C.  Origin of the right coronary artery from the pulmonary artery. Either of these options is acceptable. The risk of death with asymptomatic aortic stenosis is quite low, and aortic valve replacement is not indicated for asymptomatic patients with a transvalvar gradient less than 50 mm. In the human heart there are few natural collaterals of sufficient diameter for delivery of a significant quantity of blood. The mortality rate for cardiogenic shock after acute MI is increased more than 10 fold in comparison to no shock, b. The tricuspid valve is usually insufficient. Email your MCQs/Message/Topic request to Medicine MCQs. In the Taussig-Bing type of double-outlet right ventricle, the VSD is usually noncommitted. In the classification of Collett and Edwards, Type I truncus arteriosus has a single arterial trunk giving rise to an aorta and a main pulmonary artery; in Type II the right pulmonary arteries arise immediately adjacent to one another from the dorsal wall of the truncus; in Type III the right and left pulmonary arteries originate from either side of the truncus; and in Type IV the proximal pulmonary arteries are absent and pulmonary blood flow is by way of major aortopulmonary atresia and is no longer considered truncus arteriosus. Similarly, patients with more extensive coronary artery disease are better treated with CABG than with PTCA. For palliative increase in pulmonary blood flow, the Blalock-Taussig shunt is utilized connecting the subclavian artery to the pulmonary artery. Maximal coronary artery perfusion occurs in this part of the cardiac cycle. A. C.  Complete heart block is a common complication. This ECG shows: Wellens sign; Pardee sign; Brugada sign; aVR sign; Post your answer as a comment below. E.  The level of hypoxemia at presentation. Decreased pulmonary vascular resistance may increase pulmonary blood flow at the expense of systemic blood flow and alter the loading conditions of the left ventricle, which may complicate early arterial repair. 11 focused sequences of questions are followed by detailed explanatory answers, which draw in the relevant aspects of the current syllabus, refer you to further reading and provide you … Strokes have been reported from emboli being thrown retrograde from the balloon; however, this is very rare. High-dose aspirin  therapy contributes to the resolution of the acute manifestations of Kawasaki's disease. A systolic ejection click would signify that the stenosis is supravalvar, b. It offers a 50% improvement in mortality with 95% freedom from SCD at 5 years after implantation. Of the drugs available, recombinant tPA produces better results than SK or APSAC although it is more expensive, c. Thrombolytic therapy requires catheterization for intracoronary administration, d. Addition of heparin and antiplatelet drugs produces no incremental benefit. C.  Tricuspid valve replacement is generally an indication for using a tissue valve. The balloon pump does not directly decrease the left ventricular end-diastolic pressure. This creates transposition of the great arteries with an intact interventricular septum. Prof. Dr. Johnson Francis | February 25, 2019 | Cardiology MCQ, DM / DNB Cardiology Entrance, ECG / Electrophysiology, ECG Library | 1 Comment. C.  Survival of patients after hospital discharge following coronary reoperation is nearly equivalent to survival after primary CABG. Although complete heart block and pleural effusions can occur after any cardiac operation, they rarely occur after TAPVC repair. A. The most common conduction block that occurs in patients with dual AV node physiology is a proximal antegrade conduction block in the fast pathway because of its longer refractory period. A.  Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood. DISCUSSION: Clinical manifestations of congenital origin of the right coronary artery from the pulmonary artery are usually minimal or absent. B. D.  Hospital mortality after repair of VSD in infants approaches 20%. C.  The risk of sternal wound complications is greatly increased if the contralateral IMA is harvested at the time of reoperation. The development of angina or syncope reflects inadequate cardiac output and signifies late-stage disease. DISCUSSION: PDA causes a left-to-right shunt that produces left ventricular volume overload. D.  Standard chest massage generally provides less than 15% of normal coronary and cerebral blood flow. This can be done percutaneously with balloon dilatation or surgically with direct visualization of the aortic valve and incision of the fused commissures. The other four anomalies listed were all mentioned by Fallot in his original description of this defect. C.  In the United States doubly committed or juxta-arterial VSDs are most commonly associated with aortic insufficiency. C.  Anomalous origin of right subclavian artery from the descending aorta. Tachypnea, poor feeding, growth failure, recurrent respiratory infections, exercise intolerance, and severe cardiac failure may develop in patients with large VSDs. Pacemaker induction of atrial fibrillation. Neither poor ventricular function nor pending transplantation are contraindications to AICD implantation. Thrombolytic drugs were initially given intracoronary but can be used effectively when given systemically IV. ... cardiology mcqs here are mcqs from c.v.s Cardiovascular SECTION A: Read each question carefully and record the answer "TRUE" or "FALSE": The pain of myocardial ischemla: a) Is typically Induced by exercise and relieved by rest. a. Cardiac catheterization is indicated if the chest film shows cardiomegaly, b. Radiology report of “scimitar syndrome” findings on the chest film would indicate need for an arteriogram, c. If the catheterization report is “ostium secondum defect,” at least one pulmonary vein drains anomalously, d. Measured pulmonary vascular resistance of 14 Woods units/m2 with an ASD mandates early repair, e. An ASD with Qp/Qs of 1.8 can be observed until symptoms occur. E.  Intravenous digitalis with diuresis using furosemide as needed. symptoms prior to pregnancy. Patient's sensation of irregular heart rhythm. Dear Readers, Welcome to Cardiology Objective Questions and Answers have been designed specially to get you acquainted with the nature of questions you may encounter during your Job interview for the subject of Cardiology Multiple choice Questions. C.  It can be managed medically until the child is large enough to undergo aortic valve replacement. A. Indomethacin can cause ductus closure by cyclooxygenase inhibition which decreases endogenous prostaglandins. Anomalous coronary arteries or a retroesophageal subclavian artery are found in as many as 5% to 10% of patients. it occurs at rest. D.  Improves mortality and morbidity of subsequent Fontan procedure. If the findings at catheterization show limited disease treatable by PTCA, then it should be performed. Pulmonary hypertension is distinctly unusual with tetralogy of Fallot unless the patient has had excessive pulmonary blood flow from collaterals or systemic-to-pulmonary artery shunts for a long time. B. Finally, neonates that present with Ebstein's anomaly are markedly cyanotic, owing to their high pulmonary vascular resistance. B. The risk of damaging an intact IMA graft is 3% to 5%. DISCUSSION: Obstruction to pulmonary venous return is the most important factor affecting circulatory function when pulmonary venous anomalies exist. If the infarct was posterior, this is most likely due to a ventricular septal defect, c. Pulmonary wedge pressure tracing of prominent V waves without an O2 step-up suggests papillary muscle rupture, d. Operative repair of a post MI VSD should be delayed to allow strengthening of the myocardium to hold sutures. An ejection click is a specific physical sign of subaortic stenosis. DISCUSSION: The indications for surgical treatment of Kawasaki's disease include: (1) progressively stenotic coronary lesions demonstrated on coronary arteriography, with no distal coronary aneurysms with stenosis; (2) localized aneurysm with significant stenosis in the left main coronary artery; (3) significant stenosis in two coronary arteries; (4) presence of collateral vessels arising from a coronary artery with a proximal aneurysm; (5) progressive stenosis in the left anterior descending coronary artery; and (6) presence of a left ventricular aneurysm. 15% of sufferers have coronary artery disease. The diagnosis is confirmed by echocardiography and cardiac catheterization. Patients whose right coronary artery originates from the pulmonary artery are usually asymptomatic. Owing to an autoimmune phenomenon, left atrial myxomas can present with systemic constitutional symptoms of fever, malaise, weight loss, polymyositis, and blood dyscrasias that mimic collagen vascular disease. C.  Routine intubation and mechanical ventilation to achieve a PCO 2 between 30 and 35 mm. When the intrinsic ventricular rate falls below the escape rate of the pulse generator, the pacemaker begins to function at its programmed rate. A large VSD is approximately the size of the pulmonary valve orifice or larger. The roller pump produces nonpulsatile flow, which is different from the usual pulsatile cardiac flow. General Medicine MCQs. Calcium has no clear role in treating asystole. DISCUSSION: When the VSD is subaortic or doubly committed, the tunnel-type repair connects the left ventricle via the VSD and tunnel to the aorta. B. The goal of the EP study is either sustained or non-sustained ventricular tachycardia, b. The multiple suture lines in the atrium have been associated with a high incidence of late atrial arrhythmias and a low incidence of sinus rhythm following the Mustard and Senning operations. Myxoma is the most common benign tumor, but it can recur and the adjacent atrial septum should be resected with it. Placement of an IMA graft at the time of the first operation was critically important, neutralizing the adverse effects of elevated serum cholesterol, hypertension, and smoking on reoperation-free survival. Right ventricular outflow tract and supravalvar pulmonic stenosis, however, have been reported in patients after the arterial switch repair, owing to the reconstruction of the right ventricular outflow tract in that operation. An inducible ventricular tachyarrhythmia carries a poor prognosis with < 50% five year survival from SCD unless it can be abolished. Thrombolytic therapy should be considered immediately since the benefit is greater the earlier it is given, b. Typically, premature ventricular contractions may be conducted retrogradely through the AV conduction system and cause retrograde activation of the atrium. B.  Mitral valve replacement with either a bioprosthesis or a mechanical valve requires warfarin anticoagulation. Hypertension in coarctation is multifactorial, but the most important factors are diminished renal flow (single clip, single kidney-Goldblatt model) and mechanical factors. Discrete subaortic stenosis is approached surgically with cardiopulmonary bypass, aortic cross-clamping, and cardioplegic arrest. DISCUSSION: Decreasing pacemaker electrode tip size results in lower pacing thresholds, both at the time of implant and subsequently, because of higher current density. Transseptal puncture should not be used for diagnosis because of the risk of embolism. Typical angina is relieved promptly by rest or relaxation. C.  Most infants present with congestive heart failure. The first rule in treatment is to slow the ventricular response and attempt to limit hemodynamic instability. Prostaglandin infusion would keep the ductus open. The presence of an ejection click is more consistent with isolated valvular aortic stenosis. In Japan, however, the reverse is true: two thirds have doubly committed or juxta-arterial lesions and one third have perimembranous lesions. She is on rate control with bisoprolol, and is currently asymptomatic with a heart rate of 76bpm. The oxygen saturation of the blood in the coronary sinus is usually about 30% to 35% and varies with the magnitude of cardiac disease. Systemic venous hypertension is often present, but pulmonary hypertension almost never occurs with this malformation. When mitral stenosis exists with a secundum ASD the condition is often referred to as Lutembacher's syndrome. Other less common causes of complete heart block include ischemic heart disease, cardiomyopathic processes, Chagas' disease, and traumatic injury. A. The most likely configuration of the truncal valve is bicuspid, c. Location of the pulmonary arteries minimizes the risk of pulmonary vascular obstructive disease (Eisenmengers), d. Repair of the lesion requires an extracardiac conduit, e. Optimal timing of operative repair is at 6–12 months. Collateral circulation, when present, often prevents transmural necrosis following arterial occlusion. The goal of aspirin therapy is amelioration of symptoms and prevention of the thrombotic and embolic complications of Kawasaki's disease. By decreasing pain and anxiety, morphine IV has a significant therapeutic effect in decreasing myocardial oxygen demand. Initial efforts to improve cardiac output should include correction of poor oxygenation or acidosis and optimization of rhythm, preload and afterload before an inotropic agent is used. Although progression of pulmonary arterial obstruction has rarely been reported following early repair with the atrial or the arterial switch procedure, it is an unusual complication if operation is undertaken in infancy. In contrast to primary CABG, where the majority of deaths are a result of failure of other organ systems, 75% to 85% of deaths after reoperative CABG are due to cardiac causes. In the diffuse form of the disease the thickening of the aortic wall commonly results in significant luminal narrowing of the ascending aorta and its major branches. Primary cardiac tumors commonly arise in the left atrium and can present with dyspnea, syncope, congestive failure and systemic embolism. The VSD may be directed to either or both great vessels (doubly committed) or remote from them (noncommitted). Although many clinical aspects of Kawasaki's disease suggest an infectious agent, the search for a single agent has been unsuccessful; neither antibacterials nor antivirals have a role in the therapy of Kawasaki's disease. C.  Posterobasal aneurysms are more common than those located in the anteroapical region. These arrhythmias are notoriously refractory to medical therapy and they occur almost exclusively on a re-entrant basis. Topics by categories. Quickly memorize the terms, phrases and much more. Additional morphologic characteristics peculiar to this entity have been described. Class 2 b-blocking drugs inhibit both the sympathetic nervous system and circulating catecholamines. In the absence of cardiomegaly, cardiac catheterization to measure the pressure gradient is necessary, c. Development of syncope would suggest an intracranial lesion, d. In valvar aortic stenosis a pressure gradient of 80 mmHg is an indication for operative repair regardless of symptoms, e. In membranous subvalvar aortic stenosis a pressure gradient of 40 mmHg is an indication for operative repair. D.  Transfer of the pulmonary valve to the aortic position. D.  Two-dimensional echocardiography with continuous-wave and color-flow Doppler echocardiography. of 1:10,000. MOSBY CARDIOVASCULAR PHYSIOLOGY 10TH EDITION PDF FREE DOWNLOAD: LANGE CARDIOVASCULAR PHYSIOLOGY 9TH EDITION PDF FREE DOWNLOAD:2021. DISCUSSION: Following improvements in myocardial protection and coronary grafting techniques, perioperative myocardial infarction now occurs in less that 2% to 4% of patients in most series. The pathophysiology of WPW is a single bundle of Kent, b. Survival rate for both of these complications is improved by early rather than late repair. Coarctation produces obstruction to aortic flow, and thus the femoral pulse has a diminished volume with delayed upstroke. But if multivessel disease or unfavorable anatomy is found, operative bypass should be carried out early since results are best within 30 days of the MI. 1 2 3 … 5 Older. DISCUSSION: Secundum ASDs can frequently be closed primarily, although the use of a prosthetic or pericardial patch is indicated for large defects. Recent studies suggest that emergency coronary bypass can be used within 18 hours of shock to reduce the mortality rate to 7%. Following cardiac surgery heparinization is usually delayed for 12 to 24 hours. C.  Presence of left main coronary disease. Anatomically, the pulmonic valve is the most anterior of the cardiac valves. Captopril is a safe agent that does not appear to interfere with the normal cardiovascular response to anesthesia, and abrupt withdrawal of this agent may result in severe hypertension and should be avoided. While in earlier years younger age was an incremental risk factor for hospital death in some surgical experiences, this risk has been neutralized during the past decade. C.  The subaortic membrane is approached surgically via the aorta and aortic valve. Your email address will not be published. Origin of the left coronary artery from the pulmonary artery. A more frequent occurrence is distal embolization with limb ischemia. Increases peripheral oxygen saturations to greater than 90%. If the arrhythmia is inducible at EP study, there is an indication for operative intervention. Since the right ventricle is usually a more compliant—and therefore more distensible—chamber than the left ventricle, flow across an ASD occurs from left to right across the open tricuspid valve during diastole. C.  Adjuvant chemotherapy and irradiation are efficacious in prolonging survival. Advanced age is a relative indication for biologic valves to avoid complications of anticoagulation and because the probability of reoperation is low. Hg. The apical murmur is due to the Gallavardin phenomenon, d. Abdominal exam will show a pulsatile liver. Although wall tension does increase with increased volume, Starling properties are called forth for added efficiency. Noninvasive Cardiac Imaging: Echocardiography, Nuclear Cardiology, and MRI/CT Imaging Harrison 18th edition, Chapter-230, Diagnostic Cardiac Catheterization and Coronary Angiography: Introduction 3. C.  Left ventricular end-diastolic pressure of 18 mm. B. D.  Mitral valve replacement requires resection of the mitral valve leaflets and chordae. A. Serum complement is activated by exposure of blood to the nonphysiologic surfaces of the pump-oxygenator, and systemic vascular resistance falls. Increasing cyanosis and cyanotic spells are the most common indication for operative repair. To be classified as a ventricle, the chamber must receive at least half of an inlet valve, c. This infant is a good candidate for a Blalock-Taussig shunt, d. Optimal correction of UVH diverts all vena caval blood flow into the pulmonary arteries (Fontan procedure), e. In the absence of pulmonic stenosis, UVH usually presents as congestive heart failure. DISCUSSION: After the first-stage reconstructive (Norwood) procedure, the circulation is inherently inefficient because of the obligatory recirculation of a portion of both saturated and desaturated blood. C.  The redundant anterior leaflet of the tricuspid valve may cause obstruction of the right ventricular outflow tract. B. All Free Medical Books; Cardiology; Cardiovascular; Oxford Handbooks; MCQs … The increased risk of reoperation results from more advanced native vessel disease, a longer cross-clamp time, a longer cross-clamp time per graft, a longer time to initiate cardiopulmonary bypass, and increased blood loss. Mural thrombi and thromboembolism are directly related to the presence of atrial fibrillation. Therefore, symptomatic aortic stenosis is an indication for aortic valve replacement. This is a rare event since less than 5% of patients with coronary artery disease (CAD) are asymptomatic with exercise, b. DISCUSSION: The mortality and morbidity after reoperative CABG are approximately two to three times that of primary CABG. With this operation the patient's own pulmonary valve is transferred to the aortic position and a pulmonary allograft is inserted to replace the pulmonary valve. It is because these patients usually do not have pulmonary hypertension that infant correction with transannular patches can be performed with such great success. Finding aortic stenosis in addition to the VSD would be highly unlikely, c. The cath data indicate a restrictive type of VSD, d. If pulmonary vascular resistance falls with tolazoline administration, it is safe to close the VSD, e. Operative closure of VSDs is possible without ventriculotomy. Such a patient could progress to heart failure from ischemic cardiomyopathy, c. Typical angina pectoris is promptly relieved by rest or relaxation, d. Dyspnea on exertion can represent an angina equivalent. A. A. The goal of initial therapy of Kawasaki's disease is the reduction of inflammation, including coronary and myocardial inflammation. Myocarditis may cause a systolic murmur on auscultation because of cardiac dilatation. Contraindications to arterial switch repair include fixed types of left ventricular outflow tract obstruction, including valvar pulmonic stenosis, which would render the systemic semilunar valve stenotic or incompetent. This murmur may closely resemble that of PDA. A moderate- or large-sized PDA is associated with VSD in approximately 6% of patients of all ages; however, in infants with VSD and concomitant congestive heart failure, PDA is present in approximately 25%. The initial-transit study can be performed with any radioactive substance, but the gated equilibrium technique requires a radiopharmaceutical that remains within the blood pool for imaging. DISCUSSION: Age younger than 30 years is a relative indication for mechanical valves because of an increased incidence of calcification of tissue valves in younger persons. Similarly, hoarseness is most common after mitral valve disease with left atrial enlargement and is rarely due to tricuspid valve disease alone. Anewsysto-lic murmur is detected. B. Aspirin does not decrease the risk of the development of coronary aneurysms. General Medicine MCQs: (Best For Undergraduates) Each Block Contains 40 MCQs. Congenital aneurysms of the coronary arteries are most often asymptomatic until complications occur, usually later in life. Aggressive use of inotropic support with epinephrine. B.  Banding of the pulmonary artery in an acyanotic patient with tetralogy of Fallot to control pulmonary blood flow and prevent the development of pulmonary hypertension. Lidocaine has little use in controlling atrial dysrhythmias but is very effective in decreasing ventricular ectopy. Ischemic heart disease is the most common cause of sudden death. Complete repair always requires closure of the VSD, detachment of the pulmonary arteries from the common trunk, and re-establishment of an outflow tract from the right ventricle to the pulmonary artery. E.  Currently, mechanical prostheses are recommended for tricuspid valve replacement because the durability of bioprosthetic valves in the tricuspid position is so poor. Maintenance of ductal patency with prostaglandins (PGE 1) to provide pulmonary blood flow while the baby is transferred to an institution equipped to provide more definitive therapy. DISCUSSION: Patients who have an intact IMA graft should have severe anginal symptoms and a significant portion of myocardium at risk before reoperative coronary bypass grafting is considered. B. e. Monomorphic ventricular tachycardia is least amenable to surgical resection. Patients should be heparinized while the balloon catheter is in place. DISCUSSION: Treatment of congestive heart failure using epinephrine alone is contraindicated owing to the profound vasoconstrictive properties of epinephrine, which only exacerbate the heart failure. Distorted and stenosed central pulmonary arteries or aortic arch obstructions should be repaired at the same time the bidirectional Glenn procedure is performed. Banding of the pulmonary artery is never a consideration in patients with tetralogy of Fallot, since the predominant physiologic effect of the defect results from too little pulmonary blood flow to begin with. The ideal lesion for PTCA is focal symmetric stenosis in an epicardial vessel. Thrombolytic therapy for acute MI is of significant value in reducing mortality with benefit related to early administration. DISCUSSION: The most commonly used methods for coarctation repair are resection with anastomosis and subclavian flap aortoplasty. DISCUSSION: Eighty per cent of primary cardiac tumors are benign, and half of these benign tumors are myxomas. Patients with small VSDs do have normal right ventricular and pulmonary arterial pressures. B.  Mortality most often stems from cardiac causes after reoperation. Heparin should then be withheld approximately 4 to 6 hours before the surgical procedure. Hemodynamic compromise because of loss of AV synchrony.
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