Learning Cardiology

Q. Which of the following is not true regarding the ISCHEMIA trial ? A. Patients with stable angina were included B. The patients with LM disease were excluded with a CT angiogram C. Early invasive therapy was found to reduce MI and cardiovascular mortality compared to medical therapy in patients with stable angina D. Results are not applicable to patients with severe LV dysfunction Correct answer: C. Early invasive therapy was found to reduce MI and cardiovascular mortality compared to medical therapy in patients with stable angina Explanation: https://www.learningcardiology.com/2020/06/ischemia-trial.html

Background: We don't know the optimum mode of therapy for patients with stable ischemic heart disease along with moderate to severe myocardial ischemia on non-invasive stress testing. Routine early invasive therapy was compared with optimal medical therapy in this trial. Study design: Patients: Stable ischemic heart disease with moderate to severe ischemia on stress testing. All patients underwent CT coronary angiogram prior to inclusion in the trial to rule out significant LM disease. Exclusion: - LM stenosis >50% (on CT coronary angiogram) - Recent MI - LVEF < 35% - Unacceptable angina at baseline - NYHA class III and IV heart failure - Prior PCI or CABG within last one year Groups: Routine invasive therapy (n = 2588) vs initial optimal medical therapy (n= 2591) Interventions in both groups: - Routine invasive group: Patients underwent angiography followed by PCI or CABG as per the anatomy. - Medical therapy group: All patients were put on initial medi...

Q. Szabo technique is used for? A. PCI of ostial lesions B. PCI of SVG graft vessels C. PCI of CTO lesions D. PCI of distal left main stenosis Answer: A. PCI of ostial lesions Explanation:  Szabo technique-  Correct stent placement is very important for ostial lesions for optimal coverage of lesion.  Szabo technique first described in 2005, involves passage of two guidewires. First guidewire (primary) is placed in vessel to stented and 2nd guidewire (anchor) is placed in the lumen of side branch. 2nd guidewire is passed over most proximal strut of stent. Stent then travels over both guidewires, the movement of stent is stopped by anchor guidewire at the ostium of vessel to stented. Then the stent is deployed completely covering the ostial lesion. (Image source: drsvenkatesan.com)

Q. Which of the following is not an absolute contraindication of Sacubitril/valsartan combination? A. History of hypersensitivity to valsartan B. History of hyperkalemia with valsartan C. 1st trimester of pregnancy D. History of angioedema with ACE inhibitors Answer:  B. History of hyperkalemia with valsartan Absolute contraindications of sacubitril include 1. History of hypersensitivity to any of component of sacubitril 2. H/o angioedema due to ACE inhibitors or ARBs 3. Pregnancy Past history of hyperkalemia with valsartan is not a contraindication for the use of sacubitril as such potassium should be normal while starting it. However, potassium level should be monitored more carefully in these patients. Hence, sacubitril can be given to patients who have past history of hyperkalemia due to any cause.

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. Contraindications of IABP? A. Aortic dissection B. Abdominal aortic aneurysm C. Significant aortic regurgitation D. Severe peripheral vascular disease E. All of the above Answer: E. All of the above

Q.  In heterotaxy, peripheral blood smear is most likely to show?  A.  Lymphoblasts B.  Spherocytes C.  Howell – Jolly bodies D.  Sickle cells Answer: C. Howell - Jolly bodies Explanation: Right atrial isomerism is associated with asplenia. And, asplenia causes formation of Howell Jolly bodies in the blood. 

Q. Which of the following is not an absolute contraindication for PTMC? A. Moderate MR B. LA clot C. Severe bicommissural calcification D. Wilkins score of 10 Answer: D. Wilkins score of 10 Explanation:  Absolute contraindications of PTMC include- 1. Moderate to severe MR 2. LA clot 3. Severe bicommissural calcification NB: Mild MR and LAA clot are not absolute contraindications for PTMC.

Q. Morrow's procedure is used for? A. Ebstein's anomaly B. DCMP C. HOCM D. DORV with VSD Answer: C. HOCM Explanation:  Morrow's procedure is septal myectomy done to relieve the left ventricular outflow tract (LVOT) obstruction and in turn decreases the gradient through LVOT. 

Q. Most common cause of pulmonary hypertension? A. Idiopathic pulmonary artery hypertension B. Left heart disease C. COPD D. CTEPH Answer: B. Left heart disease