Cardiology Practice Questions

Q: What does the following ECG show?

Delta wave. ***Delta wave*** - The ECG shows a **short PR interval** and a **slurring upstroke of the QRS complex**, known as a delta wave. - This pattern is characteristic of **Wolff-Parkinson-White (WPW) syndrome**, caused by an accessory pathway that bypasses the AV node, leading to premature ventricular activation. *Osborn wave* - An Osborn wave, or J wave, is a **positive deflection at the J point** (junction of the QRS complex and ST segment), typically seen in **hypothermia**. - This ECG does not show the characteristic prominent J-wave morphology associated with Osborn waves. *Hockey stick sign* - The "hockey stick sign" usually refers to the **downsloping ST segment with a concave upward elevation** seen in conditions like **pericarditis**. - This ECG does not display the characteristic ST segment changes indicative of pericarditis. *Epsilon wave* - An Epsilon wave is a **small, positive deflection embedded in the terminal part of the QRS complex** or immediately after it, primarily seen in **arrhythmogenic right ventricular cardiomyopathy (ARVC)**. - This ECG does not exhibit the small, fragmented depolarization in the terminal QRS characteristic of an epsilon wave. *U wave* - A U wave is a **small deflection that follows the T wave**, most commonly associated with **hypokalemia**, but also seen in conditions like bradycardia or left ventricular hypertrophy. - This ECG does not demonstrate the separate wave following the T wave characteristic of a U wave.

Q: A 55-year-old woman with non-ischemic cardiomyopathy presents with palpitations. ECG shows:

Torsades de pointes. ***Torsades de pointes*** - The ECG demonstrates a polymorphic ventricular tachycardia with a characteristic **"twisting of the points"** pattern around the isoelectric line, which is pathognomonic for Torsades de Pointes. - This arrhythmia is often associated with a **prolonged QT interval**, which can be congenital or acquired due to drugs or electrolyte imbalances, and is common in patients with underlying cardiac conditions like cardiomyopathy. *Ventricular tachycardia* - While Torsades de Pointes is a form of ventricular tachycardia, the term "ventricular tachycardia" alone does not capture the specific **polymorphic and twisting morphology** seen on this ECG. - Monomorphic ventricular tachycardia typically exhibits **QRS complexes of uniform shape and amplitude**, which is not seen here. *Bidirectional tachycardia* - **Bidirectional tachycardia** is characterized by alternating QRS axis and morphology, often with a different QRS complex every other beat and an alternating axis. - This pattern is not evident in the provided ECG, which shows a continuous, varying morphology typical of Torsades. *Atrial fibrillation with aberrancy* - **Atrial fibrillation with aberrant conduction** presents with irregularly irregular rhythm and wide QRS complexes due to bundle branch block or rate-related aberrancy. - The ECG shows a **characteristic polymorphic twisting pattern** with a regular ventricular rate, not the irregular rhythm expected with atrial fibrillation. *PSVT* - **Paroxysmal supraventricular tachycardia (PSVT)** involves narrow QRS complexes and originates above the ventricles, typically presenting with heart rates of 150-250 bpm. - The ECG shows **wide, polymorphic QRS complexes**, clearly indicating a ventricular origin rather than supraventricular.

Q: A patient becomes pulseless and his BP crashes after myocardial infarction. Diagnosis is:

Ventricular fibrillation. ***Ventricular fibrillation*** - This ECG shows completely **disorganized electrical activity** with no identifiable QRS complexes, P waves, or T waves, characteristic of ventricular fibrillation. - In ventricular fibrillation, the heart muscle quivers rather than contracts effectively, leading to immediate **pulselessness** and a rapid drop in blood pressure, often after a myocardial infarction. *Monomorphic ventricular tachycardia* - This rhythm typically presents with wide QRS complexes of **uniform morphology** and a rapid, regular rate. - While it can cause hemodynamic instability, the ECG in this case does not show organized wide QRS complexes. *Bidirectional tachycardia* - This is a rare form of ventricular tachycardia characterized by **alternating QRS complex morphologies** in the same lead, which is not seen here. - It is often associated with **digoxin toxicity** or severe heart disease. *Polymorphic ventricular tachycardia* - This rhythm features **wide QRS complexes** that vary in morphology and amplitude, indicating multiple re-entrant pathways. - Although it is a life-threatening arrhythmia, the tracing here is more chaotic and completely disorganized, lacking discernible QRS complexes altogether. *Pulseless electrical activity* - PEA presents with **organized electrical activity** on ECG but **no palpable pulse** or mechanical cardiac output. - The ECG in this case shows **chaotic, disorganized waveforms** without any recognizable complexes, which is inconsistent with PEA.

Q: A 68 -year-old man presents with symptoms of alcohol withdrawal. ECG shows:

Atrial fibrillation. ***Atrial fibrillation*** - The ECG shows a **chaotic, irregular baseline with no discernible P waves**, which is characteristic of atrial fibrillation. - The ventricular rhythm is **irregularly irregular**, with varying R-R intervals, further confirming the diagnosis. - Atrial fibrillation is commonly associated with **alcohol withdrawal** (holiday heart syndrome), making this the most likely diagnosis in this clinical context. *Atrial flutter* - This rhythm is characterized by regular, sawtooth-shaped **F waves** in leads II, III, and aVF, which are absent in this ECG. - While it can also lead to a rapid ventricular rate, the atrial activity is organized, unlike the chaotic activity seen here. *PSVT* - PSVT typically presents with a **regular, narrow-complex tachycardia** with a sudden onset and termination. - The chaotic atrial activity and irregularly irregular ventricular rhythm seen in the ECG are not consistent with PSVT. *VT* - Ventricular tachycardia is characterized by a **wide-complex tachycardia**, often regular, originating from the ventricles. - The ECG shows **narrow QRS complexes** and chaotic atrial activity, ruling out VT. *Multifocal atrial tachycardia* - MAT shows at least **three distinct P wave morphologies** with varying PR intervals, creating an irregularly irregular rhythm. - However, **P waves are identifiable** in MAT, whereas this ECG shows **no discernible P waves** with a chaotic baseline, making atrial fibrillation the correct diagnosis.

Q: What does the following ECG show?

Ventricular bigeminy. ***Ventricular bigeminy*** - The ECG shows a repeating pattern of a **normal QRS complex** followed by a **premature ventricular contraction (PVC)**, which is characteristic of bigeminy. - The premature beats are wide and bizarre, indicating their **ventricular origin**, and occur every second beat. - This is a **regular coupling pattern**, distinguishing it from other PVC patterns. *Ventricular trigeminy* - This rhythm would show a PVC occurring every **third beat**, meaning two normal beats followed by one PVC. - The presented ECG consistently shows a PVC after every normal beat, not every third beat. *Atrial premature contraction* - An APC typically results in a **narrow QRS complex** because the signal originates in the atria and conducts normally through the ventricles. - The premature beats in this ECG are wide and abnormal, consistent with a ventricular origin, not an atrial one. *Atrial bigeminy* - Atrial bigeminy involves an **atrial premature contraction (APC)** following every normal beat. - An APC would typically have a **narrow QRS complex** and a P wave that looks different from the sinus P waves, which is not seen here. *Multifocal PVCs* - Multifocal PVCs refer to PVCs with **different morphologies** arising from multiple ventricular foci. - While this ECG shows frequent PVCs, they occur in a **regular bigeminal pattern** rather than irregularly with varying morphologies characteristic of multifocal PVCs.

Question 1

What does the following ECG show?

Accepted Answer

Delta wave

Answer

Osborn wave

Answer

Hockey stick sign

Answer

Epsilon wave

Answer

U wave

Question 2

A 55-year-old woman with non-ischemic cardiomyopathy presents with palpitations. ECG shows:

Accepted Answer

Torsades de pointes

Answer

Ventricular tachycardia

Answer

Bidirectional tachycardia

Answer

PSVT

Answer

Atrial fibrillation with aberrancy

Question 3

A patient becomes pulseless and his BP crashes after myocardial infarction. Diagnosis is:

Accepted Answer

Ventricular fibrillation

Answer

Monomorphic ventricular tachycardia

Answer

Bidirectional tachycardia

Answer

Polymorphic ventricular tachycardia

Answer

Pulseless electrical activity

Question 4

A 68 -year-old man presents with symptoms of alcohol withdrawal. ECG shows:

Accepted Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

PSVT

Answer

VT

Answer

Multifocal atrial tachycardia

Question 5

Comment on the diagnosis from the ECG shown below:

Accepted Answer

2:1 heart block

Answer

Trifascicular block

Answer

First degree heart block

Answer

Atrial fibrillation

Answer

Complete heart block

Question 6

In the ECG shown below, which drug will not be given?

Accepted Answer

Adenosine

Answer

Verapamil

Answer

Diltiazem

Answer

Flecainide

Answer

Amiodarone

Question 7

What does the following ECG show?

Accepted Answer

Ventricular bigeminy

Answer

Ventricular trigeminy

Answer

Atrial premature contraction

Answer

Atrial bigeminy

Answer

Multifocal PVCs

Question 8

A 35-year-old lady has been diagnosed with anxiety neurosis by her psychiatrist. She came to you for second opinion. Comment on the diagnosis based on ECG.

Accepted Answer

WPW syndrome

Answer

Sinus tachycardia

Answer

Multifocal atrial tachycardia

Answer

Atrial fibrillation

Answer

Supraventricular tachycardia

Question 9

A 46-year-old man presents with diffuse chest pain at rest and recent history of cough, fever and rhinorrhea lasting for 3 days. ECG shows diffuse ST-segment elevation with PR-segment depression. What is the most likely diagnosis?

Accepted Answer

Acute pericarditis

Answer

Constrictive pericarditis

Answer

Takotsubo-cardiomyopathy

Answer

Cor pulmonale

Answer

Acute myocardial infarction (STEMI)

Question 10

ECG of a patient had ST segment elevation in V1-V6, lead I and AVL. Which of the following branches is involved?

Accepted Answer

1

Answer

2

Answer

3

Answer

4

Answer

5

Cardiology — MCQs

Cardiology — MCQs

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