Medicine
Cardiology
A patient with atrial fibrillation is hypotensive with ongoing chest pain and pulmonary edema. What is the immediate rhythm treatment?
A. Oral beta-blocker and discharge
B. Elective Holter monitoring
C. Synchronized electrical cardioversion
D. Adenosine bolus
Correct Answer: C
Hemodynamic instability caused by a tachyarrhythmia is an indication for urgent synchronized cardioversion.
Medicine
Cardiology
Which complication or major adverse outcome is particularly associated with Atrial fibrillation?
A. Aortic rupture with tamponade
B. Ischemic stroke
C. Ventricular tachyarrhythmia
D. Acute pulmonary edema
Correct Answer: B
Left atrial thrombus formation can embolize and cause ischemic stroke.
Medicine
Cardiology
A patient is diagnosed with Atrial fibrillation. Which is the most appropriate management principle?
A. Control ventricular rate and assess anticoagulation need using validated stroke-risk assessment
B. Use an NSAID plus colchicine when not contraindicated
C. Control heart rate and shear stress with intravenous beta-blockade and arrange urgent surgery for ascending aortic involvement
D. Give aspirin and activate an urgent reperfusion pathway, preferably primary PCI when promptly available
Correct Answer: A
Stable AF commonly requires rate control plus individualized thromboembolic-risk assessment for anticoagulation.
Medicine
Cardiology
In a patient with suspected Atrial fibrillation, which investigation or diagnostic approach is most appropriate at this stage?
A. Multiple blood cultures before antibiotics followed by echocardiography
B. Electrocardiogram with echocardiography when effusion or complication is a concern
C. Urgent CT angiography of the aorta in a hemodynamically stable patient
D. 12-lead electrocardiogram
Correct Answer: D
ECG confirms atrial fibrillation and assesses ventricular rate and associated conduction abnormalities.
Medicine
Cardiology
A patient has palpitations and an irregularly irregular pulse with no consistent P waves on ECG. What is the most likely diagnosis?
A. Severe aortic stenosis
B. Infective endocarditis
C. Atrial fibrillation
D. Acute pericarditis
Correct Answer: C
An irregularly irregular rhythm with absent organized P waves is characteristic of atrial fibrillation.
Medicine
Cardiology
Which drug class is mainly used for rapid symptomatic relief of fluid overload in HFrEF?
A. Short-acting calcium-channel blocker
B. Loop diuretic
C. Antibiotic therapy
D. Thrombolytic therapy
Correct Answer: B
Loop diuretics are used to relieve congestion; they are not the main mortality-reducing component of chronic HFrEF therapy.
Medicine
Cardiology
Which complication or major adverse outcome is particularly associated with Heart failure with reduced ejection fraction (HFrEF)?
A. Acute pulmonary edema
B. Ischemic stroke
C. Intracranial hemorrhage
D. Heart failure
Correct Answer: A
Decompensated left-sided heart failure can rapidly produce pulmonary edema and severe hypoxemia.
Medicine
Cardiology
A patient is diagnosed with Heart failure with reduced ejection fraction (HFrEF). Which is the most appropriate management principle?
A. Give aspirin and activate an urgent reperfusion pathway, preferably primary PCI when promptly available
B. Control ventricular rate and assess anticoagulation need using validated stroke-risk assessment
C. Use a titratable intravenous antihypertensive with controlled blood-pressure reduction
D. Start guideline-directed HFrEF therapy and use a loop diuretic when congestion is present
Correct Answer: D
Disease-modifying HFrEF therapy reduces morbidity and mortality, while loop diuretics provide symptomatic decongestion.
Medicine
Cardiology
In a patient with suspected Heart failure with reduced ejection fraction (HFrEF), which investigation or diagnostic approach is most appropriate at this stage?
A. Urgent CT angiography of the aorta in a hemodynamically stable patient
B. Immediate 12-lead electrocardiogram
C. Transthoracic echocardiography
D. 12-lead electrocardiogram
Correct Answer: C
Echocardiography defines ejection fraction, chamber size and structural causes of heart failure.
Medicine
Cardiology
A patient has progressive exertional dyspnea, orthopnea, bilateral basal crackles, ankle edema and a reduced left-ventricular ejection fraction. What is the most likely diagnosis?
A. Acute pericarditis
B. Heart failure with reduced ejection fraction (HFrEF)
C. Acute aortic dissection
D. Acute ST-elevation myocardial infarction (STEMI)
Correct Answer: B
Congestive symptoms with objective systolic dysfunction support HFrEF.
Medicine
Cardiology
A patient with an inferior STEMI is hypotensive, has raised JVP and clear lungs. Which associated problem should be suspected?
A. Right ventricular infarction
B. Papillary muscle rupture
C. Acute ventricular septal rupture
D. Aortic dissection
Correct Answer: A
Inferior MI with hypotension, elevated JVP and clear lungs suggests right ventricular involvement.
Medicine
Cardiology
Which complication or major adverse outcome is particularly associated with Acute ST-elevation myocardial infarction (STEMI)?
A. Heart failure
B. Systemic embolization
C. Cardiac tamponade
D. Ventricular tachyarrhythmia
Correct Answer: D
Ventricular tachycardia or fibrillation can occur early after acute myocardial infarction and is a major cause of sudden death.
Medicine
Cardiology
A patient is diagnosed with Acute ST-elevation myocardial infarction (STEMI). Which is the most appropriate management principle?
A. Use a titratable intravenous antihypertensive with controlled blood-pressure reduction
B. Refer for aortic valve replacement when severe symptomatic disease is confirmed
C. Give aspirin and activate an urgent reperfusion pathway, preferably primary PCI when promptly available
D. Start targeted prolonged intravenous antimicrobial therapy after cultures and obtain specialist input
Correct Answer: C
STEMI management requires immediate antiplatelet therapy and rapid reperfusion; primary PCI is preferred when it can be delivered promptly.
Medicine
Cardiology
In a patient with suspected Acute ST-elevation myocardial infarction (STEMI), which investigation or diagnostic approach is most appropriate at this stage?
A. 12-lead electrocardiogram
B. Immediate 12-lead electrocardiogram
C. Immediate assessment for acute target-organ injury
D. Transthoracic echocardiography with Doppler
Correct Answer: B
A 12-lead ECG should be obtained immediately in suspected acute coronary syndrome because it identifies STEMI and directs reperfusion.
Medicine
Cardiology
A patient develops sudden crushing central chest pain with diaphoresis and new ST-segment elevation in contiguous ECG leads. 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. Hypertensive emergency
Correct Answer: A
Persistent ischemic chest pain with regional ST elevation is classic for acute STEMI and requires urgent reperfusion assessment.