Cardiology

Cardiology US Medical PG Question 1: Which of the following flow recording is shown below?

• A. Aorta flow recording (Correct Answer)
• B. Left ventricular flow recording
• C. Swan Ganz catheter tracing
• D. Coronary blood flow
• E. Pulmonary artery flow recording

Cardiology Explanation: ***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.

Cardiology US Medical PG 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)

• A. Ventricular fibrillation, Bretylium
• B. Ventricular tachycardia, lignocaine
• C. Torsades de pointes, Magnesium sulfate (Correct Answer)
• D. Paroxysmal ventricular tachycardia, Adenosine
• E. Atrial fibrillation, Diltiazem

Cardiology Explanation: ***Torsades de pointes, Magnesium sulfate*** - The ECG shows a polymorphic ventricular tachycardia with a characteristic **twisting of the QRS complexes** around the isoelectric line, known as **Torsades de pointes**. This rhythm is often triggered by **prolonged QT interval** and is frequently associated with **hypokalemia** and other electrolyte disturbances. - **Magnesium sulfate** is the preferred drug for Torsades de pointes, particularly when associated with hypokalemia or hypomagnesemia, as it stabilizes cardiac cell membranes and reduces excitability. *Ventricular fibrillation, Bretylium* - **Ventricular fibrillation (VF)** is characterized by chaotic, irregular electrical activity with no recognizable QRS complexes, leading to no effective cardiac output. The ECG here shows distinct QRS complexes, albeit abnormal and polymorphic. - While Bretylium was historically used for VF, its use has largely been superseded by other antiarrhythmic drugs like amiodarone. The ECG pattern observed is not typical of VF. *Ventricular tachycardia, lignocaine* - The ECG shows a form of ventricular tachycardia, but more specifically, it is a polymorphic type known as Torsades de pointes, not a monomorphic ventricular tachycardia. - **Lidocaine** is an antiarrhythmic often used for stable monomorphic ventricular tachycardia; however, it is less effective and potentially proarrhythmic in Torsades de pointes. *Paroxysmal ventricular tachycardia, Adenosine* - **Paroxysmal ventricular tachycardia (PVT)** refers to VT that starts and stops suddenly. While the image shows VT, the specific morphology (polymorphic, twisting QRS) points away from standard PVT. - **Adenosine** is primarily used for **supraventricular tachycardias** (SVTs) by blocking the AV node and is **contraindicated** in ventricular tachycardias as it can worsen conditions like Torsades de pointes. *Atrial fibrillation, Diltiazem* - **Atrial fibrillation** presents with irregularly irregular rhythm with absent P waves and varying RR intervals. The ECG here shows a **ventricular arrhythmia** with wide QRS complexes and characteristic twisting morphology, not atrial fibrillation. - **Diltiazem** is a calcium channel blocker used for rate control in atrial arrhythmias and is **inappropriate for ventricular tachycardia**, especially in a hemodynamically unstable patient with syncope and hypotension.

Cardiology US Medical PG Question 3: The ECG shows presence of ST elevation from V2-V5. What is the diagnosis?

• A. Inferior wall MI
• B. Lateral wall MI
• C. Anterior wall MI (Correct Answer)
• D. Posterior wall MI
• E. Anteroseptal MI

Cardiology Explanation: ***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.

Cardiology US Medical PG Question 4: In a patient with the ECG shown below, which drug is not to be given?

• A. Amiodarone
• B. Adenosine (Correct Answer)
• C. Diltiazem
• D. Beta blocker
• E. Procainamide

Cardiology Explanation: ***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.

Cardiology US Medical PG Question 5: Identify the condition shown in the ECG given below.

• A. Sinus rhythm
• B. PSVT
• C. Atrial fibrillation (Correct Answer)
• D. Ventricular fibrillation
• E. Atrial flutter

Cardiology Explanation: ***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.

Cardiology Flashcard 1 of 5

Question: What is Ebstein's anomaly?

Answer: atrialized right ventricle

Cardiology Flashcard 2 of 5

Question: medial medullary syndrome

Answer: stroke in paramedian branches of ASA and/or vertebral arteries

Extra Information: lower limb hemiparesis, loss of proprioception, tongue deviation

Cardiology Flashcard 3 of 5

Question: migraine headache

Answer: irritation of CN 5, meninges, and/or blood vessels

Extra Information: release of substance P, CGRP, vasoactive peptidespulsating unilateral headache; 4-72 hr duration; +/- nausea, photophobia, phonophobia, auraabortive - triptans prophylactic - propranalol, topiramate 

Cardiology Flashcard 4 of 5

Question: familial hypercholesterolemia (hyperlipidemia type IIA)

Answer:

Extra Information: severe atherosclerotic disease early in life, tendon xanthomas, corneal arcus, very early MIelevated LDL and cholesterolADLDL receptor

Cardiology Flashcard 5 of 5

Question: The average age of presentation for lung cancer is _____ years old

Answer: 60

Extra Information:   Watch Lung Carcinoma [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-pulmonary/videos/medical-pathophysiology-pulmonary-lung-cancer-lung-carcinoma?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/pulmonology/videos/lung-cancer?index=2] https://onlinemeded.org/spa/pulmonology/lung-cancer/acquire?ref=anki