RVOT obstruction in HCM – Cardiology MCQ
Right ventricular outflow tract (RVOT) obstruction with hypertrophic cardiomyopathy (HCM) would favour a diagnosis of:
a) Danon disease
b) Anderson-Fabry disease
c) Noonan syndrome
d) Pompe disease
Correct answer: c) Noonan syndrome
Even though increased thickness of right ventricular free wall can occur in both Anderson-Fabry disease and Noonan Syndrome, RVOT obstruction along with HCM is characteristic of Noonan Syndrome.
The post RVOT obstruction in HCM – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 20, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Dynamic LVOT obstruction – Cardiology MCQ
Dynamic left ventricular outflow tract (LVOT) obstruction can occur in:
a) Hypertrophic cardiomyopathy
b) Calcification of posterior mitral annulus
c) Hypovolemia
d) All of the above
Correct answer: d) All of the above
In addition to these, dynamic LVOT obstruction can also occur in hypercontractile states and sometimes even in hypertension.
Reference
Elliott PM et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). European Heart Journal (2014) 35, 2733-2779.
The pos...
Source: Cardiophile MD - May 19, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Coved ST elevation in HCM – Cardiology MCQ
Coved ST segment elevation in lateral leads in hypertrophic cardiomyopathy (HCM) is suggestive of:
a) Lateral wall myocardial infarction
b) Apical aneurysm
c) Coronary vasospasm
d) None of the above
Correct answer: b) Apical aneurysm
Coved ST segment elevation in lateral leads in hypertrophic cardiomyopathy can be due to small apical aneurysm formation in those with apical or distal hypertrophy. This can be associated with myocardial scarring. The small aneurysms may be only detected by cardiac magnetic resonance imaging, contrast ventriculography or myocardial contrast echocardiography.
The post Coved ST elevation in ...
Source: Cardiophile MD - May 19, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
North West QRS axis in HCM – Cardiology MCQ
North West (extreme superior) QRS axis in hypertrophic cardiomyopathy (HCM) is most likely due to:
a) Fabry disease
b) Noonan syndrome
c) Danon disease
d) None of the above
Correct answer: b) Noonan syndrome
In Noonan syndrome, extreme hypertrophy of the basal region of the left ventricle, often involving the right ventricular outflow tract, is responsible for the extreme North West QRS axis.
The post North West QRS axis in HCM – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
HCM by ESC 2014 guidelines – Cardiology MCQ
Diagnosis of hypertrophic cardiomyopathy (HCM) in a first degree relative by European Society of Cardiology 2014 guideline needs left ventricular wall thickness of:
a) 15 millimeters or more
b) 14 millimeters or more
c) 13 millimeters or more
d) 12 millimeters or more
Correct answer: c) 13 millimeters or more
Primary diagnosis (not in a first degree relative) needs thickening of left ventricular wall in any of the segments of 15 millimeters or more, not explainable by abnormal loading conditions (like hypertension or aortic stenosis). The thickness can be measured by any of the imaging modalities like echocardiography, ca...
Source: Cardiophile MD - May 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Strongest risk predictor in HCM
Strongest risk predictor in hypertrophic cardiomyopathy:
a) History of sudden cardiac death in multiple family members
b) Previous cardiac arrest or sustained ventricular arrhythmia
c) Septal thickness more than 30 millimeters
d) None of the above
Correct answer: b) Previous cardiac arrest or sustained ventricular arrhythmia
Septal thickness of more than 30 millimeters is one of the weakest predictors. Family history of sudden cardiac death is important, more so if there are multiple affected family members. But the strongest predictor of all is a previous history of cardiac arrest or sustained ventricular arrhythmia in t...
Source: Cardiophile MD - May 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Alcohol septal ablation
Most important complication after alcohol septal ablation for hypertrophic obstructive cardiomyopathy (HOCM) is:
a) Heart failure
b) Incomplete resolution of left ventricular outflow gradient
c) Complete heart block requiring permanent pacemaker
d) None of the above
Correct answer: c) Complete heart block requiring permanent pacemaker
Alcohol septal ablation is popular in Europe as a less invasive form of septal reduction therapy than surgical myectomy for relief of left ventricular outflow obstruction in hypertrophic obstructive cardiomyopathy. But the procedure has a seven to twenty percent risk of permanent complete at...
Source: Cardiophile MD - May 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Drug not useful for treatment of HOCM
Which of the following is not useful in the treatment of hypertrophic obstructive cardiomyopathy (HOCM)?
a) Verapamil
b) Metoprolol
c) Isoprenaline
d) Disopyramide
Correct answer: c) Isoprenaline
Isoprenaline is an inotropic agent which will increase the myocardial contractility and thereby the obstruction in hypertrophic obstructive cardiomyopathy.
The post Cardiology MCQ: Drug not useful for treatment of HOCM appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 13, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: Phenocpy of hypertrophic cardiomyopathy
Which of the following are phenocopies of hypertrophic cardiomyopathy?
a) Fabry disease
b) Noonan’s syndrome
c) Friedrich ataxia
d) All of the above
Correct answer: d) All of the above
Phenocopies of hypertrophic cardiomyopathy are diseases in which hypertrophy of the left ventricle occurs similar to that in hypertrophic cardiomyopathy, but are genetically different entities. Cardiac specific glycogen storage disease also mimics hypertrophic cardiomyopathy. In some situations, identification of phenocopy may be important as in Fabry in which disease course may be altered by replacement therapy with agalsidase alpha o...
Source: Cardiophile MD - May 12, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Anticoagulation for AF with HCM – Cardiology MCQ
Anticoagulation for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is recommended when:
a) In all patients
b) When CHADS2 score is two or more
c) When CHA2DS2-VASC score is two or more
d) None of the above
Correct answer: a) In all patients
As per the ESC (European Society of Cardiology) 2014 recommendations, anticoagulation is recommended in all patients with atrial fibrillation in hypertrophic cardiomyopathy as the stroke risk is high (occurs in over one fourth of patients). In those without AF, but large left atrium of 45 millimeters or more, 48 hour Holter monitoring is recommended in 6-12 monthly inter...
Source: Cardiophile MD - May 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Drug contraindicated in HOCM – Cardiology MCQ
Drug contraindicated in hypertrophic obstructive cardiomyopathy (HOCM):
a) Digoxin
b) Metoprolol
c) Disopyramide
d) All of the above
Correct answer: a) Digoxin
Digoxin should be avoided in HOCM because of its positive inotropic effect, which can exacerbate the left ventricular outflow tract obstruction. Metoprolol and disopyramide are useful in alleviating symptoms of HOCM due to their negative inotropic effect. Caution has to be exerted while using verapamil for its negative inotropic effect in this situation as its vasodilatory effect can sometimes be deleterious in those with dynamic left ventricular outflow tract obs...
Source: Cardiophile MD - April 30, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Bone scintigraphy in suspected HCM – Cardiology MCQ
Bone scintigraphy with 99mTc-DPD is useful in hypertrophic cardiomyopathy (HCM) to exclude:
a) HCM due to sarcomere protein mutations
b) Fabry disease
c) Danon disease
d) TTR amyloidosis
Correct answer: d) TTR amyloidosis
Transthyretin (TTR), the precursor protein in senile systemic amyloidosis and familial TTR-related amyloidosis is a tetrameric plasma transport protein synthesized in the liver. TTR-derived fibrils show avidity for bone tracers, especially 99mTechnetium-3,3-diphosphono-1,2-propano-di-carboxylic acid
(99mTc-DPD). (Source: Cardiophile MD)
Source: Cardiophile MD - April 29, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Atrial Fibrillation
In atrial fibrillation there is no effective contraction of the atria. The fibrillary waves are of low amplitude and many of them do not get conducted to the ventricles due to refractoriness of the AV node. Frequency of the fibrillary waves may be anything from 400-600 /minute. But the ventricular rate is usually around 120 per minute and irregular. If the AV node is diseased or blocked by drugs, the ventricular rate may be low. The fibrillary waves may be coarse if the atria are enlarged as in mitral stenosis. Amplitude of fibrillary waves more than 1 mm is taken as evidence of atrial enlargement. If the ventricular rhy...
Source: Cardiophile MD - April 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs
Cardiology MCQ: Risk factors in HCM
Which of the following are risk factors for sudden cardiac death in hypertrophic cardiomyopathy?
a) Family history of one more more HCM related sudden cardiac deaths
b) Massive left ventricular hypertrophy (thickness of 30 mm or more)
c) One or more episodes of recent syncope
d) All of the above
Correct answer: d) All of the above
In addition, non sustained ventricular tachycardia noted on several occasions and hypotensive or attenuated blood pressure response during exercise are also thought to be important risk factors. It is needless to say that a previous episode of resuscitated ventricular fibrillation or sustained v...
Source: Cardiophile MD - April 21, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ: SCD in young athletes
Commonest cause of sudden cardiac death (SCD) in young athletes:
a) Coronary anomalies
b) Aortic rupture
c) Hypertrophic cardiomyopathy
d) Congenital heart disease
Correct answer: c) Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy accounts for about thirty five percent of sudden cardiac death in young athletes and coronary anomalies contribute about seventeen percent. Myocarditis can be there in about six percent, aortic rupture in three percent and congenital heart disease in one percent.
Reference:
Maron BJ, Olivotto I, Spirito P, Casey SA, Bellone P, Gohman TG, et al. Epidemiology of hypertrophic cardiomyopath...
Source: Cardiophile MD - April 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
