-normalization Subsequent Coronary Angiography showed:  LAD - 90% stenosis RCA - 40-50% stenosis LCx - Normal Anterior wall hypokinesis LVEF=54% Echocardiography:  Hypokinesis / akinesis of the anterior septal and anterior apical portions of the myocardium LVEF=48% Click the button below to view answer: Show Answer

A 63-year-old man, known multivessel CAD. To evaluate the severity of ischemia in this patient. SPECT myocardial perfusion testing was performed using Tc-99m-Sestamibi. Images representing myocardial perfusion were obtained at rest and peak stress . Stress protocol is Treadmill / Bruce Duration of stress is 12 min Peak heart rate (85%) is 85 --> 150 (85%=133) Systolic BP (basal --> peak) is 150 --> 160 Double product (peak rate x BP) is 24,000 Reason for termination is Dyspnea. Typical chest pain ECG finding is 1 mm ST depression  Figure 2 with labelled pathology for clarification Subsequent Coronary Angiography:  RCA - totally occluded, left to right collaterals LAD - 50% proximal stenosis LCX - 1st marginal branch - 70% stenosis ,1st diagonal branch - 70-80% distal stenosis Left ventricular ejection fraction = 57% Click the button below to view answer: Show Answer

A 61-year-old woman with history of CAD, status post multiple PTCAs, and laser angioplasty of proximal LAD, presented with recurrent chest pain for the past few weeks to be evaluated for ischemia. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi. Images representing myocardial perfusion were obtained at rest and peak stress. Stress protocol is Treadmill / Bruce Duration of stress is 4 min 57 sec Heart Rate (basal --> peak) is 53 --> 88 (85%=134) Systolic BP (basal --> peak) is 130 --> 134 Double product (peak rate x BP) is 11,800 Reason for termination is Typical chest pain ECG finding is 1 mm ST depression Review the following images and interpret the data: Subsequent Coronary Angiography:  LAD - 30-40% proximal stenosis, 1st marginal branch - 40% proximal stenosis LCX - Totally occluded distally OM - 95% stenosis RCA - Small and totally occluded (non-dominant) Click the button below to view answer: Show Answer

Figure 1 A 64-year-old man with history of chest pain, to be evaluated for ischemia. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi. The above images represent myocardial perfusion were obtained at rest and peak stress. Stress protocol is Treadmill / Bruce Duration of stress is 4 min Peak heart rate (85%) is 90 --> 143 (85%=132) Systolic BP (basal --> peak) is 150 --> 160 Double product (peak rate x BP) is 22,900 Reason for termination is  Dyspnea and pain ECG findings are ST-T abnormality at rest, No additional changes. Figure 2 - For more clarification Click the button below to view answer: Show Answer

The above images represent the exercise dual isotope study (stress sestamibi/rest thallium) of a 53-year old woman being evaluated for dyspnea. In 1991 transthoracic echocardiogram had suggested an ASD, which was not confirmed by transesophageal echo. What is the abnormality? Click the button below to view answer: Show Answer