Cardiology Simple Revision, DR. Jane Nader

simple revision for medical students

1. Clinical Scenarios
Revision for
Medical Students
Jane Nader, MD, BUC

2. Vignette 1: Acute Pericarditis
John, a 35-year-old male, presents with sharp chest pain
improving upon sitting up. Recent viral infection noted.
Examination reveals a pericardial friction rub.
Q. Diagnosis?

3. Vignette 1: Acute Pericarditis
Q. Characteristic ECG finding in acute pericarditis?
A) ST-segment elevation
B) Pathologic Q waves
C) Deep T wave inversions
D) Prolonged QT interval
Answer: A) ST-segment elevation in all leadsexcept aVR

4. Vignette 2: Pericardial Effusion
Sara, 42, with SLE, presents with fatigue, dyspnea, and palpitations.
Examination shows muffled heart sounds and jugular venous
distension. Echocardiogram reveals large pericardial effusion.
Q. Best diagnostic tool for pericardial effusion?
A) Chest X-ray
B) ECG
C) Echocardiogram
D) MRI
Answer: C) Echocardiogram

5. Vignette 3: Cardiac Tamponade
Alex, 50y, post-vehicle accident, shows hypotension,
tachycardia, and distended neck veins. Fast ultrasound
indicates fluid around the heart, suggesting cardiac
tamponade.
Q. Identify the diagnostic triad of cardiac tamponade.
Q. What is a characteristic ECG finding?

6. Vignette 3: Cardiac Tamponade
Q. Immediate management for cardiac tamponade?
A) IV fluids
B) Urgent pericardiocentesis
C) High-dose corticosteroids
D) Observation
Answer: B) Urgent pericardiocentesis

8. Vignette 1: Peripartum Cardiomyopathy
Jessica, 32, presents postpartum with fatigue, breathlessness, and leg
swelling. Echocardiogram shows reduced ejection fraction and
ventricular dilatation.
Q. Jessica's diagnostic criteria for peripartum cardiomyopathy?
•Timing: Heart failure developing towards the end of pregnancy and up to 5
months postpartum.
•Absence of an Identifiable Cause
•Left Ventricular Dysfunction: If left ventricular ejection fraction (LVEF) less than
45%.
•Symptoms of Heart Failure
•No Pre-existing Heart Disease

9. Vignette 2: Takotsubo Cardiomyopathy
Karen, 60, experiences chest pain and breathlessness after
severe emotional stress. Angiography shows no coronary
disease, but echocardiogram reveals apical ballooning.
Q. What is your diagnosis?

10. Vignette 3: Atrial Myxoma
David, 45, reports weight loss, fever, and palpitations. Examination
reveals a mid-diastolic murmur. Transesophageal echocardiography
shows a left atrial mass.
1. Clinical manifestations of atrial myxoma in David?
2. Typical diagnosis method for atrial myxoma?

11. Vignette 3: Atrial Myxoma
David, 45, reports weight loss, fever, and palpitations. Examination
reveals a mid-diastolic murmur. Transesophageal echocardiography
shows a left atrial mass.
Q.Definitive treatment for atrial myxoma?
A) Antibiotics
B) Anticoagulation
C) Surgical resection
D) Chemotherapy
Answer: C) Surgical resection

12. Scenarios

13. AF Vignette 1: Newly Diagnosed
AF
Anna, 70, with hypertension, presents with palpitations. ECG confirms
AF with rapid response.
1. Key ECG findings in AF?
2. Management: rate control or rhythm control?

14. AF Vignette 1: Newly Diagnosed
AF
Anna, 70, with hypertension, presents with palpitations. ECG confirms
AF with rapid response.
First-line medication for rate control in AF?
A) Amiodarone
B) Digoxin
C) Sotalol
D) Metoprolol

15. AF Vignette 1: Newly Diagnosed
AF
If atrial fibrillation episodes lasted for more than one week, but less than one year, without
spontaneously returning to normal sinus rhythm, how would his condition be classified?
A) paroxysmal atrial fibrillation.
B) persistent atrial fibrillation.
C) long-standing persistent atrial fibrillation.
D) permanent atrial fibrillation.
Answer: B) persistent atrial fibrillation.

16. AF Vignette 2: AF with Embolic Stroke
Bob, 65, with chronic AF, presents with right-sided weakness. CT head
shows ischemic stroke.
1. Relationship between AF and stroke?
2. What should you do?

17. AF Vignette 2: AF with Embolic Stroke
Preferred anticoagulant?
A) Warfarin
B) Dabigatran
C) Aspirin
D) Clopidogrel
Answer: B) Dabigatran

18. CHB Vignette 1:
Acute CHB in
Myocardial
Infarction
Daniel, 68, with coronary
disease, presents with chest
pain, dizziness. ECG shows
third-degree AV block.
Q. ECG characteristics of
third-degree AV block?

19. CHB Vignette 1: Acute CHB in Myocardial
Infarction
Q. Initial management of CHB with instability?
A) Atropine
B) PCI
C) Temporary pacing
D) Beta-blockers
Answer: C) Temporary pacing

20. CHB Vignette 2: Detected in Check-up
Ella, 75, asymptomatic, found to have third-degree AV block during
check-up.
Q. Which of the following would be the most appropriate initial step in
her management?
A) Immediate cardioversion
B) Insertion of a temporary pacemaker
C) Observation with regular monitoring of vital signs
D) Start beta-blocker therapy
Answer: C) Observation with regular monitoring of vital signs

21. Q. which of the following diagnostic tests is most crucial to
determine the next steps in her management?
A) 24-hour Holter monitoring
B) Full lipid profile
C) Tilt-table testing
D) Exercise stress test
Answer: A) 24-hour Holter monitoring
CHB Vignette 2: Detected in Check-up

22. Q. If Ella develops symptoms associated with her third-
degree AV block, which of the following is the most
appropriate definitive treatment?
A) Pharmacological management with atropine
B) Implantation of a permanent pacemaker
C) Administration of intravenous fluids
D) Immediate thrombolytic therapy
Answer: B) Implantation of a permanent pacemaker
CHB Vignette 2: Detected in Check-up

23. SVT Vignette: Acute
Presentation
George, 22, presents with palpitations, heart rate of 180
bpm. ECG shows…...?
Q. Characteristic ECG findings?

24. SVT Vignette: Acute
Presentation
George, 22, presents with palpitations, heart rate of 180 bpm. ECG
showsWPW?
MCQ: First-line treatment?
A) Adenosine
B) Amiodarone
C) Diltiazem
D) Flecainide
Answer: D) Flecainide

26. Vignette 1: Dilated Cardiomyopathy (DCM)
Emma, 58, presents with breathlessness, fatigue, and
edema. Echocardiogram shows enlarged left ventricle with
reduced ejection fraction.
1. What is your diagnosis?
2. Common causes?

27. Vignette 2: Hypertrophic Cardiomyopathy (HCM)
Michael, a 20-year-old athlete, faints during training. Family
history of sudden cardiac death. Examination shows a
systolic murmur, and echocardiogram reveals asymmetric
septal hypertrophy.
Q. What is your diagnosis?

28. Vignette 2: Hypertrophic Cardiomyopathy (HCM)
Q. Which of the following is the most appropriate initial treatment to
manage Michael's condition?
A) High-intensity interval training to improve cardiovascular fitness
B) Beta-blockers to reduce heart rate and outflow tract obstruction
C) Immediate surgical intervention with septal myectomy
D) Angiotensin-converting enzyme (ACE) inhibitors to reduce afterload
Answer: B) Beta-blockers to reduce heart rate and outflow tract
obstruction

29. Vignette 2: Hypertrophic Cardiomyopathy (HCM)
Q. Which of the following is NOT a recognized risk factor for sudden
cardiac death in HCM?
A) Family history of sudden cardiac death
B) Syncope
C) Non-sustained ventricular tachycardia on Holter monitoring
D) Presence of a small pericardial effusion
Answer: D) Presence of a small pericardial effusion

30. Vignette 3: Restrictive Cardiomyopathy (RCM)
Linda, 65, has dyspnea, fatigue, and palpitations.
Echocardiogram shows normal ventricle size but abnormal
diastolic function. Biopsy confirms amyloidosis.
Q. Diagnosis??

31. Vignette 3: Restrictive Cardiomyopathy (RCM)
Q. Characteristic feature of RCM?
A) Dilated ventricles
B) Asymmetric septal hypertrophy
C) Abnormal diastolic function
D) Apical ballooning
Answer: C) Abnormal diastolic function