Cardiology MCQ – ECG changes in pericarditis – Answer
Cardiology MCQ – ECG changes in pericarditis – Answer ECG changes in pericarditis are due to involvement of: Correct answer: 3. Visceral pericardium (epicardium) and adjacent myocardium Parietal pericardium is electrically silent [1]. In pericarditis, 4 stages of ECG changes have been described: Stage 1: PR segment depression and ST segment elevation in leads other than aVR and V1 (oriented to the cavity) Stage 2: ST becomes isoelectric Stage 3: T waves get inverted Stage 4: ECG normalizes It may be noted that unlike in the evolution of myocardial infarction ST segment elevation does not co-exist with T wave in...
Source: Cardiophile MD - January 8, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Prognostic markers in pericarditis
Poor prognostic markers in pericarditis [1]: Fever more than 38 degrees Centigrade Large pericardial effusion measuring more than 20 mm on echocardiography Presence of cardiac tamponade – it may be noted that tamponade need not be related to the size of effusion, rather with the rapidity of collection Lack of response to anti-inflammatory therapy in one week Reference Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M, Abbate A. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. J Am Coll Car...
Source: Cardiophile MD - January 8, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Perimyocarditis vs Myopericarditis
Hearing the terms one may be tempted to think both are the same. But it is not so according to the 2015 ESC (European Society of Cardiology) Guidelines [1]. Myopericarditis: Pericarditis with known or clinically suspected concomitant myocardial involvement. Perimyocarditis: Predominant myocarditis with pericardial involvement. So the stress is on the second part of the name. Reference Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W; ESC Scientific Docum...
Source: Cardiophile MD - January 7, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – ECG changes in pericarditis
Cardiology MCQ – ECG changes in pericarditis ECG changes in pericarditis are due to involvement of: Visceral pericardium Parietal pericardium Visceral pericardium (epicardium) and adjacent myocardium None of the above Post your answer as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - January 7, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Impella device – Answer
Cardiology MCQ – Impella device – Answer Contraindication for placement of an Impella mechanical cardiac support device: Correct answer: 4. All of the above Impella is a percutaneous transvalvular continuous-flow microaxial pump which is used as temporary left ventricular assist device. Now devices for the right ventricle are also available (when both together are used, some call it Bipella!). Impella 2.5 delivers 2.5 l/min cardiac output while Impella CP delivers 3.5 l/min. It draws blood from the left ventricle and delivers it into the aorta. Hence it will unload the left ventricle, reducing diastolic vo...
Source: Cardiophile MD - January 6, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

ROX index
ROX index is used to predict the success (and failure) of high-flow nasal cannula (HFNC). ROX index is the ratio of pulse oximetry/fraction of inspired oxygen (FIO2) to respiratory rate. ROX index of 4.88 or measured after 12 hours of HFNC was associated with a lower risk of mechanical ventilation. This was noted in a study conducted on 157 patients with pneumonia [1]. It was a 4 year observation two center cohort study including patients with severe pneumonia treated with HFNC. 44 patients who needed mechanical ventilation was considered as HFNC failures. HFNC can delivered up to 60 litres of flow with humidified and war...
Source: Cardiophile MD - January 5, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Awake ECMO
Extracorporeal membrane oxygenation (ECMO) is used for treatment of severe respiratory or cardiopulmonary failure. Usually these patients are sedated and mechanically ventilated, though at lower tidal volumes to reduce lung injury and permit lung recovery. The concept of Awake ECMO [1] is to do away with mechanical ventilation permitting the patient to eat, drink, sit up and even possibly walk. They can also participate in physiotherapy. This considered usually in those who are in bridge to transplant situation. One study documented 6 month survival after lung transplantation as 80% in the awake ECMO group while it w...
Source: Cardiophile MD - January 3, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Risk of cerebral hypoxia with ECMO
Venoarterial extracorporeal membrane oxygenator (ECMO) is a potential lifesaving intervention in those with refractory cardiogenic shock. But there is potential risk of cerebral hypoxia because of upper body hypoxemia. Upper body is perfused by the left ventricular output which can be hypoxemic if there is pulmonary edema. Lower body is perfused with oxygenated blood from the ECMO [1]. Reference Rab T, Ratanapo S, Kern KB, Basir MB, McDaniel M, Meraj P, King SB 3rd, O’Neill W. Cardiac Shock Care Centers: JACC Review Topic of the Week. J Am Coll Cardiol. 2018 Oct 16;72(16):1972-1980. (Source: Cardiophile MD)
Source: Cardiophile MD - January 3, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiac power output
Cardiac power output (CPO) = (Mean arterial pressure x Cardiac output)/451 Mean arterial pressure = [(Systolic blood pressure − Diastolic blood pressure)/3] + Diastolic blood pressure Cardiac power output is measured in Watts and CPO less than 0.6 W is a poor prognostic indicator. It has been shown to be the strongest hemodynamic correlate of mortality in cardiogenic shock from SHOCK Trial registry [1]. Reference Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG, LeJemtel TH, Cotter G; SHOCK Investigators. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from...
Source: Cardiophile MD - January 2, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Pulmonary Artery Pulsatility Index
Pulmonary Artery Pulsatility Index (PAPI) is a recently described hemodynamic index, which has been used to predict right ventricular failure in those with inferior wall infarction and in those who have been implanted with left ventricular assist device (LVAD). It is also useful to assess the need for biventricular Impella (Bipella) support in those with cardiogenic shock on the mechanical circulatory support device Impella for the left ventricle [1]. Pulmonary artery pulsatility index (PAPI) = (systolic pulmonary arterial pressure − diastolic pulmonary pressure)/right atrial pressure. This is the pulmonary arterial...
Source: Cardiophile MD - January 2, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Recurrence of stress cardiomyopathy
Cardiology MCQ – Recurrence of stress cardiomyopathy Though stress cardiomyopathy is a reversible condition, recurrence is known. Average recurrence rate is about: 2% to 4% per year 6% to 12% per year 14% to 20% per year 20% to 40% per year Post your answer as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - January 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Pyrethroid insecticides may increase cardiovascular mortality
A study published in JAMA (Journal of American Medical Association) Internal Medicine evaluated the environmental exposure to pyrethroid insecticides by checking the levels of general pyrethroid metabolite 3-phenoxybenzoic acid in urine samples [1]. Pyrethroids are used in mosquito repellents, lice shampoos and pet sprays are generally considered to be safe insecticides. But this study found that higher levels of pyrethroid metabolites in urine over a 14 year observation period was associated with a higher risk of death from all causes or from cardiovascular diseases. The study involved 2116 adults aged 20 years or more w...
Source: Cardiophile MD - January 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Anti-Ro/SSA – Answer
Cardiology MCQ – Anti-Ro/SSA – Answer Maternal Anti-Ro/SSA antibodies are associated with fetal: Correct answer: 4. All of the above Fetal echocardiographic features of anti-Ro/SSA antibody–mediated cardiac disease includes dilated cardiomyopathy, pericardial effusion, endocardial fibroelastosis, complete heart block and atrioventricular valve regurgitation [1]. But the one familiar to most people is complete heart block in the infant of mother with systemic lupus erythematosus or other maternal connective tissue disease [2]. Back to question Reference Cuneo BF, Sonesson SE, Levasseur S, Moon-Grady AJ, K...
Source: Cardiophile MD - December 31, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

InterTAK diagnostic score for Takotsubo cardiomyopathy
InterTAK Diagnostic Score was developed from the results for International Takotsubo Registry [1] by the InterTAK International Registry Group. The score was developed for differentiating Takotsubo cardiomyopathy from acute coronary syndrome in the acute stage. InterTAK Diagnostic Score estimates the probability for Takotsubo cardiomyopathy and was found to have high sensitivity and specificity for differentiating it from acute coronary syndrome. Points were allocated as follows: Female gender: 25 points Emotional trigger: 24 points Physical trigger: 13 points Absence of ST-segment depression: 12 points Psychiatric disord...
Source: Cardiophile MD - December 31, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Anti-Ro/SSA
Cardiology MCQ – Anti-Ro/SSA Maternal Anti-Ro/SSA antibodies are associated with fetal: Complete heart block Endocardial fibroelastosis AV valve regurgitation All of the above Click here for the answer with discussion (Source: Cardiophile MD)
Source: Cardiophile MD - December 30, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Low gradient severe AS – Answer
Cardiology MCQ – Low gradient severe AS – Answer Investigation to identify low flow low gradient severe aortic stenosis: Correct answer: 2. Dobutamine echocardiography Low flow low gradient severe aortic stenosis is due to falsely low gradient when there is left ventricular dysfunction. Dobutamine increases the contractility in this situation and increases the gradient. Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - December 30, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Low gradient severe AS
Cardiology MCQ – Low gradient severe AS Investigation to identify low flow low gradient severe aortic stenosis: Global longitudinal strain Dobutamine echocardiography Cardiac magnetic resonance imaging Tissue Doppler imaging Click here the answer and discussion (Source: Cardiophile MD)
Source: Cardiophile MD - December 29, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

HFrecEF – HF with recovered EF
HFrecEF – HF with recovered EF Classification of heart failure is ever changing. We had heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Then came heart failure with mid range ejection fraction (HFmrEF) with ejection fraction between 40 and 50%. Yet another entity is heart failure with recovered ejection fraction (HFrecEF) [1]. Over half of patients with history of heart failure and left ventricular ejection fraction above 50% have HFrecEF. It has a better prognosis than HFrEF and HFpEF, but is likely to be mistook for the latter. They are less likely to...
Source: Cardiophile MD - December 28, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Coronary vasomotor function – Answer
Cardiology MCQ – Coronary vasomotor function – Answer Most validated and accurate noninvasive test for the quantitative assessment of coronary vasomotor function: Correct answer: 1. Positron emission tomography PET uses rest and vasodilator stress myocardial perfusion study after injection of blood flow radiotracers like 82Rubidium or 13N-ammonia. Image post processing yields regional and global myocardial blood flow in ml/min/g of myocardium. Coronary flow reserve is calculated as the ratio of stress to rest myocardial blood flow [1]. Assessing coronary flow reserve is important in patients with coronary micr...
Source: Cardiophile MD - December 28, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

INOCA – Ischemia and No Obstructive Coronary Artery Disease
INOCA – Ischemia and No Obstructive Coronary Artery Disease INOCA is the acronym for Ischemia and No Obstructive Coronary Artery Disease [1]. They have elevated risk for cardiovascular events like acute coronary syndrome and hospitalization for heart failure. Risk of development of heart failure with preserved ejection fraction (HFpEF) is also higher in these subjects. Some of them have coronary microvascular dysfunction and evidence of inflammation. In spite of the absence of obstructive coronary arteries, they have a risk of repeated hospitalizations and repeated coronary angiographies, involving significant health...
Source: Cardiophile MD - December 27, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

ECG Quiz 61 – Discussion
Discussion Lead I and aVL shows wide notched QRS complexes suggestive of left bundle branch block. PR interval for the sinus beat is 200 ms, at the upper limit. Rhythm strip shows sinus bradycardia with junctional escape beats (blue arrow) without preceding P waves, but same QRS morphology as the succeeding sinus beat (violet arrow). The sequence of junctional escape followed by a sinus capture beat continues throughout the rhythm strip. This constitutes an escape – capture bigeminy. Other common varieties of bigeminy are: Ectopic bigeminy Block bigeminy Echo bigeminy Ectopic bigeminy sequence can be seen whe...
Source: Cardiophile MD - December 24, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

16 fold higher risk of cancer with peripartum cardiomyopathy
German cancer registry (Robert-Koch-Institute) data has shown a 16 fold risk of cancer in those with peripartum cardiomyopathy [1]. According to the report 21 of 236 patients had cancer, of which 12 had cancer diagnosed before peripartum cardiomyopathy. 11 of them had cardiotoxic chemotherapy. Of these, 17% fully recovered cardiac function compared to 55% of peripartum cardiomyopathy patients without cancer. Of the 10 patients who developed cancer after peripartum cardiomyopathy, 80% had left ventricular ejection fraction of 50% or more after cancer therapy. Authors mention that the high prevalence could be due to geneti...
Source: Cardiophile MD - December 23, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardio Oncology Source Type: blogs

ECG Quiz 61
Click here for the discussion (Source: Cardiophile MD)
Source: Cardiophile MD - December 23, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Prediction of heart failure in leukemia
Researchers have developed a twenty one point score to predict the development of heart failure in acute leukemia patients treated with anthracyclines [1]. They obtained baseline echocardiographic measurements including left ventricular ejection fraction and global longitudinal strain in 450 acute leukemia patients treated with anthracyclines. A 21 point risk score was generated by evaluating potential risk factors for heart failure using Fine and Gray’s regression analysis. Six variables were selected based on their statistical significance and clinical relevance (assigned score points for each in brackets): Age ...
Source: Cardiophile MD - December 22, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardio Oncology Onco Cardiology Source Type: blogs

Machine learning to predict risk of MI and CV death
Machine learning has been used to predict the long term risk of myocardial death and cardiac death in a study published in Cardiovascular Research from the European Society of Cardiology. It was a prospective study using clinical parameters, coronary artery calcium scoring and automated epicardial adipose tissue quantification. The study included 1912 asymptomatic persons from EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) trial with long-term follow-up after coronary artery calcium scoring. Epicardial adipose tissue is a metabolically active fat deposit which has b...
Source: Cardiophile MD - December 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Machine Learning and AI in Cardiology Source Type: blogs

Long working hours – masked and sustained hypertension
Long working hours – masked and sustained hypertension Long working hours has been shown to give rise to masked and sustained hypertension in a recent study published in the journal Hypertension from the American Heart Association [1]. Study data was collected over 5 years from over 3500 white collar workers. Workplace clinic blood pressure was the mean of first three readings taken at workplace during rest. Ambulatory blood pressure was the mean of daytime recordings taken every 15 minutes during working hours. When the clinic blood pressure was below 140/90 mm Hg and ambulatory blood pressure was 135/85 ...
Source: Cardiophile MD - December 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Type of respiratory failure in shock – Answer
Cardiology MCQ – Type of respiratory failure in shock Type of respiratory failure in shock: Correct answer: 4. Type 4 Type 1: Hypoxic respiratory failure Type 2: Hypercapnic respiratory failure Type 3: Perioperative respiratory failure due to atelectasis Type 4: Hypoperfusion of respiratory muscle in shock Back to question Reference Harrison’s Principles of Internal Medicine, 20th Edition (Source: Cardiophile MD)
Source: Cardiophile MD - December 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Potential risks of hyperoxemia
Potential risks of hyperoxemia: Detrimental effects due to vasoconstriction of the vasculature Generation of reactive oxygen species which could cause: Toxic myocardial contractile dysfunction Increased oxidative stress Reperfusion injury Myocardial cell death Earlier it was common practice to give supplemental oxygen for acute coronary syndrome and after percutaneous coronary interventions. This practice has been discontinued after publication of the DETO2X-AMI trial [1] and other similar studies which showed no benefit for supplemental oxygen in those with normal oxygen saturation. Reference Hofmann R, James SK, J...
Source: Cardiophile MD - December 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Anti hypertensive medication can reduce BP variability
Blood pressure variability can be assessed either from ambulatory BP recordings or from multiple clinic visit recordings. BP variability is associated with target organ damage and future cardiovascular events [1]. A recent study published in the Journal of American Heart Association reported that elderly persons treated with antihypertensive medication for two years had a lower BP variability [2]. They also noted that high systolic BP variability was associated with increased mortality on long term follow up. References Chowdhury EK, Owen A, Krum H, Wing LMH, Nelson MR, Reid CM. Second Australian National Bloo...
Source: Cardiophile MD - December 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Type of respiratory failure in shock
Cardiology MCQ – Type of respiratory failure in shock Type of respiratory failure in shock: Type 1 Type 2 Type 3 Type 4 Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - December 20, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Classic cardiogenic shock – Answer
Cardiology MCQ – Classic cardiogenic shock – Answer My Cardiology MCQ books on Amazon “Classic” cardiogenic shock having hypotension with features of hypoperfusion, needing inotropes and mechanical circulatory support comes under Stage — of the 2019 SCAI (Society for Cardiovascular Angiography and Intervention) classification: Correct answer: 3. Stage C The Society for Cardiovascular Angiography and Intervention (SCAI) has classified cardiogenic shock into stages from A through E. Stage A: “At risk” for cardiogenic shock – large myocardial infarction or heart failure, but no...
Source: Cardiophile MD - December 19, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Classic cardiogenic shock
Cardiology MCQ – Classic cardiogenic shock “Classic” cardiogenic shock having hypotension with features of hypoperfusion, needing inotropes and mechanical circulatory support comes under Stage — of the 2019 SCAI (Society for Cardiovascular Angiography and Intervention) classification: Stage A Stage B Stage C Stage D Post your answer as a comment below (Source: Cardiophile MD)
Source: Cardiophile MD - December 18, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Moderate aortic stenosis – Cardiology MCQ – Answer
Moderate aortic stenosis – Cardiology MCQ Mean pressure gradient across the aortic valve in moderate aortic stenosis is between: Correct answer: 1. 20-39 mm Hg In addition a peak aortic velocity between 3.0 to 3.9 also qualifies for moderate aortic stenosis. Severe aortic stenosis has a mean transvalvar gradient of 40 mm Hg or more. Peak aortic velocity in severe aortic stenosis is taken as 4 m/s or more. In case of low flow, low gradient severe aortic stenosis, valve area below 1 sq cm is the cut off value. Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - December 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Moderate aortic stenosis – Cardiology MCQ
Moderate aortic stenosis – Cardiology MCQ Mean pressure gradient across the aortic valve in moderate aortic stenosis is between: 20-39 mm Hg 40-50 mm Hg 50-60 mm Hg 60-70 mm Hg Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - December 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Warfarin for nonvalvular AF – Answer
Cardiology MCQ – Warfarin for nonvalvular AF – Answer Warfarin given in patients with nonvalvular atrial fibrillation (AF) can reduce ischemic stroke by — %: Correct Answer: 3. 60% A meta analysis of 29 trials including a total of 28,044 participants showed that warfarin reduced stroke by 64% while antiplatelet agents reduced stroke by 22% in those with nonvalvular atrial fibrillation. Absolute increase in major extracranial hemorrhages was 0.3% or lesser in this meta analysis. Back to question Reference Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients ...
Source: Cardiophile MD - December 17, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Warfarin for nonvalvular AF
Cardiology MCQ – Warfarin for nonvalvular AF Warfarin given in patients with nonvalvular atrial fibrillation (AF) can reduce ischemic stroke by — %: 20% 40% 60% 80% Post your answer as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - December 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

SCAI Shock Stages A Through E
The Society for Cardiovascular Angiography and Intervention (SCAI) has classified cardiogenic shock into stages from A through E. This was developed by a multidisciplinary team from cardiology (interventional, advanced heart failure and noninvasive), emergency medicine, critical care and cardiac nursing. Stage A: “At risk” for cardiogenic shock – large myocardial infarction or heart failure, but not yet in shock, with normal mentation and systolic blood pressure of 100 mm Hg or more. Stage B: “Beginning” shock – hypotension or tachycardia without features of hypoperfusion (normal mentation). Systolic BP
Source: Cardiophile MD - December 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

MELD and MELD-XI scores
Model for End-Stage Liver Disease (MELD) score is a logarithmic function of creatinine, total bilirubin and International Hospitalized Ratio (INR): MELD = 9.57(logeCreatinine) + 3.78(logeBilirubin) + 11.21(logeINR) + 6.43. MELD score was originally developed to assess prognosis in patients undergoing transjugular intrahepatic portosystemic shunts (TIPS) for cirrhosis liver [1]. Later MELD score has been used in cardiovascular conditions like patients undergoing left ventricular assist device (LVAD) placement to operative transfusion requirements, morbidity, and mortality [2]. An important limitation f...
Source: Cardiophile MD - December 15, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Least progression of valvular lesion – Answer
Cardiology MCQ – Least progression of valvular lesion – Answer Which of these three lesions is least likely to progressive and have a favourable clinical course among aortic stenosis, mitral regurgitation and aortic regurgitation? Correct Answer: 1. Aortic regurgitation Asymptomatic severe aortic stenosis and mitral regurgitation has poor long term outcome with overall mortality near to 10% per year, while that of asymptomatic severe aortic regurgitation is almost similar to that of age/sex matched population. 1998 AHA guidelines mentioned annual sudden death risk of only 0.2%, progression to asymptomatic left...
Source: Cardiophile MD - December 15, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Potential mechanisms of reduced heart failure hospitalization with SGLT2 inhibitors
Four main potential reasons for protection against heart failure (HF) hospitalization by SGLT2 inhibitors: Contraction of plasma volume and reduction of blood pressure reducing preload and afterload. Increased ketone production can be used for the production of ATP by the myocardium more efficiently.  Inhibition of sodium-hydrogen exchange in myocardial cells can lead to reduction of hypertrophy, systolic dysfunction, fibrosis and remodeling. Reduced arrhythmic risk possibily due to suppression of sympathetic nervous system leading to lower sudden cardiac death. Reference Cherney DZ, Odutayo A, Aronson R, Ezekowi...
Source: Cardiophile MD - December 14, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Least progression of valvular lesion
Cardiology MCQ – Least progression of valvular lesion Which of these three lesions is least likely to progressive and have a favourable clinical course among aortic stenosis, mitral regurgitation and aortic regurgitation? Aortic regurgitation Aortic stenosis Mitral regurgitation All progresses at an equal rate Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - December 14, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Treatment of transthyretin amyloid cardiomyopathy – Answer
Cardiology MCQ – Treatment of transthyretin amyloid cardiomyopathy – Answer Recently developed pharmacotherapy which has been shown to halt and reverse the progression of transthyretin amyloid cardiomyopathy: Correct answer: 2. Tafamidis  Transthyretin amyloid cardiomyopathy is due to transthyretin amyloid fibril deposition in the myocardium. Tafamidis acts by binding to transthyretin and prevents tetramer dissociation, thus preventing amyloid formation. Back to question Reference Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M, Kristen AV, Grogan M, Witteles R, Damy T, Dr...
Source: Cardiophile MD - December 14, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

ACC/AHA Stages of valvular heart disease
Stage A: At risk of developing valve disease Stage B: Progressive valve disease Stage C: Asymptomatic severe valve disease Stage D: Symptomatic severe valve disease Reference Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J A...
Source: Cardiophile MD - December 13, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

CHAD-STOP for cardiac amyloidosis
CHAD-STOP is the mnemonic for the initial steps in the management of cardiac amyloidosis: C: Conduction and rhythm disorder prevention H: High heart rate maintenance A: Anticoagulation D: Diuretics STOP: STOP beta receptor and calcium channel blockers, digoxin and renin-angiotensin-aldosterone inhibitors Preload reserve is limited in cardiac amyloidosis due to severe diastolic dysfunction. Hence the only way to increase the cardiac output is by the heart rate reserve and hence it should not be cut down by beta blockade or calcium channel blockade. Renin-angiotensin-aldosterone inhibitors carry the risk of severe hypotens...
Source: Cardiophile MD - December 13, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Treatment of transthyretin amyloid cardiomyopathy
Cardiology MCQ – Treatment of transthyretin amyloid cardiomyopathy Recently developed pharmacotherapy which has been shown to halt and reverse the progression of transthyretin amyloid cardiomyopathy: Trastuzumab Tafamidis Tranexamic acid Tamoxifen Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - December 13, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

“ Exclusion tests ” for primary aldosteronism
“Exclusion tests” for primary aldosteronism Oral sodium loading test Saline infusion test Captopril challenge test Fludrocortisone with salt loading test Though these tests were proposed as ‘confirmatory tests’ for primary aldosteronism, it was found that their negative predictive value was more than the positive predictive value. Reference Rossi GP. Primary Aldosteronism: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019 Dec 3;74(22):2799-2811. Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Palumbo G, Rizzoni D, ...
Source: Cardiophile MD - December 12, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Cardiology MCQ – Stroke risk in non valvar AF – Answer
Cardiology MCQ – Stroke risk in non valvar AF – Answer Stroke risk in chronic non valvar atrial fibrillation was increased by — fold in Framingham study: Correct answer: 2. Five fold In the same study, chronic AF with rheumatic heart disease had 17 fold increase in stroke risk. The study report had a follow up period of 24 years. Conventionally non valvar AF is defined as AF in the absence of moderate or severe mitral stenosis or prosthetic valve. Milder degrees of mitral stenosis and other valvular lesions are not excluded from ‘non-valvar’ AF! Back to question Reference Wolf PA, Dawber TR,...
Source: Cardiophile MD - December 11, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Associations of primary aldosteronism
Cardiology MCQ – Associations of primary aldosteronism Which of the following are associated with primary aldosteronism? Hypertension Atrial fibrillation Obstructive sleep apnea All of the above Post your answer as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - December 11, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Primary aldosteronism
Cardiology MCQ – Primary aldosteronism Primary aldosteronism is an important cause of secondary hypertension. It is characterised by: Low levels of plasma renin and high levels of plasma aldosterone High levels of plasma renin and high levels of plasma aldosterone Low levels of plasma renin and low levels of plasma aldosterone None of the above Post your answer as a comment below. (Source: Cardiophile MD)
Source: Cardiophile MD - December 11, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Cardiology MCQ – Stroke risk in non valvar AF
Cardiology MCQ – Stroke risk in non valvar AF Stroke risk in chronic non valvar atrial fibrillation was increased by — fold in Framingham study: Two fold Five fold Ten fold Seventeen fold Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - December 11, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs