Cardiology

Topics in this chapter

• Ischemic Heart Disease
• Valvular and Rheumatic Disease
• Cardiomyopathies and Amyloidosis
• Heart Failure and Complications
• Arrhythmias and Pacemaker Management
• Congenital Heart Disease
• Cardiovascular Pharmacotherapy

Practice questions

1. Question 1Q-8FDF24

   A 55-year-old male with a history of anterior ST-elevation myocardial infarction 2 years ago presents with progressively worsening dyspnea on exertion and lower extremity edema. Echocardiography reveals a large left ventricular apical aneurysm with a mural thrombus and an ejection fraction of 30%. Which of the following is the most definitive long-term complication associated specifically with this structural cardiac lesion?

   1. A.Ventricular free wall rupture
   2. B.Refractory ventricular arrhythmias and systemic thromboembolism
   3. C.Acute severe mitral regurgitation due to papillary muscle rupture
   4. D.Paradoxical pulse and constrictive physiology
   See the answer and solution
2. Question 2Q-CCE911

   A 68-year-old man presents with syncopal episodes. On examination, he has a delayed and weak carotid upstroke (pulsus parvus et tardus) and a harsh systolic ejection murmur heard best at the right second intercostal space radiating to the carotids. Which of the following echocardiographic findings defines severe high-gradient aortic stenosis?

   1. A.Aortic valve area > 1.5 cm2, mean gradient < 20 mmHg
   2. B.Aortic valve area < 1.0 cm2, mean gradient >= 40 mmHg, peak velocity >= 4.0 m/s
   3. C.Aortic valve area 1.0 - 1.5 cm2, mean gradient 20-39 mmHg
   4. D.Aortic valve area < 1.0 cm2, mean gradient < 40 mmHg with reduced ejection fraction
   See the answer and solution
3. Question 3Q-919DFA

   A 45-year-old female presents with fatigue, dyspnea on exertion, and palpitations. Physical examination reveals an irregular pulse, a loud first heart sound, an opening snap followed by a low-pitched rumbling middiastolic murmur with pre-systolic accentuation at the apex. Which of the following is the most common cause of this condition?

   1. A.Degenerative calcification
   2. B.Rheumatic heart disease
   3. C.Infective endocarditis
   4. D.Congenital bicuspid valve
   See the answer and solution
4. Question 4Q-6BC730

   A 28-year-old competitive athlete collapses during a soccer match and is brought to the emergency department, where he is declared dead. Post-mortem examination reveals disproportionate thickening of the interventricular septum compared to the left ventricular free wall, with myocyte disarray on histology. Which inheritance pattern and genetic locus category are most typically associated with this condition?

   1. A.Autosomal recessive; mitochondrial DNA mutations
   2. B.Autosomal dominant; mutations in genes encoding sarcomeric proteins
   3. C.X-linked dominant; dystrophin gene mutations
   4. D.Autosomal dominant; genes encoding low-density lipoprotein receptors
   See the answer and solution
5. Question 5Q-281708

   A 60-year-old male with chronic heart failure with reduced ejection fraction (HFrEF) is currently on maximally tolerated doses of an ACE inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist. Despite this therapy, he remains symptomatic with NYHA class III symptoms, a heart rate of 74 bpm, and a normal sinus rhythm. Which of the following agents should be added next to target his heart rate and reduce heart failure hospitalization?

   1. A.Ivabradine
   2. B.Digoxin
   3. C.Amlodipine
   4. D.Hydralazine and isosorbide dinitrate
   See the answer and solution