Cardiology Practice Questions

Q: Which of the following flow recording is shown below?

Aorta flow recording. ***Aorta flow recording*** - This tracing depicts the typical **phasic flow in the aorta**, with a rapid increase during **systole** as blood is ejected from the left ventricle, followed by a decrease during **diastole**. - The graph clearly labels "Systole" and "Diastole," and the y-axis shows pressure in **mm/Hg**, which is characteristic of arterial pressure recordings. *Left ventricular flow recording* - Left ventricular (LV) pressure recordings typically show a rapid rise during **isovolumetric contraction**, a sustained peak during ejection, and a rapid fall during **isovolumetric relaxation**. - LV flow (or volume) recordings would specifically show changes in the amount of blood within the ventricle, which is not what this graph represents. *Swan Ganz catheter tracing* - A Swan-Ganz catheter, or pulmonary artery catheter, measures pressures in the **right atrium, right ventricle, pulmonary artery**, and **pulmonary capillary wedge pressure**. - The waveform associated with a Swan-Ganz catheter varies depending on its location and would not display the characteristic aortic pressure waveform shown. *Coronary blood flow* - **Coronary blood flow** refers to the blood supply to the heart muscle itself and typically has a pattern where flow is highest during **diastole** (due to ventricular compression of coronary arteries during systole). - The presented graph shows flow peaking during systole, which is inconsistent with coronary blood flow dynamics. *Pulmonary artery flow recording* - **Pulmonary artery flow** would show a similar systolic peak but with significantly **lower pressures** (typically 25/10 mm Hg) compared to the aorta (120/80 mm Hg). - The pressure magnitude shown in this tracing is consistent with **systemic arterial pressure**, not pulmonary arterial pressure.

Q: The ECG shows presence of ST elevation from V2-V5. What is the diagnosis?

Anterior wall MI. ***Anterior wall MI*** - **ST elevation** in leads **V2-V5** is indicative of an anterior myocardial infarction, as these leads primarily reflect the electrical activity of the anterior wall of the left ventricle. - The **anterior wall** is supplied by the **left anterior descending artery (LAD)**, and occlusion of this vessel typically results in these ECG changes. - The contiguous lead pattern from V2-V5 confirms extensive anterior wall involvement. *Inferior wall MI* - **Inferior wall MIs** are characterized by **ST elevation** in leads **II, III, and aVF**. - These leads are not primarily affected with ST elevation in the given scenario (V2-V5). *Lateral wall MI* - **Lateral wall MIs** typically show **ST elevation** in leads **I, aVL, V5, and V6**. While V5 is included, the primary elevation pattern across V2-V5 points more broadly to an anterior infarction. - Absence of ST elevation in I and aVL makes isolated lateral MI less likely. *Posterior wall MI* - A **posterior wall MI** is diagnosed by **ST depression** in leads **V1-V3** (reciprocal changes) and tall R waves in V1-V2, not ST elevation. - To confirm, posterior leads (V7-V9) would show ST elevation. *Anteroseptal MI* - **Anteroseptal MI** typically shows **ST elevation** in leads **V1-V4**, focusing on the septal region. - While there is overlap with V2-V4, the extension to V5 indicates more extensive anterior wall involvement rather than isolated anteroseptal territory.

Q: In a patient with the ECG shown below, which drug is not to be given?

Adenosine. ***Adenosine*** - The ECG shows a **wide complex tachycardia** with signs of **ventricular preexcitation** (e.g., short PR interval, delta waves in some leads like V4-6). This rhythm could represent **atrial fibrillation with Wolff-Parkinson-White (WPW) syndrome**. - **Adenosine** is **contraindicated** in patients with **WPW with atrial fibrillation** because it can block the AV node, forcing impulses down the accessory pathway, which can accelerate the heart rate and lead to **ventricular fibrillation**. - Among AV nodal blockers, adenosine poses the **most acute risk** of precipitating life-threatening arrhythmias. *Amiodarone* - **Amiodarone** is an **antiarrhythmic drug** that can be used in patients with **wide complex tachycardia**, including those with preexcitation. - It is generally considered a safer option for rate control in **AF with WPW** compared to AV nodal blocking agents. *Diltiazem* - **Diltiazem** is a **calcium channel blocker** that primarily works by **blocking the AV node**. - Similar to adenosine, **AV nodal blockers** are contraindicated in AF with WPW as they can increase conduction down the accessory pathway, posing a risk of **ventricular fibrillation**. - However, adenosine is considered the **most acutely dangerous** among AV nodal blockers. *Beta blocker* - **Beta-blockers** are also **AV nodal blocking agents** that slow conduction through the AV node. - Like adenosine and diltiazem, they are contraindicated in **AF with WPW** due to the risk of shunting impulses down the accessory pathway and potentially leading to **ventricular fibrillation**. *Procainamide* - **Procainamide** is a **class IA antiarrhythmic** that blocks both the AV node and the accessory pathway. - It is considered **first-line therapy** for hemodynamically stable **AF with WPW** as it slows conduction through the accessory pathway without the risk of accelerating ventricular rate. - It is a **safe option** in this clinical scenario.

Q: Identify the condition shown in the ECG given below.

Atrial fibrillation. ***Atrial fibrillation*** - The ECG shows a rhythm that is **irregularly irregular**, which is a classic hallmark of atrial fibrillation due to chaotic atrial activity. - There is an **absence of distinct P waves**, which are replaced by fibrillatory waves (f waves) that are often subtle and variable in morphology. *Sinus rhythm* - Sinus rhythm is characterized by a **regular rhythm** originating from the sinoatrial node, with a distinct P wave before every QRS complex. - The ECG in the image clearly demonstrates an **irregular rhythm** and no clear P waves. *PSVT* - Paroxysmal supraventricular tachycardia (PSVT) typically presents with a **regular, fast heart rate** and narrow QRS complexes, with P waves often hidden within the QRS or T waves. - The rhythm in the ECG is **irregular**, not regular, ruling out typical PSVT. *Atrial flutter* - Atrial flutter is characterized by **organized atrial activity** with a regular atrial rate (typically 250-350 bpm) producing classic **"sawtooth" flutter waves** (F waves), most visible in leads II, III, and aVF. - The ventricular response may be regular or irregular depending on AV conduction, but the ECG shows **absence of organized flutter waves** and instead demonstrates chaotic fibrillatory activity. *Ventricular fibrillation* - Ventricular fibrillation (VF) is a chaotic, life-threatening arrhythmia characterized by **no discernible P waves or QRS complexes**, and a completely irregular, undulating baseline. - While the rhythm is irregular, the presence of **identifiable QRS complexes** rules out ventricular fibrillation, which involves complete disorganization of ventricular electrical activity.

Q: A 65-year-old elderly male with the ECG shown below has a history of sweating and chest pain for the last 24 hrs . Which of the following is not given in managing the patient?

Thrombolytic therapy. ***Thrombolytic therapy*** - The ECG shows significant **Q waves** and **T-wave inversion** in inferolateral leads (II, III, aVF, V5, V6), indicating an **evolving or established myocardial infarction** (MI), not an acute ST-elevation MI (STEMI suitable for immediate thrombolysis). - Given the symptoms began 24 hours ago, the patient is likely outside the optimal window for thrombolytic therapy, which is most effective within **12 hours** of symptom onset for STEMI. After 12-24 hours, the benefits are marginal, and risks of bleeding increase. *Aspirin* - **Aspirin** is an integral part of NSTEMI/STEMI management as an **antiplatelet agent**, given to almost all patients who are not allergic, regardless of time of presentation. - It works by **inhibiting cyclooxygenase** and thereby reducing platelet aggregation, preventing further clot formation. *Statin* - **Statins** are initiated early in MI management, even in the acute phase, for their **pleiotropic effects** beyond lipid-lowering, including **stabilizing plaques** and reducing inflammation. - Long-term statin therapy is crucial for **secondary prevention** in patients with established coronary artery disease. *Morphine* - **Morphine** is often used in the acute management of MI for **pain relief** and can also provide some **venodilation**, reducing preload and myocardial oxygen demand. - While typically used during the active chest pain phase, it remains an option for symptom management if pain persists, even after 24 hours. *Beta-blockers* - **Beta-blockers** are a cornerstone of post-MI management, started within the first 24 hours in hemodynamically stable patients without contraindications. - They reduce **myocardial oxygen demand**, prevent arrhythmias, and improve long-term survival. - Standard therapy even at 24 hours post-MI presentation.

Q: A 52-year-old diabetic patient complains of palpitations. His ECG is given below. The first line of management is:

Adenosine. ***Adenosine*** - The ECG shows a **narrow complex tachycardia** with a regular rhythm at a rate of about 150 bpm. This is consistent with **supraventricular tachycardia (SVT)**. - **Adenosine** is the **first-line pharmacologic treatment** for stable SVT as it transiently blocks the AV node, often terminating the re-entrant pathway for most SVTs. - Administered as a rapid IV push (6 mg initially, followed by 12 mg if needed). *Primary PCI* - **Primary PCI** (Percutaneous Coronary Intervention) is indicated for ST-elevation myocardial infarction (STEMI) or high-risk non-STEMI. - The ECG does not show signs of acute myocardial infarction, such as **ST-segment elevation** or new Q waves. *Cardioversion* - **Cardioversion** is typically used for unstable tachyarrhythmias (e.g., associated with hypotension, altered mental status, acute heart failure, or ischemic chest pain). - While effective for SVT, it's not the first-line treatment for a stable patient when adenosine can be tried first. *IV amiodarone* - **IV amiodarone** is an antiarrhythmic drug used for various tachyarrhythmias, including ventricular tachycardia and refractory SVT. - It is generally considered for SVT if adenosine is ineffective or contraindicated, or in cases of wide complex tachycardia of uncertain origin, but not as the initial treatment for stable narrow-complex SVT. *Vagal maneuvers* - **Vagal maneuvers** (Valsalva maneuver, carotid sinus massage) are non-pharmacologic interventions that can terminate SVT by increasing vagal tone. - While these should be attempted initially in stable patients, the question asks for the **first-line management**, which in the context of pharmacologic options is adenosine. - Vagal maneuvers have variable success rates and adenosine remains the definitive first-line pharmacologic treatment.

Q: A 76-year-old male came to emergency department with complaints of retrosternal pain for 6 hours. The following is the ECG of the same patient. What is the appropriate next line of management of this patient? (AIIMS May 2016)

Primary percutaneous intervention. ***Primary percutaneous intervention*** - The ECG shows significant **ST-segment elevations** in leads V1-V6, indicative of an extensive **anterior ST-elevation myocardial infarction (STEMI)**. - Given the patient's presentation with retrosternal pain for 6 hours and the ECG findings of STEMI, **primary percutaneous intervention (PCI)** is the preferred reperfusion strategy, especially when available within recommended timeframes. - Primary PCI is superior to thrombolysis and should be performed within **90 minutes of first medical contact** when available. *IV abciximab* - Abciximab is a **glycoprotein IIb/IIIa inhibitor** used as an adjunct to PCI to prevent thrombus formation, not as a standalone reperfusion therapy. - While it might be used during or after PCI, it is not the primary intervention for acute STEMI. *IV thrombolysis* - **Thrombolysis** is an alternative reperfusion strategy for STEMI when primary PCI is not available or cannot be performed timely (e.g., within 120 minutes of first medical contact). - Since primary PCI is generally superior and available in this emergency department setting, thrombolysis would be a second-line choice. *Low molecular weight heparin* - **Low molecular weight heparin (LMWH)** is an anticoagulant used in the management of STEMI to prevent clot propagation and re-occlusion. - However, it is an adjunctive therapy and not a primary reperfusion strategy for opening the occluded coronary artery. *Aspirin and observation* - While **aspirin** is indeed a critical first-line medication in STEMI (loading dose 162-325 mg), observation alone without reperfusion therapy is **inappropriate** for STEMI. - STEMI requires urgent reperfusion therapy (PCI or thrombolysis) to restore blood flow and minimize myocardial damage. - Conservative management would lead to increased mortality and complications.

Q: A 16-year-old boy has a history of recurrent episodes of fainting in school assembly. ECG was done. Which is incorrect about the condition?

Pacemaker is treatment of choice. ***Pacemaker is treatment of choice*** - The ECG shows features of **Wolff-Parkinson-White (WPW) syndrome**, which is a type of **pre-excitation syndrome**. The primary treatment for symptomatic WPW syndrome, especially in a young person with recurrent syncope, is typically **catheter ablation** of the accessory pathway, not a pacemaker. - A pacemaker is generally indicated for bradyarrhythmias or certain types of heart block, neither of which is the primary issue in WPW syndrome. *Pre-excitation syndrome* - The ECG demonstrates characteristic findings of pre-excitation syndrome, specifically Wolff-Parkinson-White syndrome, where an **accessory pathway** bypasses the AV node, leading to early ventricular activation. - This is a **correct statement** about the condition shown in the ECG. *Wide QRS* - The ECG shows a **widened QRS complex** (greater than 0.10 seconds), which is a common feature of WPW syndrome due to the fusion of ventricular activation via the normal conduction system and the accessory pathway. - This broadens the QRS duration as ventricular depolarization starts earlier. This is a **correct statement**. *Delta wave* - A **delta wave**, which is a slurred upstroke of the QRS complex, is evident in the ECG and represents the initial, slow ventricular activation through the accessory pathway. - The delta wave is a hallmark of WPW syndrome. This is a **correct statement**. *Short PR interval* - The ECG demonstrates a **short PR interval** (less than 0.12 seconds), which is a characteristic finding of pre-excitation syndrome. - This occurs because the accessory pathway allows rapid conduction that bypasses the normal AV nodal delay. This is a **correct statement**.

Question 1

Which of the following flow recording is shown below?

Accepted Answer

Aorta flow recording

Answer

Left ventricular flow recording

Answer

Swan Ganz catheter tracing

Answer

Coronary blood flow

Answer

Pulmonary artery flow recording

Question 2

A hypokalemic patient develops syncope with hypotension in ICU. Name the ECG abnormality with preferred drug to be used. (Recent NEET Pattern 2016-17)

Accepted Answer

Torsades de pointes, Magnesium sulfate

Answer

Ventricular fibrillation, Bretylium

Answer

Ventricular tachycardia, lignocaine

Answer

Paroxysmal ventricular tachycardia, Adenosine

Answer

Atrial fibrillation, Diltiazem

Question 3

The ECG shows presence of ST elevation from V2-V5. What is the diagnosis?

Accepted Answer

Anterior wall MI

Answer

Inferior wall MI

Answer

Lateral wall MI

Answer

Posterior wall MI

Answer

Anteroseptal MI

Question 4

In a patient with the ECG shown below, which drug is not to be given?

Accepted Answer

Adenosine

Answer

Amiodarone

Answer

Diltiazem

Answer

Beta blocker

Answer

Procainamide

Question 5

Identify the condition shown in the ECG given below.

Accepted Answer

Atrial fibrillation

Answer

Sinus rhythm

Answer

PSVT

Answer

Ventricular fibrillation

Answer

Atrial flutter

Question 6

A 65-year-old elderly male with the ECG shown below has a history of sweating and chest pain for the last 24 hrs . Which of the following is not given in managing the patient?

Accepted Answer

Thrombolytic therapy

Answer

Aspirin

Answer

Statin

Answer

Morphine

Answer

Beta-blockers

Question 7

A 52-year-old diabetic patient complains of palpitations. His ECG is given below. The first line of management is:

Accepted Answer

Adenosine

Answer

Primary PCI

Answer

Cardioversion

Answer

IV amiodarone

Answer

Vagal maneuvers

Question 8

A 76-year-old male came to emergency department with complaints of retrosternal pain for 6 hours. The following is the ECG of the same patient. What is the appropriate next line of management of this patient? (AIIMS May 2016)

Accepted Answer

Primary percutaneous intervention

Answer

IV abciximab

Answer

IV thrombolysis

Answer

Low molecular weight heparin

Answer

Aspirin and observation

Question 9

A 16-year-old boy has a history of recurrent episodes of fainting in school assembly. ECG was done. Which is incorrect about the condition?

Accepted Answer

Pacemaker is treatment of choice

Answer

Pre-excitation syndrome

Answer

Wide QRS

Answer

Delta wave

Answer

Short PR interval

Question 10

A 65-year-old man presents with crushing chest pain for 2 hours. On examination, BP = 80/60 mm Hg and JVP is elevated 4 cm above the sternal angle. All are true about the condition shown except:

Accepted Answer

ST segment depression in lead II, III, aVF

Answer

ST elevation in V4R

Answer

Right ventricular infarction

Answer

Cardiogenic shock

Answer

Proximal right coronary artery occlusion

Cardiology — MCQs

Cardiology — MCQs

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