Learning Cardiology

Q. A 46 years old patient presented to you with history of chest pain for 3 hours duration. Initial ECG done at primary centre showed ST elevation in inferior leads which have completely resolved now. Patient is pain free at present. His vitals and clinical examination are completely normal. What should be the next appropriate strategy? A. Discharge the patient since clinical examination is normal and patient does not have any chest pain B. Observe him for at least 24 hours for recurrence of chest pain and then ask to follow in cardiology clinic C. Arrange early coronary angiography preferably within 24 hours D. Get the cardiac biomarkers done and if normal, discharge the patient to follow up in cardiology OPD Answer:  C. Arrange early coronary angiography preferably within 24 hours

Q. A 50 year old man presents with severe crushing chest pain radiating to left arm. His ECG showed dominant R waves in V1 and V2 leads. The T waves were upright and tall along with ST segment depressions.  Which artery is most likely to be occluded? A.  Right coronary artery B.  Septal branch of left anterior descending  artery C.  Circumflex artery D. Left main coronary artery Answer: C. Circumflex artery Explanation: The ECG changes are suggestive of posterior wall MI. Posterior myocardial infarction usually results from occlusion of the left circumflex coronary artery but the anatomy can vary a little. Occlusion of the right coronary artery may also result in a posterior MI. The changes of posterior myocardial infarction are seen indirectly in the anterior precordial leads. Leads V1 to V3 face the endocardial   surface of the posterior wall of the left ventricle. As these leads record from the opposite side of the heart instead of directly over the

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.

MINOCA -Myocardial Infarction With Non Obstructive Coronary Arteries MINOCA is clinically defined by the presence of 1-Acute MI criteria 2-Absence of obstructive coronary artery disease (less than 50 percent stenosis, if any, of the epicardial coronary arteries) 3-No other cause for the clinical presentation at the time of angiography e.g. takotsubo cardiomyopathy