Cardiology Practice Questions

Q: A 32-year-old patient presents to the emergency department with palpitations and dizziness. An ECG is obtained. Identify the cardiac rhythm shown in the image.

PSVT. ***PSVT*** - This rhythm is characterized by a **narrow QRS complex** (<0.12 seconds), a **regular rhythm**, and a **rate between 150-250 bpm**, which are classic features of **Paroxysmal Supraventricular Tachycardia (PSVT)**. - P-waves are often obscured or hidden within the QRS complex or T-wave due to the rapid rate and altered conduction pathway originating above the ventricles. *Ventricular Tachycardia* - **Ventricular Tachycardia (VT)** is characterized by a **wide QRS complex** (>0.12 seconds) due to ventricular origin, which is not seen in the provided image. - While it can be regular, the primary differentiating factor here is the **QRS duration**. *Atrial Tachycardia* - **Atrial Tachycardia** typically shows an identifiable P-wave with a different morphology than sinus P-waves, or a consistently different PR interval, which is not clearly discernible in this rapid, narrow-complex rhythm. - Although it's a supraventricular rhythm, the term PSVT is more encompassing for rhythms with these specific characteristics when the P-waves are hidden. *Ventricular Fibrillation* - **Ventricular Fibrillation (VF)** is a chaotic, irregular rhythm with no discernible P-waves, QRS complexes, or T-waves, appearing as a wavy baseline, which is distinctly different from the organized rhythm shown. - This rhythm is incompatible with life and results in immediate circulatory collapse.

Q: Identify the cardiac condition represented in the image.

Ventricular tachycardia. ***Ventricular tachycardia*** - The image displays a **wide, regular QRS complex tachycardia**, which is characteristic of **ventricular tachycardia (VT)**. - The QRS complexes are broad and bizarre, originating from an ectopic focus within the ventricles. *Atrial fibrillation* - **Atrial fibrillation** is characterized by an **irregularly irregular rhythm** with the absence of distinct P waves and varying R-R intervals. - The rhythm shown in the image is regular, which rules out atrial fibrillation. *Atrial flutter* - **Atrial flutter** typically presents with a "sawtooth" pattern of **flutter waves** in specific leads (e.g., II, III, aVF) and a regular or irregular ventricular response, often with a 2:1 or 3:1 block. - The image does not show these characteristic flutter waves. *Supraventricular tachycardia* - **Supraventricular tachycardia (SVT)** usually presents with a **narrow QRS complex** (unless there's an underlying bundle branch block) and a regular rhythm, originating from above the ventricles. - The QRS complexes in the image are wide, indicating a ventricular origin, not supraventricular.

Q: Which type of cardiomyopathy is associated with alcohol abuse?

Dilated cardiomyopathy. ### Dilated cardiomyopathy - Chronic **alcohol abuse** is a well-established cause of **dilated cardiomyopathy**, leading to weakening and enlargement of the ventricles [1]. - This condition results in impaired systolic function and can cause **heart failure** [1]. *Hypertrophic cardiomyopathy* - This condition is primarily characterized by **pathological thickening of the heart muscle**, often genetic, and is not directly caused by alcohol abuse. - It leads to issues with relaxation and filling of the heart, rather than dilation and weakness. *Pericarditis* - **Pericarditis** is the inflammation of the sac surrounding the heart (pericardium), most commonly caused by viral infections, autoimmune diseases, or injury. - It is not directly linked to alcohol abuse as a primary cause. *Myocarditis* - **Myocarditis** is the inflammation of the heart muscle, often triggered by viral infections, autoimmune reactions, or certain medications. - While heavy alcohol use can weaken the heart, myocarditis is primarily an inflammatory process not directly caused by alcohol.

Q: What is the most appropriate immediate management for a hemodynamically unstable patient with supraventricular tachycardia (SVT)?

CARDIOVERSION. ***CARDIOVERSION*** - In a **hemodynamically unstable** patient with **supraventricular tachycardia (SVT)**, immediate **synchronized electrical cardioversion** is the treatment of choice to restore sinus rhythm rapidly and stabilize the patient. - Instability is defined by symptoms such as **hypotension**, **altered mental status**, signs of **shock**, **ischemic chest discomfort**, or **acute heart failure**. *IV Amiodarone* - While amiodarone is an **antiarrhythmic drug** used for various tachyarrhythmias, it is typically reserved for **hemodynamically stable** patients or for refractory cases after other interventions, as its onset of action is not immediate. - It works by blocking potassium channels, prolonging repolarization, and has a slower effect compared to cardioversion in an unstable setting. *IV Verapamil* - Verapamil, a **calcium channel blocker**, is used to slow the ventricular rate in SVT, particularly in stable patients. - However, in **hemodynamically unstable** patients, it can worsen **hypotension** and should be avoided. *IV Metoprolol* - Metoprolol, a **beta-blocker**, is also used to slow the heart rate in stable SVT by blocking beta-adrenergic receptors [1]. - Like verapamil, it is **contraindicated** in **hemodynamically unstable** patients due to its potential to cause or worsen **hypotension** and **cardiac depression**.

Q: Identify the condition in the provided ECG image.

Atrial flutter. ***Atrial flutter*** - The ECG shows characteristic **sawtooth flutter waves**, particularly evident in inferior leads (II, III, aVF) and V1. These represent rapid, regular atrial activity. - There is a **regular ventricular response** (narrow QRS complexes), indicating a consistent conduction ratio through the AV node, which is typical for atrial flutter with a fixed block. *Atrial fibrillation* - Characterized by **irregularly irregular R-R intervals** and the **absence of distinct P waves**, replaced by fibrillatory waves. - The ECG image displays a regular ventricular rhythm and clear flutter waves, distinguishing it from atrial fibrillation. *Cardiomyopathy* - Cardiomyopathy refers to diseases of the heart muscle and is a **structural diagnosis**, not an electrical rhythm diagnosis. - While cardiomyopathy can predispose to arrhythmias, the ECG itself directly identifies an **electrical rhythm disturbance**, not the underlying heart structure. *General arrhythmia* - This option is too broad; while atrial flutter is indeed an arrhythmia, it's essential to identify the **specific type of arrhythmia** for accurate diagnosis and management. - A more precise diagnosis is necessary to guide clinical decisions, as treatments vary significantly based on the specific arrhythmia.

Q: Osborn J waves are seen in which of the following conditions?

Hypothermia. ***Hypothermia*** - **Osborn J waves**, or **J waves**, are characteristic electrocardiogram (ECG) findings in patients with **hypothermia**. - These waves are small, positive deflections seen at the **junction of the QRS complex and the ST segment**, most prominent in the precordial leads. *Hypocalcemia* - Hypocalcemia typically manifests on an ECG as a **prolonged QT interval** due to delayed repolarization, which can increase the risk of arrhythmias. - It does not cause Osborn J waves. *Hyperkalemia* - Hyperkalemia causes distinct ECG changes including **tall, peaked T waves**, prolonged PR interval, widened QRS complex, and ultimately sine wave formation [1]. - Osborn J waves are not associated with hyperkalemia. *Hypokalemia* - Hypokalemia is associated with ECG changes such as **flattening or inversion of T waves**, prominent U waves, and ST-segment depression [1]. - It does not lead to the formation of Osborn J waves.

Q: A patient presents to you with an irregularly irregular pulse of 120/minutes and a pulse deficit of 20. Which of the following would be the jugular venous pressure (JVP) finding?

Absent a wave. ***Absent a wave*** - An **irregularly irregular pulse** with a **pulse deficit** strongly suggests **atrial fibrillation (AF)**. - In AF, the atria quiver chaotically instead of contracting effectively, leading to the **absence of a coordinated atrial contraction** and thus an **absent 'a' wave** in the JVP. *Normal JVP* - A normal JVP would show a regular **'a' wave** corresponding to normal atrial contraction. - This is inconsistent with the **irregularly irregular pulse** and **pulse deficit** seen in the patient, which points to a significant atrial arrhythmia. *Cannon a wave* - A **cannon 'a' wave** results from the right atrium contracting against a closed tricuspid valve, leading to a large, prominent wave in the JVP. - This is typically seen in conditions like **complete heart block** or **ventricular tachycardia with AV dissociation**, not atrial fibrillation. *Raised JVP with normal waveform* - A raised JVP with a normal waveform indicates increased right atrial pressure but preserves the normal sequence of atrial contraction and relaxation. - This could be due to conditions like **right heart failure** or **volume overload**, but would still show the presence of an 'a' wave, which is absent in atrial fibrillation.

Q: What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

Hypokalemia. ***Hypokalemia*** - **Prominent U waves** on an ECG are a classic sign of **hypokalemia**, indicating delayed repolarization of ventricular myocardial cells. - Other ECG changes associated with hypokalemia include **ST-segment depression**, **flattened T waves**, and a prolonged QT interval. *Hyponatremia* - **Hyponatremia** primarily affects neurological function and can lead to symptoms like confusion and seizures [1]. - It does not typically cause specific characteristic ECG changes such as **prominent U waves**. *Hypocalcemia* - **Hypocalcemia** is often associated with a **prolonged QT interval** on an ECG, which reflects delayed ventricular repolarization [2]. - However, it is not primarily linked to the appearance of prominent U waves. *Hypercalcemia* - **Hypercalcemia** is known to cause a **shortened QT interval** on the ECG due to accelerated repolarization. - It does not typically manifest with prominent U waves.

Q: A 55-year-old hypertensive patient presents with severe chest pain radiating to the back. What does a CT scan of the thorax typically reveal?

Type B Aortic dissection. ***Type B Aortic dissection*** - A CT scan of the thorax would show a **tear in the descending aorta**, typically distal to the left subclavian artery, consistent with a type B dissection. - The combination of **hypertension** and **severe chest pain radiating to the back** is highly suggestive of an aortic dissection, and involvement of the descending aorta (Type B) often presents with radiating back pain. *Type A Aortic dissection* - A type A dissection involves the **ascending aorta**, which would typically present with chest pain radiating to the neck or jaw, or acute onset of symptoms suggestive of a stroke or myocardial infarction. - While it's also an aortic dissection, its location is different, and the pain typically radiates to different areas. *Pulmonary Embolism* - A **pulmonary embolism** would appear as a filling defect in the pulmonary arteries on a CT angiogram, not a tear in the aorta. - Though it can cause chest pain, it's typically pleuritic and not usually described as severe and radiating to the back in the same manner as an aortic dissection. *Thoracic Aortic Aneurysm* - A **thoracic aortic aneurysm** is a localized dilation of the aorta, not a tear, and it typically presents with chronic or less acute symptoms unless it ruptures or causes compression. - While an aneurysm can be present, the acute and severe nature of the pain described points more strongly to an acute event like dissection rather than a stable aneurysm.

Question 1

A 32-year-old patient presents to the emergency department with palpitations and dizziness. An ECG is obtained. Identify the cardiac rhythm shown in the image.

Accepted Answer

PSVT

Answer

Ventricular Tachycardia

Answer

Atrial Tachycardia

Answer

Ventricular Fibrillation

Question 2

Identify the cardiac condition represented in the image.

Accepted Answer

Ventricular tachycardia

Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

Supraventricular tachycardia

Question 3

Which type of cardiomyopathy is associated with alcohol abuse?

Accepted Answer

Dilated cardiomyopathy

Answer

Hypertrophic cardiomyopathy

Answer

Pericarditis

Answer

Myocarditis

Question 4

What is the most appropriate immediate management for a hemodynamically unstable patient with supraventricular tachycardia (SVT)?

Accepted Answer

CARDIOVERSION

Answer

IV Amiodarone

Answer

IV Verapamil

Answer

IV Metoprolol

Question 5

Identify the condition in the provided ECG image.

Accepted Answer

Atrial flutter

Answer

Atrial fibrillation

Answer

Cardiomyopathy

Answer

General arrhythmia

Question 6

Osborn J waves are seen in which of the following conditions?

Accepted Answer

Hypothermia

Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Hypokalemia

Question 7

Which of the following statements is true about the Bundle of Kent?

Accepted Answer

It is an accessory pathway connecting the atria to the ventricles in WPW syndrome.

Answer

It is an abnormal pathway connecting the atria to the ventricles in WPW syndrome.

Answer

It is slower than the AV nodal pathway.

Answer

None of the options.

Question 8

A patient presents to you with an irregularly irregular pulse of 120/minutes and a pulse deficit    of 20. Which of the following would be the jugular venous pressure (JVP) finding?

Accepted Answer

Absent a wave

Answer

Normal JVP

Answer

Cannon a wave

Answer

Raised JVP with normal waveform

Question 9

What electrolyte imbalance is most commonly associated with prominent U waves on ECG?

Accepted Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypocalcemia

Answer

Hypercalcemia

Question 10

A 55-year-old hypertensive patient presents with severe chest pain radiating to the back. What does a CT scan of the thorax typically reveal?

Accepted Answer

Type B Aortic dissection

Answer

Type A Aortic dissection

Answer

Pulmonary Embolism

Answer

Thoracic Aortic Aneurysm

Cardiology — MCQs

Cardiology — MCQs

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