Learning Cardiology

Q. Which of the following risk factor is responsible for most attributable deaths worldwide? A . Smoking B . Hypertension C . Diabetes melllitus D . Hyperlipidemia Answer: B. Hypertension Explanation: Hypertension accounts for more attributable deaths worldwide than any other risk factor, whereas smoking and hyperlipidemia are second and third, respectively. Additional risk factors in a patient have cumulative effect and increase risk of mortality.

Q. A 60-year-old man with no previous symptoms had a routine ECG. The ECG shows left bundle branch block. The patient is currently taking Aspirin 75 mg od. He has a family history of myocardial infarction. He smokes 20 cigarettes a day. The GP is concerned and refers the patient for further investigation. On examination, BP is 120/70 mmHg and there are no findings during cardiovascular examination.  Which of the following investigations is indicated? A.  Exercise ECG B.  CT of coronary arteries C.  Myocardial perfusion imaging D.  Coronary angiography    Answer: C. Myocardial perfusion imaging Explanation: For a patient with moderate likelihood of CAD (this patient is not symptomatic so is not in the high-risk category) non-invasive testing such as Exercise tolerance tests or myocardial perfusion tests should be performed. An exercise ECG test (TMT) will be difficult to interpret in this case due to the ECG changes of LBBB. Thus its most  appropriate to conduct a myocardial

Q. A trial assessed a statin tablet compared to placebo for stroke prevention over 1 year. There were 10% of patients developing stroke in the group taking a tablet and 20% in the carotid endarterectomy group developing a stroke over the 1 year. What is the number needed to treat over 1 year to prevent 1 death?    Options: A. 1 B.  10 C. 10 0 D. 1000 Answer: B. 10 Explanation: Number needed to treat (NNT) is defined as number of patients being given treatment for prevention of one death. Number need to treat: 1/Absolute risk reduction Stroke in patients taking tablet: 10%= 0.1 Stroke in patients undergoing endarterectomy: 20%= 0.2 Absolute risk reduction: 0.2-0.1= 0.1 So, Number needed to treat to save one life: 1/0.1= 10  

Q. Lipidic cells are characteristic of which cardiac tumor? A. Papillary fibroelastomatosis B. Atrial myxoma C. Fibrosarcoma D. Rhabdomyoma  Answer: B. Atrial myxoma Atrial myxoma: Most common benign cardiac tumour. Most commonly seen in left atrium. May be associated with Carney's complex. Lipidic cells are characteristic of atrial myxoma.

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.

Q.  A patient with atrial fibrillation was prescribed  digoxin.  What does it bind to in order to generate its  mode of action? A. Calcium channel B. Potassium channel C.  Na-Ca transporter D. Na / K- ATPase   Answer: D.    Na / K- ATPase   Explanation:  Digoxin belongs to cardiac glycoside group of medications. It is obtained from foxglove plant. Half life is 36 hours . Mechanism of action: Inhibition of Na/K ATPase and ultimately increased intracellular calcium. Eliminated mainly by renal excretion through P-glycoproteins . Narrow therapeutic index. Can cause gynecomastia . Effective plasma level between 0.5 to 1.0 ng/ml .

Q. Litten's sign is seen in? A. Rheumatic heart disease B. SLE C. Infective endocarditis D. Aortic regurgitation Answer: C. Infective endocarditis Explanation:  In infective endocarditis , white centred hemorrhages (cotton wool spots) can be seen in the retina on the fundoscopic examination of the patients. These are called as roth spots and sign is known as Litten's sign. 

Q. Batista procedure is used for? A. Ebstein's anomaly B. DCMP C. HOCM D. Tricuspid atresia Answer: B. DCMP Explanation: Batista procedure is also called as left ventricular reduction surgery . It is used in dilated cardiomyopathy and is supposed to improve geometric remodeling. Initial reports showed promising results. However, this method was found to be of very little benefit. Hence it is no longer considered a recommended treatment for this disease. 

Q. Which of the following is not a major criteria for congestive heart failure? A. Hepatojugular reflex B. PND attacks C. S3 gallop D. Tachycardia (Heart rate more than 120/minute) Answer: D. Tachycardia (Heart rate more than 120/minute) Explanation:  Framingham proposed the diagnostic criteria for congestive heart failure. Either 2 major or one major and 2 minor criterias should be fulfilled for the diagnosis of CHF Major criterias are: Paroxysmal nocturnal dyspnea Weight loss of 4.5 kg in 5 days in response to treatment Neck vein distention Rales Acute pulmonary edema Hepatojugular reflux S  3  gallop Central venous pressure >16 cm water Circulation time of ≥25 seconds Radiographic cardiomegaly Pulmonary edema, visceral congestion, or cardiomegaly at autopsy And minor criterias are: Nocturnal cough Dyspnea on ordinary exertion A decrease in vital capacity by one third the maximal value recorded Pleural effusion T