Dr. Usman's Cardiology Notes

  Welcome to cardiology toacs mock exam , there will be 40 stations, time for each station is usually 3 mins in the exam but in this video it will be, 1 min. you can pause the video if you need more time.  Answer key is also shown in the video after 40 stations.

A 50 year old man history of NIDDM, renal artery stenosis and longstanding hypertension now presented with CHF. You have to evaluate him for ischemia. SPECT myocardial perfusion studies were performed using Tc-99m-Sestamibi and Persantine. Images representing myocardial perfusion were obtained at rest and peak stress. Stress protocol = Persantine Duration of stress = 4 min Peak heart rate (basal --> peak) = 72 --> 87 (85%=144 ) Systolic BP (basal --> peak) = 166 --> 120 Double product (peak rate x BP) = 10,520 Reason for termination = Protocol achieved. No chest pain ECG findings = No ST changes Figure 1 Figure 2: Labelled for easy identification Subsequent Echocardiography: LV dilatation with severe reduction in systolic function EF=15-20% Mild mitral regurgitation (1+) Left atrial enlargement Click the button below to view answer: Show Answer

A 55 year old man with positive family history (mother - MI at age 54, sister - CAD and CVA at age 50), No history of cardiac diseases, came for evaluation of CAD. SPECT myocardial perfusion studies were performed using Thallium-201. Images representing myocardial perfusion were obtained at stress, reinjection and 4 h delayed. Stress protocol is Treadmill / Modified Bruce Duration of stress is 4 min 37 sec Peak heart rate (basal --> peak) is 100 --> 134 (85%=140) Systolic BP (basal --> peak) is 108 --> 114 Double product (peak rate x BP) is 15,300 Reason for termination  is  Fatigue, No chest pain ECG findings: Upsloping ST changes Echocardiography:  Dilated LV with severe reduction in global systolic function (EF = about 25%) Severe hypokinesis of the anterior, septal, and apical walls, and akinesis of the inferior wall. Mild RV enlargement with reduced RV function 2+ MR, 1+ TR Figure 1 Figure 2: Labelled for easy identification Click the bu...

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

A 49-year-old woman with history of postprandial chest pain for the last 3 weeks. Evaluate 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 39 sec Heart rate (basal --> peak) is 76 --> 162 (85%=145) Systolic BP (basal --> peak) is 140 --> 170 Double product (peak rate x BP) is 27,500 Reason for termination is Dyspnea.Atypical chest pain ECG findings are Upsloping ST depression during stress, 1 mm horizontal ST depression during recovery Figure 1 Figure 2: labelled for easy identification 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

A 60-year-old man was referred for an exercise dual-isotope study for further evaluation of atrial fibrillation and exercise-induced left bundle branch block. Representative perfusion images are displayed in addition to an image from the raw data. What non-myocardial abnormality is seen? Click the button below to view answer: Show Answer

Figure 1 Figure 2 A 69-year-old woman presented to the emergency room complaining of chest pain. She subsequently returned twice, complaining of chest discomfort. The above image (Figure 1) represent results of a dual isotope study (stress sestamibi/rest thallium). Figure 2 is Thallium rest at suspected area. What abnormality is present? Click the button below to view answer: Show Answer

A 73-year-old woman presented with increasing cough and dyspnea. A dual isotope (Rest-TI-201, Stress-Sestamibi) study was acquired. R wave gating was performed during the post-stress acquisition. End diastolic (Figure 1) and end systolic (Figure 2) images are given above. What diagnosis is suggested by these findings? Click the button below to view answer: Show Answer