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TEC Cardiologia study materials
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TEC Cardiologia practice questions

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Question 1Cardiologia

Which finding on the 12-lead ECG is most characteristic of acute ST-elevation myocardial infarction of the inferior wall?

  1. Peaked T waves in leads V5 and V6
  2. ST elevation in leads V1 to V4
  3. ST elevation in leads II, III and aVF Correct answer.
  4. ST depression in leads II, III and aVF

Explanation

The inferior wall of the left ventricle is electrically viewed by the inferior leads II, III and aVF, so acute transmural ischemia there produces ST elevation in those leads. Reciprocal ST depression is typically seen in aVL and sometimes in the anterior leads. ST elevation confined to V1-V4 instead indicates an anterior infarct.

Question 2Cardiologia

A 68-year-old man has sudden palpitations. The ECG shows a narrow-complex tachycardia that is irregularly irregular with no visible P waves. What is the most likely diagnosis?

  1. Atrial fibrillation Correct answer.
  2. Atrial flutter with 2:1 block
  3. Ventricular tachycardia
  4. Sinus tachycardia

Explanation

An irregularly irregular narrow-complex tachycardia without discernible P waves is the hallmark of atrial fibrillation, in which chaotic atrial activation produces variable AV conduction. Atrial flutter usually shows regular flutter waves and often a regular ventricular rate. Ventricular tachycardia is broad-complex.

Question 3Cardiologia

Which murmur is classically described as a midsystolic crescendo-decrescendo murmur heard best at the right upper sternal border and radiating to the carotids?

  1. Aortic stenosis Correct answer.
  2. Aortic regurgitation
  3. Mitral regurgitation
  4. Mitral stenosis

Explanation

Aortic stenosis generates turbulent flow across a narrowed valve during systole, producing a crescendo-decrescendo murmur at the right second intercostal space that radiates to the neck. Mitral murmurs are heard at the apex, and aortic regurgitation is a diastolic murmur.

Question 4Cardiologia

Which laboratory marker rises earliest after the onset of myocardial infarction and is therefore useful for very early detection?

  1. Myoglobin Correct answer.
  2. Troponin I
  3. LDH
  4. CK-MB

Explanation

Myoglobin is released rapidly from injured myocytes and can rise within one to two hours of infarction, making it the earliest conventional marker. However, it lacks cardiac specificity because it is also present in skeletal muscle. Troponin and CK-MB rise later but are more specific.

Question 5Cardiologia

A patient with chronic heart failure has an ejection fraction of 30 percent. Which drug class has been shown to reduce mortality in this setting by blocking the harmful effects of neurohormonal activation?

  1. Thiazolidinediones
  2. Class IC antiarrhythmics
  3. Dihydropyridine calcium channel blockers
  4. Angiotensin-converting enzyme inhibitors Correct answer.

Explanation

ACE inhibitors blunt the renin-angiotensin-aldosterone axis and have consistently reduced mortality in heart failure with reduced ejection fraction. Dihydropyridine calcium channel blockers and class IC antiarrhythmics can worsen outcomes in systolic dysfunction. Thiazolidinediones cause fluid retention and are avoided.

Question 6Cardiologia

Which ECG interval represents the time from the onset of ventricular depolarization to the end of ventricular repolarization?

  1. QRS duration
  2. PR interval
  3. RR interval
  4. QT interval Correct answer.

Explanation

The QT interval spans from the beginning of the QRS complex to the end of the T wave, encompassing both ventricular depolarization and repolarization. It is rate-dependent and is commonly corrected for heart rate. Prolongation predisposes to torsades de pointes.

Question 7Cardiologia

Which physical examination finding is most typical of cardiac tamponade?

  1. Widened pulse pressure
  2. Bounding pulses
  3. Pulsus paradoxus Correct answer.
  4. Systolic murmur at the apex

Explanation

In cardiac tamponade, pericardial pressure compresses the heart and exaggerates the normal inspiratory fall in systolic blood pressure, producing pulsus paradoxus. Jugular venous distension and muffled heart sounds complete Beck triad. Bounding pulses and widened pulse pressure suggest aortic regurgitation instead.

Question 8Cardiologia

Which rhythm disturbance is the most common cause of sudden cardiac death in patients with hypertrophic cardiomyopathy?

  1. Complete heart block
  2. Atrial flutter
  3. Sinus bradycardia
  4. Ventricular fibrillation Correct answer.

Explanation

Patients with hypertrophic cardiomyopathy are at risk of malignant ventricular arrhythmias, and ventricular fibrillation is the terminal event leading to sudden death. Risk is stratified by factors such as wall thickness, family history and syncope. Bradyarrhythmias and atrial flutter are not the typical terminal mechanism.

Question 9Cardiologia

A 58-year-old woman presents with tearing chest pain radiating to the back. Blood pressure is 190/100 mmHg in the right arm and 150/90 mmHg in the left arm. What is the most appropriate initial diagnostic test in a stable patient?

  1. Transthoracic echocardiography with dobutamine
  2. Coronary angiography
  3. Contrast-enhanced CT angiography of the aorta Correct answer.
  4. Treadmill exercise stress test

Explanation

The combination of tearing pain, interarm blood pressure difference and hypertension strongly suggests aortic dissection, for which CT angiography is the preferred rapid diagnostic study in a stable patient. Exercise stress testing is contraindicated in suspected dissection. Coronary angiography addresses coronary disease, not the aortic wall.

Question 10Cardiologia

A patient on warfarin has an INR of 7.5 and no active bleeding. What is the most appropriate management?

  1. Transfuse platelets
  2. Continue warfarin at the same dose
  3. Give intravenous heparin
  4. Withhold warfarin and give oral vitamin K Correct answer.

Explanation

For a markedly elevated INR without bleeding, warfarin should be withheld and low-dose oral vitamin K given to reverse the coagulopathy gradually. Continuing the same dose risks hemorrhage. Heparin does not reverse warfarin, and platelet transfusion is not indicated for an isolated INR elevation.

Question 11Cardiologia

A 72-year-old man has exertional syncope, a harsh systolic murmur at the right upper sternal border and a slow-rising carotid pulse. Which finding best predicts symptom onset in this condition?

  1. Presence of a fourth heart sound
  2. A normal chest radiograph
  3. The appearance of symptoms such as syncope or angina Correct answer.
  4. A soft first heart sound

Explanation

In severe aortic stenosis, the onset of syncope, angina or dyspnea marks a critical point with high short-term mortality and is the trigger for valve replacement. Physical signs and imaging support the diagnosis but do not themselves define this prognostic threshold. A fourth heart sound is common and nonspecific.

Question 12Cardiologia

A patient with ST-elevation myocardial infarction receives fibrinolysis. Which finding indicates successful reperfusion?

  1. Recurrence of chest pain after initial relief
  2. Rapid resolution of ST elevation and relief of chest pain Correct answer.
  3. Persistent ST elevation with new Q waves
  4. Onset of a new systolic murmur

Explanation

Successful fibrinolysis is signaled by rapid relief of pain, resolution of ST elevation and reperfusion arrhythmias. Persistent ST elevation or new Q waves suggests failed reperfusion. A new murmur may indicate a mechanical complication such as mitral regurgitation.

Question 13Cardiologia

Which mechanism best explains the benefit of beta-blockers after myocardial infarction?

  1. Selective dilation of the renal artery
  2. Increase of heart rate to improve coronary perfusion
  3. Direct lysis of coronary thrombus
  4. Reduction of myocardial oxygen demand and protection against ventricular arrhythmias Correct answer.

Explanation

Beta-blockers lower heart rate, contractility and blood pressure, reducing oxygen demand while also raising the threshold for ventricular arrhythmias. These effects limit infarct expansion and reinfarction. They do not dissolve thrombus or increase heart rate.

Question 14Cardiologia

A 30-year-old woman has palpitations and a narrow-complex regular tachycardia at 180 beats per minute. The rhythm terminates abruptly with intravenous adenosine. What is the most likely mechanism?

  1. Ventricular reentry through scar tissue
  2. Complete atrioventricular block
  3. Reentry involving the atrioventricular node Correct answer.
  4. Enhanced automaticity of the sinus node

Explanation

Paroxysmal supraventricular tachycardia commonly results from reentry circuits involving the AV node, which are sensitive to adenosine because it transiently blocks AV nodal conduction. Sinus node automaticity does not terminate abruptly with adenosine. Ventricular reentry produces broad-complex tachycardia.

Question 15Cardiologia

Which echocardiographic finding is most consistent with cardiac tamponade?

  1. Right ventricular diastolic collapse Correct answer.
  2. Severe aortic stenosis
  3. Left atrial enlargement
  4. Left ventricular hypertrophy

Explanation

When pericardial pressure exceeds right ventricular diastolic pressure, the right ventricular free wall collapses during diastole, a sensitive sign of tamponade. Additional features include right atrial collapse and respiratory variation in mitral inflow. Hypertrophy, aortic stenosis and atrial enlargement are unrelated to tamponade physiology.

Question 16Cardiologia

A 45-year-old man with a dilated left ventricle has an ejection fraction of 25 percent and a left bundle branch block with QRS duration of 160 ms. Which therapy offers the greatest additional benefit?

  1. Class I antiarrhythmic therapy
  2. Calcium channel blockers
  3. Cardiac resynchronization therapy Correct answer.
  4. Digoxin monotherapy

Explanation

Cardiac resynchronization therapy improves symptoms and survival in patients with reduced ejection fraction and a wide QRS with left bundle branch morphology by restoring coordinated ventricular contraction. Digoxin improves symptoms but not mortality. Class I antiarrhythmics and calcium channel blockers are harmful in systolic dysfunction.

Question 17Cardiologia

Which feature on the ECG distinguishes ventricular tachycardia from a supraventricular tachycardia with aberrancy?

  1. Heart rate above 150 beats per minute
  2. Narrow QRS complexes
  3. Regular RR intervals
  4. Presence of atrioventricular dissociation Correct answer.

Explanation

Atrioventricular dissociation, where atrial and ventricular activation are independent, is a highly specific sign of ventricular tachycardia. A very fast rate, regular rhythm and narrow complexes can occur in both rhythms, so they do not reliably separate them. Capture and fusion beats also favor ventricular tachycardia.

Question 18Cardiologia

A patient with infective endocarditis develops sudden severe dyspnea and a new holosystolic murmur. What complication should be suspected?

  1. Acute mitral regurgitation from valve destruction Correct answer.
  2. Aortic dissection
  3. Constrictive pericarditis
  4. Pulmonary embolism

Explanation

Vegetations can erode valve leaflets, causing acute severe regurgitation and abrupt pulmonary edema, most often of the mitral or aortic valve. Constrictive pericarditis develops slowly and does not produce a new holosystolic murmur. Aortic dissection and pulmonary embolism do not explain the murmur.

Question 19Cardiologia

Which congenital lesion typically presents with cyanosis that improves with crying but worsens with feeding, and shows decreased pulmonary vascularity on chest radiography?

  1. Patent ductus arteriosus
  2. Atrial septal defect
  3. Tetralogy of Fallot Correct answer.
  4. Ventricular septal defect

Explanation

Tetralogy of Fallot includes pulmonary stenosis and a ventricular septal defect, producing right-to-left shunting and cyanosis with reduced pulmonary blood flow. Crying increases intrathoracic pressure and can alter the shunt, sometimes relieving cyanosis. The other lesions are typically acyanotic with increased pulmonary flow.

Question 20Cardiologia

A 60-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 0. What is the recommended approach to anticoagulation?

  1. Start aspirin plus clopidogrel
  2. No anticoagulation is indicated Correct answer.
  3. Start warfarin with a target INR of 3.0
  4. Start a direct oral anticoagulant

Explanation

A CHA2DS2-VASc score of 0 in a man indicates low thromboembolic risk, and anticoagulation is not recommended because bleeding risk outweighs benefit. Anticoagulation is generally offered at scores of 2 or more, with consideration at 1. Dual antiplatelet therapy is not a substitute for anticoagulation in atrial fibrillation.

Question 21Cardiologia

A patient with a mechanical mitral valve is being considered for anticoagulation. Which regimen is appropriate?

  1. Aspirin alone
  2. Clopidogrel alone
  3. A direct factor Xa inhibitor
  4. Warfarin with a target INR of about 3.0 Correct answer.

Explanation

Mechanical mitral valves require vitamin K antagonist therapy, typically with a target INR near 3.0, because direct oral anticoagulants have failed to protect against valve thrombosis in this setting. Antiplatelet monotherapy is inadequate for mechanical prostheses.

Question 22Cardiologia

Which hemodynamic pattern is characteristic of constrictive pericarditis?

  1. Marked elevation of pulmonary capillary wedge pressure with preserved ventricular filling
  2. Wide pulse pressure with a high cardiac output
  3. Paradoxical increase in right atrial pressure during inspiration
  4. Equalization of diastolic pressures across cardiac chambers Correct answer.

Explanation

Rigid pericardium constrains all chambers, so diastolic pressures in the right atrium, right ventricle, pulmonary artery and left heart equalize. Ventricular filling is impaired, producing prominent y descents and a pericardial knock. Right atrial pressure normally rises with inspiration, but in tamponade it fails to fall appropriately.

Question 23Cardiologia

A young athlete collapses during exertion and is found to have a structurally normal heart, a prolonged QT interval and a family history of sudden death. Which channelopathy is most likely?

  1. Brugada syndrome
  2. Long QT syndrome Correct answer.
  3. Wolff-Parkinson-White syndrome
  4. Catecholaminergic polymorphic ventricular tachycardia

Explanation

A prolonged QT interval with exertional syncope and a family history of sudden death points to long QT syndrome, a repolarization disorder of potassium or sodium channel genes. Brugada syndrome shows ST elevation in V1-V3 without QT prolongation. Catecholaminergic polymorphic ventricular tachycardia typically has a normal resting ECG.

Question 24Cardiologia

A patient with severe heart failure has a cardiac index of 1.6 L/min/m2, a pulmonary capillary wedge pressure of 28 mmHg and cold extremities. Which classification best describes this profile?

  1. Warm and dry, requiring only oral therapy
  2. Cold and wet, requiring inotropic support and diuresis Correct answer.
  3. Cold and dry, requiring fluid loading
  4. Warm and wet, requiring vasodilators alone

Explanation

A low cardiac index defines a cold profile, and an elevated wedge pressure with congestion defines a wet profile. This combination reflects cardiogenic shock physiology and usually requires inotropic support plus diuresis. Warm and dry patients are compensated, while cold and dry patients are hypovolemic.

Question 25Cardiologia

Which finding on cardiac magnetic resonance imaging is characteristic of acute myocarditis?

  1. Marked pericardial calcification
  2. Subendocardial enhancement in a coronary territory
  3. Subepicardial or midwall late gadolinium enhancement Correct answer.
  4. Severe left ventricular hypertrophy with apical sparing

Explanation

Myocarditis produces inflammation and necrosis that is typically patchy and located in the midwall or subepicardium, which is reflected in nonischemic late gadolinium enhancement patterns. Subendocardial enhancement in a coronary distribution instead indicates infarction. Pericardial calcification and apical-sparing hypertrophy suggest other diseases.

Question 26Cardiologia

Which heart sound is best described as a low-pitched diastolic sound heard just after S2 and loudest at the apex with the patient in the left lateral decubitus position?

  1. Fourth heart sound
  2. Opening snap
  3. Third heart sound Correct answer.
  4. Mid-diastolic rumble

Explanation

S3 is a low-frequency early diastolic sound produced by rapid ventricular filling and is best heard at the apex with the bell while the patient lies in the left lateral decubitus position. It is common in young people and in states of volume overload or reduced ventricular compliance.

Question 27Cardiologia

Which ECG finding is the earliest and most sensitive sign of acute transmural myocardial ischemia?

  1. Hyperacute peaked T waves Correct answer.
  2. ST-segment depression
  3. New left bundle branch block
  4. Pathologic Q waves

Explanation

Hyperacute, tall and peaked T waves are the earliest ECG manifestation of acute transmural ischemia, preceding ST elevation. Q waves indicate established necrosis and appear later, so they are not an early sign.

Question 28Cardiologia

Which class of antihypertensive drug is most appropriate as first-line therapy for a young patient with hypertension and a history of asthma?

  1. Thiazide-type diuretic
  2. Thiazolidinedione
  3. Non-selective beta-blocker
  4. Angiotensin-converting enzyme inhibitor Correct answer.

Explanation

ACE inhibitors are effective first-line antihypertensives and do not provoke bronchospasm, so they are suitable in asthma. Beta-blockers can precipitate bronchoconstriction in patients with reactive airway disease.

Question 29Cardiologia

Which valve lesion produces a mid-diastolic, low-pitched rumble with an opening snap at the apex?

  1. Aortic stenosis
  2. Mitral regurgitation
  3. Mitral stenosis Correct answer.
  4. Tricuspid regurgitation

Explanation

Mitral stenosis causes restricted opening of the valve leaflets, generating an opening snap followed by a low-pitched mid-diastolic rumble heard best at the apex. The murmur intensifies during maneuvers that increase flow across the valve.

Question 30Cardiologia

Which biomarker is most specific for myocardial injury when measured 3 to 6 hours after the onset of chest pain?

  1. Lactate dehydrogenase
  2. Myoglobin
  3. Creatine kinase MB
  4. High-sensitivity troponin Correct answer.

Explanation

Cardiac troponins I and T are highly specific to myocardium and rise within a few hours of injury, remaining elevated for days. High-sensitivity assays detect very small elevations and are the preferred diagnostic marker for acute myocardial infarction.

Question 31Cardiologia

Which rhythm is characterized by an irregularly irregular ventricular response with no discernible P waves?

  1. Atrioventricular nodal reentrant tachycardia
  2. Sinus tachycardia
  3. Atrial flutter
  4. Atrial fibrillation Correct answer.

Explanation

Atrial fibrillation produces chaotic atrial activity without organized P waves, so the ventricular response is irregularly irregular. The absence of discrete P waves and the irregular R-R interval are the defining surface ECG features.

Question 32Cardiologia

Which dietary modification is recommended for a patient with chronic heart failure and reduced ejection fraction who has no renal impairment?

  1. Restricting fluid intake to 500 mL daily
  2. Increasing sodium intake
  3. Restricting sodium intake Correct answer.
  4. Restricting potassium intake

Explanation

Limiting dietary sodium reduces fluid retention and helps control congestive symptoms in chronic heart failure. Extreme fluid restriction is reserved for selected patients with refractory congestion or hyponatremia rather than applied routinely.

Question 33Cardiologia

Which finding defines stage A heart failure in the American College of Cardiology and American Heart Association classification?

  1. Risk factors for heart failure without structural disease Correct answer.
  2. Refractory symptoms at rest despite therapy
  3. Structural heart disease without symptoms
  4. Structural heart disease with prior symptoms

Explanation

Stage A comprises patients at risk for heart failure, such as those with hypertension, diabetes, or cardiotoxic exposure, who have no structural abnormality and no symptoms. Stages progress from risk alone to structural disease, then symptoms, then refractory disease.

Question 34Cardiologia

A 34-year-old man has a blood pressure of 168/104 mmHg in both arms on three separate visits. Which secondary cause should be screened for first when there is hypokalemia and a metabolic alkalosis?

  1. Obstructive sleep apnea
  2. Primary aldosteronism Correct answer.
  3. Pheochromocytoma
  4. Renovascular disease

Explanation

Primary aldosteronism causes hypertension with hypokalemia and metabolic alkalosis because aldosterone promotes sodium retention and potassium excretion. Screening with the aldosterone-to-renin ratio is indicated in hypertensive patients with unprovoked hypokalemia.

Question 35Cardiologia

A 62-year-old woman with a prior myocardial infarction presents with dyspnea and a new holosystolic murmur at the apex radiating to the axilla. Which complication is most likely?

  1. Ventricular septal defect
  2. Left ventricular free wall rupture
  3. Pericardial effusion
  4. Papillary muscle rupture with acute mitral regurgitation Correct answer.

Explanation

Ischemic rupture of a papillary muscle produces acute severe mitral regurgitation with a new apical holosystolic murmur and rapid pulmonary edema. The finding of a murmur radiating to the axilla localizes the regurgitation to the mitral valve.

Question 36Cardiologia

A patient with dilated cardiomyopathy has an ejection fraction of 30 percent and persistent symptoms despite optimal medical therapy. Which additional therapy improves survival in this population?

  1. Mineralocorticoid receptor antagonist Correct answer.
  2. Dihydropyridine calcium channel blocker
  3. Verapamil
  4. Class IC antiarrhythmic

Explanation

Mineralocorticoid receptor antagonists reduce mortality and hospitalization in patients with heart failure and reduced ejection fraction who remain symptomatic despite standard therapy. They are recommended in patients with an ejection fraction of 35 percent or less.

Question 37Cardiologia

A 70-year-old man has syncope and a harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids. Which finding would confirm severe aortic stenosis?

  1. Aortic valve area of 2.0 cm2
  2. Mean aortic gradient of 10 mmHg
  3. Preserved left ventricular ejection fraction
  4. Peak aortic velocity of 4.5 m/s Correct answer.

Explanation

Severe aortic stenosis is defined by a peak aortic jet velocity of at least 4.0 m/s, a mean gradient of at least 40 mmHg, or a valve area of 1.0 cm2 or less. A velocity of 4.5 m/s therefore confirms severe disease.

Question 38Cardiologia

Which ECG finding is characteristic of acute pericarditis?

  1. Sawtooth flutter waves
  2. Peaked T waves with a shortened QT interval
  3. Reciprocal ST depression in all leads
  4. Diffuse concave ST elevation with PR depression Correct answer.

Explanation

Acute pericarditis produces widespread concave-upward ST elevation and PR segment depression reflecting inflammation of the epicardium and atrial wall. The changes are diffuse rather than confined to a single coronary territory.

Question 39Cardiologia

A patient with atrial fibrillation and a CHA2DS2-VASc score of 3 is being started on anticoagulation. Which agent is preferred for a mechanical aortic valve?

  1. Dabigatran
  2. Warfarin Correct answer.
  3. Rivaroxaban
  4. Apixaban

Explanation

Direct oral anticoagulants are not recommended for patients with mechanical heart valves because trials showed inferior or unsafe outcomes. Warfarin with an international normalized ratio target of 2.0 to 3.0 for an aortic valve is the standard of care.

Question 40Cardiologia

Which mechanism explains the therapeutic benefit of cardiac resynchronization therapy in patients with heart failure and a wide left bundle branch block?

  1. Enhanced vagal tone
  2. Restoration of coordinated ventricular contraction Correct answer.
  3. Increased atrioventricular node refractoriness
  4. Reduction of myocardial oxygen demand

Explanation

Biventricular pacing resynchronizes the delayed activation of the lateral left ventricular wall caused by left bundle branch block, improving stroke volume and reducing mitral regurgitation. The resulting reverse remodeling is associated with improved symptoms and survival.

Question 41Cardiologia

A 55-year-old woman has a blood pressure of 150/95 mmHg and a potassium of 3.1 mmol/L with a metabolic alkalosis. Which test is the best initial screen for the likely cause?

  1. Aldosterone-to-renin ratio Correct answer.
  2. Overnight oximetry
  3. Renal artery Doppler
  4. Plasma metanephrines

Explanation

The combination of hypertension, hypokalemia, and metabolic alkalosis suggests primary aldosteronism, for which the aldosterone-to-renin ratio is the initial screening test. Confirmatory testing follows an elevated ratio.

Question 42Cardiologia

A patient with hypertrophic cardiomyopathy has a resting left ventricular outflow tract gradient of 60 mmHg and persistent symptoms despite beta-blockade. Which pharmacologic agent is most appropriate next?

  1. Hydralazine
  2. Digoxin
  3. Nifedipine
  4. Disopyramide Correct answer.

Explanation

Disopyramide has negative inotropic effects that reduce dynamic outflow tract obstruction and can improve symptoms in patients with hypertrophic cardiomyopathy who remain symptomatic on beta-blockers. It is used with caution because of its proarrhythmic and anticholinergic effects.

Question 43Cardiologia

Which echocardiographic finding distinguishes restrictive cardiomyopathy from constrictive pericarditis?

  1. Preserved ventricular wall thickness
  2. Pericardial thickening
  3. Biatrial enlargement with normal ventricular size Correct answer.
  4. Annulus reversus on tissue Doppler

Explanation

Restrictive cardiomyopathy is characterized by biatrial enlargement with normal or near-normal ventricular cavity size and wall thickness. Constrictive pericarditis typically shows pericardial thickening and annulus reversus on tissue Doppler imaging.

Question 44Cardiologia

A 28-year-old man has syncope during exertion, and his ECG shows a short PR interval with a delta wave. Which arrhythmia is he most at risk for?

  1. Complete heart block
  2. Atrioventricular nodal reentrant tachycardia
  3. Atrial fibrillation with rapid conduction over an accessory pathway Correct answer.
  4. Ventricular fibrillation from a prolonged QT interval

Explanation

Wolff-Parkinson-White syndrome involves an accessory pathway that can conduct atrial impulses rapidly to the ventricles. Atrial fibrillation in this setting can produce very fast ventricular rates and degenerate into ventricular fibrillation.

Question 45Cardiologia

Which medication is recommended for a patient with acute decompensated heart failure and a systolic blood pressure of 80 mmHg with signs of hypoperfusion?

  1. Intravenous nitroglycerin
  2. Inotropic support with dobutamine Correct answer.
  3. Intravenous furosemide alone
  4. Oral metoprolol

Explanation

Hypotension with evidence of hypoperfusion indicates cardiogenic shock, which requires inotropic support to maintain cardiac output and organ perfusion. Dobutamine is a commonly used inotrope in this setting.

Question 46Cardiologia

A 66-year-old man has a bicuspid aortic valve and a dilated ascending aorta of 5.2 cm. Which management is most appropriate?

  1. Serial imaging every 5 years
  2. Aortic valve balloon valvuloplasty
  3. Surgical aortic root replacement Correct answer.
  4. Beta-blocker therapy alone

Explanation

Aortic root diameter of 5.0 cm or greater in a patient with a bicuspid valve is an indication for surgical replacement to prevent dissection or rupture. Surgery is recommended even in the absence of severe valve dysfunction.

Question 47Cardiologia

A patient with severe aortic stenosis and a normal ejection fraction has a mean gradient of 25 mmHg and a calculated valve area of 0.8 cm2. Which condition best explains this discordance?

  1. Low-flow low-gradient aortic stenosis Correct answer.
  2. Measurement error from an incorrect left ventricular outflow tract diameter
  3. Moderate aortic stenosis
  4. High-output state

Explanation

Low-flow low-gradient aortic stenosis occurs when reduced stroke volume produces a lower gradient than expected for the calculated valve area. It requires confirmation with dobutamine stress echocardiography to distinguish true severe from pseudosevere stenosis.

Question 48Cardiologia

A patient with a suspected acute aortic dissection has a blood pressure of 180/100 mmHg. Which medication should be given first to reduce the risk of propagation?

  1. Intravenous nitroprusside alone
  2. Oral amlodipine
  3. Intravenous labetalol Correct answer.
  4. Intravenous furosemide

Explanation

Beta-blockade is the initial therapy in acute aortic dissection because it lowers both blood pressure and the rate of left ventricular pressure rise, reducing shear stress on the aortic wall. A vasodilator may be added afterward if blood pressure remains elevated.

Question 49Cardiologia

A patient with severe mitral regurgitation has an ejection fraction of 55 percent and no symptoms, but serial imaging shows a left ventricular end-systolic dimension of 45 mm. Which management is most appropriate?

  1. Exercise stress testing every 6 months
  2. Mitral valve repair or replacement Correct answer.
  3. Continued observation with annual echocardiography
  4. Afterload reduction with an ACE inhibitor alone

Explanation

An end-systolic dimension of 45 mm or greater indicates decompensation of the left ventricle in severe mitral regurgitation and is an indication for surgery even without symptoms. Delaying surgery risks irreversible ventricular dysfunction.

Question 50Cardiologia

A 40-year-old man with a prosthetic valve develops fever and a new aortic regurgitation murmur. Which finding on transesophageal echocardiography would confirm a perivalvular abscess?

  1. A thickened valve leaflet
  2. A small pericardial effusion
  3. A paravalvular echolucent cavity with color flow Correct answer.
  4. A mobile vegetation on the valve leaflet

Explanation

A perivalvular abscess appears as an echolucent cavity adjacent to the valve annulus, often with abnormal color flow indicating a fistula or pseudoaneurysm. Transesophageal echocardiography is the preferred imaging modality because of its superior resolution.