Medicine
Cardiology
A 58-year-old man with stable ischemic heart disease has LDL cholesterol well above target despite maximal tolerated high-intensity statin. What is the usual next lipid-lowering step?
A. Stop statin and use niacin alone
B. Add ezetimibe
C. Add digoxin
D. Add hydrochlorothiazide
Correct Answer: B
Ezetimibe is commonly added when LDL remains above goal despite maximally tolerated statin therapy, with PCSK9-directed therapy considered thereafter in appropriate high-risk patients.
Medicine
Cardiology
Which feature favors constrictive pericarditis over cardiac tamponade?
A. Kussmaul sign
B. Pulsus paradoxus
C. Electrical alternans
D. Marked respiratory variation in mitral inflow only
Correct Answer: A
A rise or failure of JVP to fall with inspiration, Kussmaul sign, is characteristic of constrictive physiology and is usually absent in classic tamponade.
Medicine
Cardiology
A patient with acute decompensated heart failure has severe dyspnea, bilateral crackles and peripheral edema but preserved blood pressure. Which initial therapy most directly treats congestion?
A. IV loop diuretic
B. Large IV saline bolus
C. Verapamil
D. Thrombolysis
Correct Answer: A
Intravenous loop diuretics are used to rapidly relieve volume overload and congestion in acute decompensated heart failure.
Medicine
Cardiology
A 60-year-old smoker has calf pain after walking 100 meters that resolves with rest. What bedside test is most useful to support the diagnosis of peripheral arterial disease?
A. Allen test
B. Ankle-brachial index
C. D-dimer
D. Tilt-table test
Correct Answer: B
The ankle-brachial index is a simple noninvasive test for lower-extremity peripheral arterial disease.
Medicine
Cardiology
A patient taking warfarin for a mechanical mitral valve has an INR of 1.4. Why is a direct oral anticoagulant generally not substituted?
A. DOACs cause universal hepatotoxicity
B. DOACs are not recommended for mechanical prosthetic valves
C. DOACs cannot be taken orally
D. Warfarin has no drug interactions
Correct Answer: B
Vitamin K antagonists remain standard anticoagulation for mechanical prosthetic valves; DOACs are not recommended in this setting.
Medicine
Cardiology
Which finding most strongly supports cardiac tamponade?
A. Wide pulse pressure
B. Pulsus paradoxus with elevated JVP
C. Bounding peripheral pulses
D. Fixed split S2
Correct Answer: B
Tamponade impairs ventricular filling, producing elevated venous pressure and exaggerated inspiratory fall in systolic blood pressure.
Medicine
Cardiology
A 30-year-old woman has recurrent palpitations. ECG during symptoms shows a regular narrow-complex tachycardia at 190/min. Vagal maneuvers fail. What is the next best treatment in a stable patient?
A. Adenosine
B. Atropine
C. Lidocaine
D. Magnesium sulfate
Correct Answer: A
Adenosine is first-line acute pharmacologic therapy for stable regular narrow-complex re-entrant supraventricular tachycardia after vagal maneuvers fail.
Medicine
Cardiology
A patient 3 days after MI suddenly develops acute pulmonary edema and a new loud holosystolic murmur at the apex radiating to the axilla. What is most likely?
A. Dressler syndrome
B. Papillary muscle rupture causing acute mitral regurgitation
C. Ventricular aneurysm
D. Right ventricular infarction
Correct Answer: B
Papillary muscle rupture typically occurs several days after MI and causes abrupt severe mitral regurgitation with pulmonary edema.
Medicine
Cardiology
A 72-year-old woman with severe aortic stenosis develops exertional dyspnea, angina and syncope. What is the definitive treatment?
A. Long-term nitrates alone
B. Aortic valve replacement
C. Digoxin
D. Permanent anticoagulation only
Correct Answer: B
Symptomatic severe aortic stenosis has a poor prognosis without valve replacement; transcatheter or surgical replacement is selected according to patient factors.
Medicine
Cardiology
Which ECG finding is most characteristic of acute pericarditis?
A. Localized ST elevation with reciprocal depression
B. Diffuse concave ST elevation with PR depression
C. ST depression only in V1-V3
D. Pathologic Q waves in contiguous leads
Correct Answer: B
Acute pericarditis classically causes diffuse concave ST elevation and PR-segment depression rather than a territorial infarction pattern.
Medicine
Cardiology
A 24-year-old athlete has exertional syncope and a harsh systolic murmur that becomes louder with Valsalva. What is the most likely diagnosis?
A. Aortic stenosis
B. Hypertrophic obstructive cardiomyopathy
C. Mitral stenosis
D. Atrial septal defect
Correct Answer: B
Dynamic LV outflow obstruction in hypertrophic cardiomyopathy increases when preload falls, such as during Valsalva.
Medicine
Cardiology
A patient with HFrEF remains symptomatic despite ACE inhibitor/ARNI, evidence-based beta-blocker and mineralocorticoid receptor antagonist. Which drug class also reduces heart-failure hospitalization and cardiovascular death even without diabetes?
A. DPP-4 inhibitor
B. SGLT2 inhibitor
C. Sulfonylurea
D. Alpha-glucosidase inhibitor
Correct Answer: B
SGLT2 inhibitors are foundational therapy in HFrEF and provide benefit irrespective of diabetes status.
Medicine
Cardiology
A 55-year-old man has tearing chest pain radiating to the back and unequal arm blood pressures. What is the best initial imaging test if he is hemodynamically stable?
A. Exercise ECG
B. CT angiography of the aorta
C. Coronary calcium score
D. Chest ultrasound only
Correct Answer: B
Stable suspected acute aortic syndrome is rapidly assessed with CT angiography; unstable patients may require bedside transesophageal echocardiography.
Medicine
Cardiology
A patient with acute inferior STEMI becomes hypotensive with raised JVP and clear lungs. Which complication is most likely?
A. Left ventricular free-wall rupture
B. Right ventricular infarction
C. Papillary muscle rupture
D. Ventricular septal rupture
Correct Answer: B
Hypotension, elevated JVP and clear lung fields after inferior MI strongly suggest right ventricular infarction.
Medicine
Cardiology
A 68-year-old man with atrial fibrillation presents with hypotension, chest pain and pulmonary edema. What is the most appropriate immediate management?
A. IV amiodarone
B. Synchronized electrical cardioversion
C. Oral beta-blocker
D. Digoxin
Correct Answer: B
Hemodynamic instability due to atrial fibrillation requires urgent synchronized electrical cardioversion rather than delayed pharmacologic rate control.
Medicine
Cardiology
Which treatment should generally be avoided until aortic dissection has been excluded in a patient with a dissection-like presentation?
A. Analgesia
B. Careful blood-pressure control
C. Urgent aortic imaging
D. Thrombolytic therapy
Correct Answer: D
Thrombolysis can be catastrophic in aortic dissection because it increases life-threatening bleeding.
Medicine
Cardiology
Which complication or major adverse outcome is particularly associated with Acute aortic dissection?
A. Intracranial hemorrhage
B. Heart failure
C. Aortic rupture with tamponade
D. Systemic embolization
Correct Answer: C
Proximal dissection can rupture into the pericardium, causing tamponade and sudden death.
Medicine
Cardiology
A patient is diagnosed with Acute aortic dissection. Which is the most appropriate management principle?
A. Control ventricular rate and assess anticoagulation need using validated stroke-risk assessment
B. Control heart rate and shear stress with intravenous beta-blockade and arrange urgent surgery for ascending aortic involvement
C. Use a titratable intravenous antihypertensive with controlled blood-pressure reduction
D. Refer for aortic valve replacement when severe symptomatic disease is confirmed
Correct Answer: B
Initial anti-impulse therapy limits propagation; Stanford type A dissections generally require emergency surgical management.
Medicine
Cardiology
In a patient with suspected Acute aortic dissection, which investigation or diagnostic approach is most appropriate at this stage?
A. Urgent CT angiography of the aorta in a hemodynamically stable patient
B. Transthoracic echocardiography
C. 12-lead electrocardiogram
D. Immediate assessment for acute target-organ injury
Correct Answer: A
CT angiography rapidly defines the dissection anatomy in stable patients; alternative imaging is used when CT is unsuitable or the patient is unstable.
Medicine
Cardiology
A patient develops abrupt severe tearing chest pain radiating to the back with an inter-arm blood-pressure difference. What is the most likely diagnosis?
A. Acute ST-elevation myocardial infarction (STEMI)
B. Heart failure with reduced ejection fraction (HFrEF)
C. Atrial fibrillation
D. Acute aortic dissection
Correct Answer: D
Abrupt maximal-at-onset tearing pain with pulse or blood-pressure asymmetry is classic for aortic dissection.