Kardiologi

Loud 1st heart sound is heard in

A 52-year-old man with known heart failure and LVEF of 37% came to the outpatient clinic with shortness of breath. He is NYHA class III with no signs of fluid overload on examination. His BP is 110/60 mmHg, and his heart rate is 55 bpm. He is on bisoprolol 5 mg od and ramipril 10 mg od. His tests reveal Na 137 mmol/L, K 4.5 mmol/L, urea 7 mmol/L, and creatinine 85 μmol/L. Which medication will you giver next?

Papillary muscles are not found in which of the following valves?

Which modality best describes coronary anatomy?

A 36-year-old woman with an 8-month history of progressive exertional dyspnea came to outpatient clinic. Her HR was 74 bpm, regular, BP 120/80 mmHg, and no pedal edema. JVP and carotid upstroke were normal. Cardiac auscultation revealed normal S1, an accentuated P2 with narrow splitting of S2, an ejection click, and a 2/6 ejection systolic murmur. What is the likely diagnosis?

You review a 60-year-old man with NHYA class II heart failure in clinic. He has LVEF 35%, BP 110/50 mmHg, and heart rate 80 bpm (sinus rhythm). Current medications are bisoprolol 1.25 mg and ramipril 7.5mg. What medication alteration would you recommend?

A 62-year-old hypertensive man came to the ED with chest pain thet came very suddenly in the left chest whilst he was lifting a heavy plant pot. The pain is difficult to localize, the intensity has been constant and persistent. On the way to the hospital, the pain has changed location to the left side of the lower thoracic back. He recently had treatment for thoracic back pain from a chiropractor. He is perspiring, looks unwell, and anxious, but has no shortness of breath. Blood pressure is 160/90 mmHg, heart rate is 100 bpm and saturations are 99% on room air. The ECG does not show acute ST change. D-dimer is 1700 ng/mL (normal < 500 ng/mL), and troponin is awaited. Qhat is the most likely diagnosis?

Most common cause of right ventricular heart failure is?

Cardiac resynchronizing therapy can do all of the following except

Which one of the following beta blockers is the most cardioselective?

A 32-year-old smoker came to the ED with an hour of ongoing chest pain. The pain is described as left-sided and sharp but not focal. There is no postural change and no change with inspiration. He appears clinically well. The emergency team are concerned because he has anterior ST elevation and show you his ECG like the figure below. What do you recommend?

Beta blockers are contraindicated in all of the following conditions except

Which of the following is the most important risk factor of aortic aneurysm?

A 45-year-old woman presents with ongoing chest pain. Her is BP 140/80 mmHg, heart rate 90 bpm, and saturations 99% on room air. What should you do next?

The figure below was obtained during angiography of a patient who had redo coronary artery bypass grafting in 1987. He had 3 grafts and has a recurrence of angina. Interpret the figure below

A 51-year-old man came to the hospital with complaints of fatigue and cough. He had a chest X-ray as shown below. What does his chest X-ray show?

A 51-year-old man came to the hospital with complaints of fatigue and cough. He had a chest X-ray as shown below. The patient also then had an echocardiogram showing mild tricuspid regurgitation, velocity of 4.7 m/s, elevated right atrial pressure of 20 mmHg, and estimated pulmonary artery systolic pressure of 110 mmHg. What are these findings suggestive of?

Verapamil is the first choice for which SVT?

The ECG shown below is diagnostic of which of the following?

A 26-year-old patient came with palpitations and chest pain. His blood pressure is 80/60 mmHg. His ECG result is shown in the figure below. What should the initial management be?

A 27-year-old man came with sharp central chest pain and palpitations after drinking three cans of energy drink. The symptoms were ongoing when he initially attended the ED, and an ECG showed a sinus tachycardia with no ST change. The pain subsided shortly afterwards. He is normally fit and well. His father recently had a myocardial infarction at the age of 62. All observations and examination are normal. Troponin and D-dimer tests were negative. What would you recommend?

A 59-year-old Pakistani male presented to the ER with complaints of headache. He had a computed tomography (CT) scan of his head, which showed evidence of subdural hemorrhage. He also had a chest X-ray (figure shown below) in the ER. What does the X-ray show?

A 59-year-old man with long-standing hypertension came to the clinic. He complains of some breathlessness that does not limit his physical activity. He has no other comorbidities. A transthoracic echocardiogram demonstrates aortic root dilatation and severe aortic regurgitation. Which one of the following is not an indication for surgery?

Potassium sparing diuretics acts at

Which of the following inotropic agent increases SVR?

An echocardiogram of a 82-year-old woman showed both severe aortic stenosis and severe mitral regurgitation. The wrong statement regarding patients with combined or multiple valve lesions is:

The drug of choice for patients with paroxysmal SVT is

Which one of the following is not a contraindication to an ACE inhibitor?

Which of the following drug is indicated in asymptomatic LV dysfunction?

Which Calcium channel blocker below that maximally increases digoxin level?

Which of the following ECG finding that strongly suggests congestive cardiomyopathy?

In the evaluation of a patient with chest pain and right bundle branch (RBBB) on ECG, which of the following is true regarding exercise stress testing?

Burgada syndrome is charactherized by which of the following

A 55-year-old man with diabetes and prior myocardial infarction with a right coronary artery (RCA) stent presented with chest pain. His cardiac markers were normal and EF on echo was 45% with inferior wall hypokinesis. The results of a stress Sestamibi scan are shown below. What would you recommend?

A 52-year-old patient presents with breathlessness. He had hypertension for many years and has been non-compliant with his medication. His echocardiogram demonstrates an EF of 70%, with marked concentric hypertrophy. Which one of the following therapies is not appropriate?

A 63-year-old man with known pulmonary fibrosis was admitted with an infection. He is not responding to broad-spectrum antibiotic therapy. He is a lifelong smoker. ECG demonstrated 1st degree AV block with complete RBBB and a normal QRS axis. His CXR is of poor quality but could be consistent with fluid overload. Echocardiography demonstrates thinning of the septum and apex with overall moderate impairment of systolic function. Which one of the following investigations is least likely to help with the underlying diagnosis?

The vasodilator stress study shown in figure below is indicative of what?

A 74-year-old woman presents to your hospital with a VF arrest. She is successfully resuscitated and a subsequent ECG demonstrates a clear-cut anterior myocardial infarction with >2 mm St elevation in leads V2–V6. Coronary angiography demonstrates a suboccluded proximal LAD, with a small unobstructed circumflex artery and a 70% stenosis in the proximal RCA. She undergoes successful coronary intervention to her proximal LAD and has an uncomplicated recovery from her infarct. Her echocardiogram demonstrates akinesia of the apex, but an overall EF estimated at 35–40%. She is established on dual anti-platelet therapy, ramipril, bisoprolol, and a statin. What other therapy should she have?

The following ion that has the highest concentration in cardiac ventricle?

External cardiac massage is usually done in

Diuretics has one of the following properties

Which of the following below is not the properties of ACE inhibitors?

A 48 hours post anterior STEMi patient who was successfully treated with primary angioplasty came to your ward. He has type 2 DM and hypertension. He is gradually improving, having initially suffered with heart failure. He still feels chest pain and auscultation reveals minimal basal crepitations. Echocardiography revealed an ejection fraction of 40%. BP is 110/70 mmHg, HR 55 bpm at rest. Ramipril has been titrated to 2.5 mg bd with bisoprolol 2.5mg od. U&Es have remained normal. How would you improve his medical treatment?

A 59-year-old man with a bicuspid aortic valve and a history of benign prostatic hypertrophy presents with fever and lethargy. These symptoms have been present for 1 week. He had been with oral antibiotics for a urinary tract infection a week prior to admission. On examination, an ejection systolic murmur was audible on auscultation. Routine bloods and blood and urine cultures were taken. His urine culture has grown Escherichia coli. The admitting team suspects endocarditis. What is the next step of management?

Atrial fibrillation is usually seen in all of the following patients except

An asymptomatic 30-year-old man came for a routine medical check-up. His ECG result was shown in the figure below. What is the interpretation of this ECG?

The figure below showed which of the following rhythm?

One of your patients has small vessel coronary disease which is not suitable for revascularization. They are still experiencing class 2 angina particularly in the evening despite bisoprolol 0 mg od. Blood pressure is 35/90 mmHg. What would you recommend next?

A 35-year-old man came with acute heart failure. He has a 2-week history of progressive breathlessness. He has history of type II diabetes mellitus. Echocardiogram shows an EF of 25% with anterior, septal, and lateral wall motion defects. He is stabilized on medication with furosemide, spironolactone, bisoprolol, and ramipril. What would be your next course of investigation?

A 38-year-old iV drug abuser presents with a -week history of malaise, fatigue, and rigors. His temperature on admission was 38.5°C. examination revealed a pan-systolic murmur which was loudest at the left sternal edge. Three sets of blood cultures were taken. Transthoracic echocardiography (TTe) showed vegetation on the tricuspid valve with moderate TR. Which one of the following organisms is most likely to be positive in blood cultures?

A 25-year-old man presents to the ED with a broad complex tachycardia that is irregularly irregular. The patient is haemodynamically uncompromised. An anaesthetist is not available to assist with immediate DC cardioversion. What is the best initial treatment option?