Cardiology Multiple Choice Questions

Cardiology
by Medical Educator Cardiology

Cardiology is the branch of medicine that deals with the diagnosis and treatment of heart and cardiovascular diseases. It involves a range of medical and surgical procedures, from preventive measures such as lifestyle changes and medication, to invasive procedures such as angioplasty and heart surgery.

With the increasing incidence of heart disease worldwide, cardiology is a crucial area of healthcare that has a significant impact on the health and well-being of patients. Our cardiovascular examination MCQ is a comprehensive tool that will test your knowledge of cardiology and help you expand your understanding. Get ready to test yourself below.

Table of Contents

Atrial fibrillation

Which of the following is true in AF?

  • The JVP has a single waveform rather than a double waveform
  • It can be diagnosed without an ECG
  • It is strongly associated with hypercholesterolaemia
  • It carries no increased mortality compared to normal sinus rhythm
  • The JVP characteristically has giant V waves

The JVP has a single waveform rather than a double waveform

A superb question! The JVP normally has an “a” wave and a “v” wave. These are from atrial and ventricular contraction respectively. Hence in AF where the atrium is fibrillating you get no a wave.

Giant V waves occur in tricuspid regurgitation.

You need an ECG to diagnose AF because things like ectopics can cloud the matter (e.g. frequent atrial ectopics).

Post MI treatment

A patient makes a good recovery following emergency treatment. She is a non smoker. Her cholesterol is 3.1 (<5.5) with an HDL of 1.

Assuming she has no contraindications to any of the following which class of drugs should she take following her STEMI? (please select all that apply)

  • ACE inhibitor
  • Statin
  • Calcium Channel Blocker
  • Aspirin
  • Fibrate
  • Thiazide diuretic
  • Loop Diuretic
  • Spirinolactone
  • Clopidrogel
  • Beta Blocker
  • Nitrate

ACE inhibitor
Statin
Aspirin
Beta Blocker

4 key drugs. There is also now new evidence to support the use of Omega3 fatty acids.

Ca channel blocker: no good evidence.

Beta blocker: yes! Not for hypertension as a sole treatment based on the recent evidence from large antihypertension trial data.

Clopidrogel is given for varuing durations following non-ST elevation Myocardial infaction but not in non ST elevation MI (NSTEMI).

Statins should be given to all as secondary prevention as they have a protective effect that goes beyond that of simple lipid lowering.

NYHA Criteria

A 62 year old man is breathless following his heart attack. He is unable to climb a flight of 10 stairs without stopping. Which of the following is true?

  • He has NYHA (New York Heart Association) class I heart failure
  • He has NYHA class II heart failure
  • He has NYHA class III heart failure
  • He has NYHA class IV heart failure
  • NYHA class is not appropriate for use in patients who have sustained myocardial infarction.

He has NYHA class III heart failure.

NYHA Class I = significant exertion to make you breathless
NYHA Class II = SOB on moderate exertion
NYHA Class III =SOB on minimal exertion (e.g. one flight of stairs)
NYHA Class IV =SOB at rest

CLINICAL PEARL – this is critically important in clinical exams. You can’t comment on a patients functional status unless you’ve seen them exert themselves or they are SOB at rest.

Diastolic murmur

A patient has mixed aortic valve disease. How could you make the diastolic murmur in this case louder?

  • Roll the patient into the left lateral position
  • Lie the patient flat
  • Listen in expiration
  • Listen in inspiration
  • None of the above

Listen in expiration.

In mixed aortic valve disease the stenotic murmur will give a systloic noise (ESM) and the aortic regurgitation will produce a diastolic murmur. The murmur of AR is heard best with the patient sat forward listening at the left sternal edge in expiration.

Mitral regurgitation

Which of the following is not true of Mitral Regurgitation?

  • The S1 can be soft
  • The murmur is Pansystolic
  • There is no A wave in the JVP
  • The murmur may be due to functional dilation of the LV (e.g. in cardiomyopathy)
  • It is a common cause of atrial fibrillation

There is no A wave in the JVP.

In MR the atrial contraction will still cause an A wave, unless the patient is in AF. Remember also: displaced apex beat (from the 5th intercostal space mid clavicular line towards anterior axilliary line/6th/7th intercostal space).

Best treatment?

A patient has ongoing pain and has ECG changes that are considered “thrombolysable”. Based on the available evidence what is the best treatment for her?

  • Thrombolyse immediately
  • Emergency Angiography +/- +/- plasty/stent *
  • Either Thrombolysis or emergency angiography+/- plasty/ stent have almost identical outcomes
  • Emergency Coronary artery Bypass Graft
  • None of the above

Emergency Angiography +/- +/- plasty/stent.

In centres with available facilities emergency PCI (percutaneous coronary intervention) is the gold standard treatment of choice. It has a survival advantage over thrombolysis although this is only small it is significant.

Aortic stenosis

In aortic stenosis with regards to the second heart sound which of the following is true?

  • It does not “split”
  • There is splitting of the S2 P2 (pulmonary) and A2 (aortic)
  • There is reverse splitting of the S2

There is reverse splitting of the S2.

This is because normally the aortic valve shuts before the pulmonary valve. In severe AS, as the ventricle takes longer to empty, the valve takes longer to shut. Therefore there’s reversed or “paradoxical” splitting of S2.

Man with blackouts

A man presents with blackouts. His cardiac exam is as follows:

Pulse: Slow rising

First heart sound (s1): normal

Second Heart sound (s2) : normal

Murmur: Ejection systolic and early diastolic rumbling murmur

What is the most likely diagnosis?

  • Aortic Stenosis
  • Aortic Stenosis with Aortic Regurgitation
  • Aortic Stenosis with Mitral Regurgitation
  • Mitral stenosis with mitral regurgitation
  • Aortic Sclerosis

Aortic Stenosis with Aortic Regurgitation

The ESM suggests AS as does the slow rising pulse. BUT! Theres also an early diastolic murmur heard. This is probably AR making the diagnosis of Mixed aortic valve disease.

Which test?

A man presents to a cardiology clinic with atypical chest pain occurring at rest. His GP has arranged a series of extensive investigation which have shown the following. The history is atypical but there is a suggestion of a possibility of exercise induced chest pain.

ECG: Left bundle branch block

CXR: Normal heart size

Blood tests: Normal

Echo: Normal

The patient is keen to have futher investigations. Which would you suggest as the least expensive and invasive test to clarify if he has coronary artery disease that is causing him symptoms?

  • Coronary angiography
  • Cardiac MRI
  • Exercise tolerance test
  • Myocardial Perfusion scan
  • Right and left heart cardiac catherisation

Myocardial Perfusion scan.

A cardiac MRI will give details of the structure and function of the heart as will a left heart catheter. However it will not identify ischaemia.

An ETT would be helpful but he has LBBB. This means the associated ST depression that occurs with ischaemia will not be seen on the ECH and therefore an ETT would be essentially pointless, this leaves us with a MPS.

An MPS will give an idea of cardiac perfusion at both rest and during stress (e.g. induced by drugs at the time of the test). This gives a “dynamic” picture and can identify areas that are ischaemic during stress (hence reversible ischaemia)

This makes it “better” than an angiogram in this situation as its reversible ischemic areas that cause angina. The presence of mild disease at angiogram does not mean that this disease is causing his symptoms.

Atrial fibrillation

A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him “dying ” as a result of the AF.

PMHx:
Hypertension (treated), Mild COPD. Nil else of note.

DHx
Verapamil (as treatment for AF)
Amlodipine
Simvastatin
PRN inhalers

SHx
Lives alone. Independent. Can carry out all ADL’s (activities of daily living)

What is the anticoagulation schedule you would recommend to prevent stroke?

a. Clopidrogel
b. Warfarin
c. Aspirin
d. No anticoagulation
e. Warfarin and Aspirin
 
 
 
 

The answer is….. b. Warfarin

Based on NICE Guidance 36 (AF) and the CHADS 2 scoring system.

The CHADS2 score is an excellent aide memoir to anticoagulation in AF. It is based on:

CHADS2 Stands for Score
C Congestive heart failure 1point
H hypertension 1point
A Age>75 1point
D Diabetes Mellitus 1point
S2 Previous stroke/ TIA 2 points

SCORE

  • 2 or over=Warfarin
  • 1= Warfarin or aspirin
  • 0=aspirin

This means our chap here will score:

  • 1 for being >75
  • 1 for being hypertensive

This means he should be treated with warfarin (assuming he has no contraindications)

A link to the original publication citation in circulation is available here. (link will open in a new window)