Learning Cardiology

Q 1. Contrast CT angiography of a patient. What is the Diagnosis? Q 2. What is optimum mode of management? Answer 1: Type A aortic dissection Answer 2: Surgical repair

Q. A 66-year-old man presents with central chest pain radiating to the arm and the scapula. He has a history of hypertension and diabetes. He takes aspirin, gliclazide and metformin. On examination, he has absent pulses in the right arm and an irregularly irregular heartbeat. The blood pressure is 160/100 mmHg. He also complains of some left sided arm and leg weakness compared to the right. ECG showed significant ST elevation in leads II, III, aVf. His troponin I was 10 (normal less than 0.02). What should be next line of management? A. I/V thrombolysis B. Primary PCI for myocardial infarction C. CT aortography D. NCCT head Answer: C. CT aortography Explanation: The patient has chest pain mimicking the clinical history of myocardial infarction but has two other features (absent pulses unilaterally and hemiparesis) which could be manifestations of occlusion of vascular supply from the aorta. In aortic dissection, if the dissection flap occludes the bloo

Q. Myocardial infarction in case of aortic dissections most commonly involve? A. LAD territory B. RCA territory C. LCx territory D. Ramus intermedius territory Answer: B. RCA territory Explanation:  Aortic dissections when extending to aortic root, may involve coronary arteries and cause myocardial infarction. Most commonly involved coronary artery in aortic dissections is right coronary artery.

Q. Calcium sign is seen in? A. Aortic aneurysm B. Aortic dissection C. Rheumatic heart disease D. Constrictive pericarditis Answer: B. Aortic dissection Explanation: The calcium sign is defined as the separation of the intimal calcification from the outer aortic soft tissue border by more than 10 mm . It is a specific chest radiographic finding of aortic dissection. It is more commonly seen in descending aortic dissection than aortic arch dissections.