Cardiology Practice Questions

Q: A 65-year-old patient of STEMI underwent thrombolysis with STK. The ECG tracing performed after thrombolysis is shown below. What does it exhibit?

Accelerated idioventricular rhythm. ***Accelerated idioventricular rhythm*** - The ECG shows a wide-QRS rhythm with a regular rate between 50 and 100 bpm, which is characteristic of an **accelerated idioventricular rhythm (AIVR)**. - AIVR is often seen during the **reperfusion phase** after thrombolysis or PCI for STEMI, typically resolves spontaneously, and rarely requires treatment unless it causes hemodynamic instability. *Ventricular bigeminy* - **Ventricular bigeminy** involves a normal sinus beat followed by a premature ventricular contraction (PVC), occurring in an alternating pattern. - The rhythm shown in the ECG is regular and appears to be originating from the ventricles without alternating premature beats and normal beats. *Ventricular tachycardia* - **Ventricular tachycardia (VT)** is a wide-QRS rhythm that typically has a rate greater than 100 bpm (usually 100-250 bpm). - The rate in the provided ECG tracing is slower, falling within the range for AIVR, not VT. *Ventricular escape rhythm* - **Ventricular escape rhythm** is a wide-QRS rhythm with a slower rate, typically between 20 and 40 bpm, serving as a backup pacemaker when higher pacemakers fail. - The rate shown in the ECG is faster (50-100 bpm), which is consistent with AIVR rather than a ventricular escape rhythm. *Wenckebach phenomenon* - The **Wenckebach phenomenon (Mobitz Type I AV block)** is characterized by progressive prolongation of the PR interval until a QRS complex is dropped. - The ECG tracing shows a regular wide-QRS rhythm with no P waves preceding the QRS complexes, which is inconsistent with an AV block.

Q: What ECG finding is shown here?

T-wave alternans. ***T-wave alternans*** - The ECG shows a beat-to-beat alternation of the **T-wave amplitude** or morphology. This is particularly noticeable in lead V3 where consecutive T-waves vary in height. - **T-wave alternans** is a potential marker for **electrical instability of the myocardium** and an increased risk of ventricular arrhythmias and sudden cardiac death. *Hyperacute T-wave* - Hyperacute T-waves are typically seen in the very early stages of a **myocardial infarction** and are usually broad, symmetric, and unusually tall. - While the T-waves in V3 are tall, the key feature here is the **alternating pattern**, not just their height, and they are not particularly broad. *T-wave inversion* - **T-wave inversion** refers to a T-wave that is pointing downwards below the baseline, which is not seen in the provided ECG lead (V3 shows upright T-waves). - Inverted T-waves can indicate myocardial ischemia, infarction, or other cardiac conditions. *Wellens syndrome* - **Wellens syndrome** presents with characteristic **biphasic or deeply inverted T-waves** in the precordial leads (V2-V3), typically indicating critical stenosis of the left anterior descending (LAD) artery. - While Wellens syndrome involves T-wave abnormalities in V3, it shows a consistent pattern of inverted or biphasic T-waves, not the alternating amplitude pattern seen here. *Artifact* - **Artifacts** are disturbances or errors in the ECG tracing caused by external factors such as patient movement, electrical interference, or poor electrode contact. - While the tracing quality looks generally good, the consistent, rhythmic alternation of the T-wave morphology is a physiological phenomenon rather than a random artifact.

Q: Comment on the ECG shown:

VT. ***VT*** - The ECG shows a **wide complex tachycardia** with **QRS duration > 0.12 seconds**, which is a hallmark of ventricular tachycardia. - The rhythm is regular with a fast rate, and there is **AV dissociation** visible in several leads (e.g., V1, V2), indicating the ventricles and atria are beating independently. - **AV dissociation is pathognomonic for VT** and is the key distinguishing feature in this ECG. *PSVT* - **Paroxysmal supraventricular tachycardia (PSVT)** typically presents with a **narrow QRS complex** (<0.12 seconds) as it originates above the ventricles. - This ECG clearly shows **wide QRS complexes**, ruling out typical PSVT. *Ventricular fibrillation* - **Ventricular fibrillation (VF)** is characterized by **chaotic, irregular electrical activity** with no distinguishable QRS complexes, P waves, or T waves, leading to cardiac arrest. - The ECG displayed shows a **regular rhythm** with clearly defined, albeit wide, QRS complexes. *Junctional tachycardia* - **Junctional tachycardia** typically presents with a **narrow QRS complex** and an absent or inverted P wave, often occurring before or after the QRS complex. - The wide QRS complexes seen in this ECG are inconsistent with a junctional origin. *SVT with aberrancy* - **SVT with aberrant conduction** (e.g., RBBB or LBBB pattern) can present with wide QRS complexes, making it a differential for wide complex tachycardia. - However, the presence of **AV dissociation** in this ECG strongly favors VT over SVT with aberrancy, as SVT maintains 1:1 AV conduction.

Q: Which score is calculated during performance of this test?

Duke score. ***Duke score (Duke Treadmill Score)*** - The image depicts a patient undergoing a **cardiac stress test** on a treadmill, and the **Duke Treadmill Score** is the primary score calculated during this test. - The Duke Treadmill Score is calculated using the formula: **Exercise time (minutes) - (5 × ST deviation in mm) - (4 × angina index)**. - It provides **prognostic information** for patients with suspected coronary artery disease and stratifies them into low, moderate, or high-risk categories. - This score integrates **exercise capacity, ECG changes, and angina symptoms** into a single prognostic value. *Bruce score (Bruce Protocol)* - The **Bruce Protocol** is the name of the standardized exercise testing protocol with progressive stages of increasing speed and incline. - It is the **method/protocol** used to conduct the test, not a score that is calculated. - While the test follows the Bruce Protocol, no "Bruce score" is derived from it. *Jones score (Jones Criteria)* - The **Jones criteria** are diagnostic criteria used for diagnosing **rheumatic fever**. - Completely unrelated to cardiac stress testing or exercise capacity assessment. *DeBakey score (DeBakey Classification)* - The **DeBakey classification** categorizes **aortic dissections** based on anatomical involvement. - Used in vascular surgery, not in exercise stress testing. *Wells score* - The **Wells score** is used for assessing the pretest probability of **deep vein thrombosis (DVT)** or **pulmonary embolism (PE)**. - Unrelated to cardiac stress testing or functional capacity evaluation.

Q: Which is correct about the ECG shown below?

Second degree heart block, Wenckebach. ***Second degree heart block, Wenckebach*** - The ECG shows progressive **PR interval lengthening** with each successive beat, followed by a **dropped QRS complex**, indicating a Wenckebach (Mobitz Type I) block. - This pattern **"P-R-elongates-elongates-drops"** is characteristic of Wenckebach, where the SA node fires normally but AV nodal conduction progressively fails. *First degree heart block* - First-degree heart block is characterized by a **constantly prolonged PR interval** (greater than 0.20 seconds) without any dropped QRS complexes. - The ECG in the image clearly shows a **dropped beat** and progressively lengthening PR intervals, which are not features of a first-degree block. *Second degree heart block, Mobitz Type II* - Mobitz Type II is characterized by **constant PR intervals** with sudden, unpredictable dropped QRS complexes without prior PR prolongation. - This ECG shows **progressive PR lengthening** before the dropped beat, which is the hallmark of Mobitz Type I (Wenckebach), not Mobitz Type II. - Mobitz Type II typically occurs at the level of the His-Purkinje system and often progresses to complete heart block. *2:1 block* - A 2:1 block implies that **every other P wave is blocked**, resulting in two P waves for every QRS complex. - The given ECG shows a different pattern where the PR interval prolongs before a beat is dropped, which is not a fixed 2:1 conduction ratio. *Third degree heart block* - Third-degree (complete) heart block involves **complete dissociation** between atrial and ventricular activity, meaning P waves and QRS complexes occur independently. - This ECG demonstrates a clear relationship between the P waves and QRS complexes (until a beat is dropped), ruling out complete AV dissociation.

Q: Which device is shown here?

Holter. ***Holter*** - The image shows a **small, portable device** connected to the chest via several **electrodes**, designed to record the heart's electrical activity over an extended period. - This setup is characteristic of a **Holter monitor**, used for continuous ambulatory electrocardiography to detect intermittent arrhythmias or other cardiac events. - Holter monitors provide **continuous 24-48 hour recording** without patient activation. *IABP* - An **Intra-Aortic Balloon Pump** (IABP) is an invasive device typically inserted into the aorta via a peripheral artery, with its effects seen on hemodynamic monitoring rather than external chest electrodes. - It is used for temporary mechanical circulatory support in patients with severe heart failure or cardiogenic shock, not for ambulatory ECG recording. *ICD* - An **Implantable Cardioverter-Defibrillator** (ICD) is a surgically implanted device, usually beneath the skin in the chest or abdomen, with leads going into the heart. - It is used to detect and correct life-threatening arrhythmias and would not be visible externally as a connected portable device with electrodes. *AED* - An **Automated External Defibrillator** (AED) is a portable device used in emergency situations to deliver an electrical shock to restore normal heart rhythm in cases of sudden cardiac arrest. - It consists of large pads applied to the chest for defibrillation and is not used for continuous, long-term monitoring as depicted. *Event recorder* - An **event recorder** is similar to a Holter monitor but is **patient-activated** and worn for longer periods (weeks to months). - Unlike the Holter's continuous recording, event recorders capture ECG data only when the patient experiences symptoms and presses a button, making it unsuitable for detecting asymptomatic arrhythmias. - The image shows a device with continuous electrode attachment typical of Holter monitoring, not an event recorder.

Question 1

A 65-year-old patient of STEMI underwent thrombolysis with STK. The ECG tracing performed after thrombolysis is shown below. What does it exhibit?

Accepted Answer

Accelerated idioventricular rhythm

Answer

Ventricular bigeminy

Answer

Ventricular tachycardia

Answer

Wenckebach phenomenon

Answer

Ventricular escape rhythm

Question 2

What ECG finding is shown here?

Accepted Answer

T-wave alternans

Answer

Hyperacute T-wave

Answer

T-wave inversion

Answer

Artifact

Answer

Wellens syndrome

Question 3

A 50-year-old man is admitted to hospital with Levine sign. BP on admission is 70/50 mm Hg. On auscultation S2 is wide split with S3 gallop rhythm. The ECG is shown below. Which is the correct statement about this patient?

Accepted Answer

Start Streptokinase

Answer

Give bolus fluid

Answer

IV Atropine

Answer

IV Metoprolol

Answer

Start IV Dopamine

Question 4

A 40-year-old man was admitted to the hospital emergency with sudden onset of symptoms and signs of severe left ventricular failure. What would be the best management of this patient?

Accepted Answer

DC shock 25-50 J

Answer

Esmolol

Answer

Ibutilide

Answer

Digoxin

Answer

Adenosine

Question 5

A 50-year-old man is admitted to hospital with Levine sign. BP on admission is 90/60 mm Hg. On auscultation S2 is wide split with S3 gallop rhythm. Which is correct statement about this patient?

Accepted Answer

RCA occlusion with RV dysfunction

Answer

LAD occlusion with LV dysfunction

Answer

Posterior descending artery blockage with RV dysfunction

Answer

Left circumflex artery blockage with LV dysfunction

Answer

Obtuse marginal artery occlusion with lateral wall dysfunction

Question 6

Comment on the ECG shown:

Accepted Answer

VT

Answer

PSVT

Answer

Ventricular fibrillation

Answer

Junctional tachycardia

Answer

SVT with aberrancy

Question 7

Which score is calculated during performance of this test?

Accepted Answer

Duke score

Answer

Bruce score

Answer

Jones score

Answer

DeBakey score

Answer

Wells score

Question 8

Which is correct about the ECG shown below?

Accepted Answer

Second degree heart block, Wenckebach

Answer

First degree heart block

Answer

2:1 block

Answer

Third degree heart block

Answer

Second degree heart block, Mobitz Type II

Question 9

What is not recommended while wearing this cardiac device?

Accepted Answer

Taking a bath

Answer

Use of cell-phone

Answer

Consumption of energy drinks

Answer

Consumption of coffee

Answer

Exercise

Question 10

Which device is shown here?

Accepted Answer

Holter

Answer

IABP

Answer

ICD

Answer

AED

Answer

Event recorder

Cardiology — MCQs

Cardiology — MCQs

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