Cardiology — MCQs

Cardiology Indian Medical PG Practice Questions and MCQs

Question 1521: Which one of the following is not an early complication of acute myocardial infarction?

A. Pericarditis
B. Papillary muscle dysfunction
C. Ventricular septal defect
D. Dressler's syndrome (Correct Answer)

Explanation: ***Dressler's syndrome*** - **Dressler's syndrome** (post-myocardial infarction syndrome) is a **late complication** of acute myocardial infarction, typically occurring weeks to months after the event. - It is an **immune-mediated pericarditis**, characterized by chest pain, fever, and pericardial effusion, but is not seen immediately following an MI. *Papillary muscle dysfunction* - **Papillary muscle dysfunction** or rupture can occur as an **early complication** due to ischemia and necrosis of the muscle, leading to **mitral regurgitation** [1]. - This usually manifests within hours to days of the infarct, especially in **inferior MIs** affecting the posterior papillary muscle. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is an **early mechanical complication** resulting from necrosis and rupture of the interventricular septum. - It typically presents within the **first week** after an MI, causing a new **holosystolic murmur** and signs of heart failure. *Pericarditis* - **Early pericarditis** (within a few days of MI) results from inflammation overlying the necrotic myocardial tissue [1]. - It presents with **pleuritic chest pain** that improves with leaning forward and a **pericardial friction rub**, and is distinct from Dressler's syndrome.

Question 1522: A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?

A. Observation and investigation of other causes (Correct Answer)
B. Pacemaker insertion
C. Isoprenaline
D. Atropine

Explanation: ***Observation and investigation of other causes*** - **First-degree heart block** is usually **asymptomatic** and benign, rarely causing dizziness or other symptoms. - The dizziness experienced by the patient is likely due to another underlying condition and warrants **further investigation** rather than direct intervention for the heart block [2], [3]. *Pacemaker insertion* - **Pacemaker insertion** is reserved for **symptomatic heart blocks** of higher degrees (e.g., Mobitz II or complete heart block) or those with significant hemodynamic compromise [1]. - Given that first-degree heart block is typically asymptomatic, inserting a pacemaker would be an **overtreatment** and unnecessary for this condition alone. *Isoprenaline* - **Isoprenaline** is a **beta-agonist** that increases heart rate and AV conduction, sometimes used in certain bradyarrhythmias. - However, for first-degree heart block, which is generally benign, pharmacologic intervention with agents like **isoprenaline** is not typically indicated and carries risks of adverse effects [2]. *Atropine* - **Atropine** is an anticholinergic drug used to **increase heart rate** by blocking vagal stimulation of the SA and AV nodes. - While it can improve AV conduction, it is not indicated for **asymptomatic first-degree heart block** or when symptoms like dizziness are unlikely to be directly caused by the block itself.

Question 1523: Duroziez's sign is associated with which of the following conditions?

A. Aortic Regurgitation (Correct Answer)
B. Pericardial effusion
C. Tricuspid Regurgitation
D. Mitral Stenosis

Explanation: ***Aortic Regurgitation*** - **Duroziez's sign** is a characteristic **systolic and diastolic bruit** heard over the femoral artery, indicative of significant **aortic regurgitation**. [1], [2] - This sign occurs due to the rapid antegrade and retrograde flow of blood during systole and diastole, respectively, caused by the incompetent aortic valve. [2] *Tricuspid Regurgitation* - **Tricuspid regurgitation** is primarily associated with **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It does not produce arterial bruits like Duroziez's sign. *Pericardial effusion* - **Pericardial effusion** is characterized by the accumulation of fluid in the pericardial sac, which can lead to distant heart sounds, **pulsus paradoxus**, and electrical alternans on ECG. - It does not involve vascular bruits in peripheral arteries. *Mitral Stenosis* - **Mitral stenosis** classically presents with a **diastolic rumble** and an **opening snap**, typically heard at the apex. - It is a left-sided heart valve condition that does not cause peripheral arterial bruits.

Question 1524: In the context of chest pain evaluation, which is the best way to differentiate between stable angina and NSTEMI?

A. ECG
B. Cardiac-biomarker (Correct Answer)
C. Trans thoracic Echocardiography
D. Multi uptake gated Acquisition scan

Explanation: **Cardiac-biomarker** - **Cardiac biomarkers**, particularly **troponin**, are crucial for differentiating between **unstable angina** and **NSTEMI** [1], [2]. In NSTEMI, there is evidence of **myocardial necrosis**, leading to elevated cardiac troponins [2]. - **Stable angina** and **unstable angina** do not involve myocardial necrosis, so troponin levels remain within the normal range [1]. *ECG* - While an **ECG** is essential in the initial assessment of chest pain, it may show **non-specific changes** in both **unstable angina** and **NSTEMI**, such as T-wave inversions or ST-segment depression [2]. - The definitive distinction of **NSTEMI** often relies on **sequential biomarker measurements**, as ECG changes alone may not be sufficient for diagnosis or differentiation from unstable angina [2]. *Trans thoracic Echocardiography* - **Echocardiography** can show **regional wall motion abnormalities** that might suggest ischemia, but these findings are not specific enough to differentiate between **stable angina** and **NSTEMI** immediately. - It is more useful for assessing **ventricular function**, identifying **valvular disease**, or detecting other causes of chest pain, rather than acute differentiation of coronary syndromes. *Multi uptake gated Acquisition scan* - A **MUGA scan** assesses **left ventricular ejection fraction** and wall motion, primarily used in evaluating global cardiac function and monitoring cardiotoxicity from chemotherapy. - It is **not a first-line diagnostic tool** for differentiating between acute coronary syndromes like **stable angina** and **NSTEMI** because it does not directly detect acute myocardial injury.

Question 1525: Which of the following statements about atrial myxomas is correct?

A. More prevalent in males.
B. Most myxomas are hereditary.
C. Most commonly found in the Left Atrium. (Correct Answer)
D. Distant metastasis is commonly observed.

Explanation: ***Most commonly found in the Left Atrium.*** - **Atrial myxomas** are typically found in the **left atrium** (approximately 75-80% of cases), often attached to the **interatrial septum** near the fossa ovalis. - Their presence in the left atrium can lead to **obstruction of the mitral valve**, causing symptoms mimicking mitral stenosis [1]. *More prevalent in males.* - **Atrial myxomas** are more common in **females** than males, with a female-to-male ratio of approximately 2:1. - This higher prevalence in women is a consistent finding in epidemiological studies of cardiac myxomas [2]. *Most myxomas are hereditary.* - The vast majority of **atrial myxomas** are **sporadic** (non-hereditary), accounting for about 90-95% of cases. - A small percentage (5-10%) are part of a familial syndrome known as **Carney complex**, which is an autosomal dominant disorder. *Distant metastasis is commonly observed.* - **Atrial myxomas** are generally **benign tumors** and do not metastasize to distant sites. - While they can embolize fragments, leading to systemic effects, these are not true metastases.

Question 1526: Becks triad is seen in

A. Cardiac tamponade (Correct Answer)
B. Restrictive cardiomyopathy
C. Constrictive pericarditis
D. None of the options

Explanation: ***Cardiac tamponade*** - **Beck's triad** is a set of three clinical signs associated with acute cardiac tamponade: **hypotension**, **jugular venous distension (JVD)**, and **muffled heart sounds**. [1] - These signs result from the accumulation of fluid in the pericardial sac, which compresses the heart and impairs its ability to fill. [1] *Constrictive pericarditis* - While it can manifest with JVD and signs of right heart failure, **muffled heart sounds** and acute **hypotension** as part of Beck's triad are not typical for its chronic nature. [2] - It involves a rigid, fibrotic pericardium that restricts diastolic filling, often with a **pericardial knock** rather than muffled sounds. [2] *Restrictive cardiomyopathy* - This condition involves impaired ventricular relaxation and filling, leading to signs of heart failure, including JVD. [3] - However, it does not typically present with the acute, severe **hypotension** or **muffled heart sounds** characteristic of cardiac tamponade. [3] *None of the options* - This option is incorrect as cardiac tamponade is the condition associated with Beck's triad.

Question 1527: Wide pulse pressure is seen in all except which of the following?

A. Aortic Regurgitation
B. PDA
C. A.V. malformation
D. Aortic stenosis (Correct Answer)

Explanation: **Aortic stenosis** - In **aortic stenosis**, there is a fixed obstruction to left ventricular outflow, leading to a compensatory increase in systolic pressure to overcome the stenotic valve [2]. - The **reduced stroke volume** and impaired flow through the rigid valve cause a lower pulse pressure, often resulting in a **narrow pulse pressure**. *PDA (Patent Ductus Arteriosus)* - In **PDA**, blood flows from the aorta to the pulmonary artery during systole and diastole, causing a decrease in diastolic pressure. - This creates a **run-off phenomenon**, leading to a **wide pulse pressure** due to high systolic and low diastolic pressures. *Aortic Regurgitation* - **Aortic regurgitation** involves blood flowing back into the left ventricle during diastole, causing a rapid fall in diastolic pressure [1]. - The increased stroke volume from the left ventricle leads to a high systolic pressure, resulting in a **wide pulse pressure** [1]. *A.V. malformation (Arteriovenous Malformation)* - An **AV malformation** creates a shunt where arterial blood flows directly into the venous system, bypassing the capillary bed. - This leads to a **decrease in peripheral resistance** and an increased cardiac output, causing a higher systolic pressure and a lower diastolic pressure, thereby producing a **wide pulse pressure**.

Question 1528: Which of the following is not typically used for secondary prevention of myocardial infarction?

A. Aspirin
B. Statins
C. Beta blockers
D. Warfarin (Correct Answer)

Explanation: ***Warfarin*** - While Warfarin is an **anticoagulant**, its primary role is in preventing *thromboembolism* in conditions like **atrial fibrillation** [1] or **mechanical heart valves**, not routinely for general **secondary prevention of MI** unless specific indications exist. - Unlike the other options, it doesn't directly address the underlying plaque rupture or reduce the workload of the heart in the typical post-MI patient. *Aspirin* - **Aspirin** is a cornerstone of secondary prevention after MI due to its **antiplatelet** effects, which help prevent future clot formation [2]. - It reduces the risk of recurrent MI, stroke, and cardiovascular death by inhibiting **platelet aggregation** [2]. *Statins* - **Statins** are crucial for secondary prevention as they aggressively lower **LDL cholesterol** levels, stabilizing existing plaques and preventing further plaque progression. - They have pleiotropic effects beyond lipid lowering, including **anti-inflammatory** and **endothelial function improvement**. *Beta blockers* - **Beta blockers** reduce myocardial oxygen demand by decreasing heart rate and contractility, which helps prevent recurrent ischemic events and improves survival post-MI [3]. - They are particularly beneficial in patients with **left ventricular dysfunction** or **hypertension** following an MI [1].

Question 1529: The severity of mitral stenosis can be judged by-

A. Duration of murmur
B. Intensity of murmur
C. Presence of left ventricular S3
D. Loud S1 (Correct Answer)

Explanation: ***Loud S1*** - A **loud S1** in mitral stenosis indicates that the **mitral valve leaflets are still mobile** and able to snap shut forcefully, which is characteristic of early to moderate stenosis [2]. - As mitral stenosis becomes more severe and the valve becomes calcified and rigid, the S1 sound may become diminished or even absent due to reduced leaflet mobility [1]. *Intensity of murmur* - The **intensity (loudness)** of the diastolic murmur in mitral stenosis **does not directly correlate with the severity** of the stenosis. - A loud murmur can be heard with mild stenosis, while a soft murmur in severe stenosis may be due to reduced cardiac output or left atrial pressure. *Duration of murmur* - While a **longer duration of the diastolic murmur** can coincide with more severe mitral stenosis, it is not as reliable a single indicator as other findings. - The duration is influenced by the pressure gradient across the valve and the length of diastole [2]. *Presence of left ventricular S3* - A **left ventricular S3** is typically associated with **left ventricular dysfunction** and volume overload, as seen in conditions like mitral regurgitation or dilated cardiomyopathy [3]. - It is **not a feature of mitral stenosis**, where the primary issue is obstruction to left ventricular filling.

Question 1530: Among the following emerging risk factors, which is considered the most important predisposing factor for coronary artery disease?

A. ↑ Lipoprotein(a) (Correct Answer)
B. Homocysteinemia
C. ↑ Fibrinogen
D. ↑ plasminogen activator inhibitors 1

Explanation: ***↑ Lipoprotein(a)*** - **Lipoprotein(a) [Lp(a)]** is an **independent and causal risk factor** for **Coronary Artery Disease (CAD)**, with its elevated levels strongly associated with increased cardiovascular risk. - Its proatherogenic and prothrombotic properties, attributed to its structural similarity to **LDL** and **plasminogen**, make it a particularly potent emerging risk factor. *Homocysteinemia* - While **elevated homocysteine levels** are associated with increased risk of **atherosclerosis** and **thrombosis**, the evidence for it as an independent causal risk factor for **CAD** is weaker compared to Lp(a). - Its contribution to **CAD** risk is often considered in the context of other traditional risk factors and may be influenced by nutrient deficiencies like **folate** and **B vitamins**. *↑ Fibrinogen* - **Elevated fibrinogen levels** are a marker of **inflammation** and are associated with an increased risk of **CAD** due to its role in **blood coagulation** and **platelet aggregation** [1]. - However, fibrinogen is considered more of a **risk marker** and a component of the inflammatory response rather than a primary, independent causal factor like Lp(a). *↑ plasminogen activator inhibitors 1* - **Elevated plasminogen activator inhibitor-1 (PAI-1)** levels promote a **prothrombotic state** by inhibiting **fibrinolysis**, which can contribute to the development of **CAD**. - While important in the pathophysiology of **thrombosis**, it is generally considered a downstream mediator in the context of vascular injury and inflammation, rather than the most significant emerging predisposing factor compared to Lp(a).

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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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