A 61yo man has been referred to the OPD with frequent episodes of breathlessness and chest
pain a/w palpitations. He has a regular pulse rate=60bpm. ECG=sinus rhythm. What is the most
appropriate inv to be done?
a. Cardiac enzymes
b. CXR
c. ECG
d. Echo
e. 24h ECG
answer: E
To look for an intermittent ECG abnormality
ECG of an 80yo pt of ICH shows saw-tooth like waves, QRS complex of 80ms duration,
ventricular rate=150/min and regular R-R interval. What is the most porbable dx?
a. Atrial fib
b. Atrial flutter
c. SVT
d. Mobitz type1 second degree heart block
e. Sinus tachycardia
answer: B
A 1m boy has been brought to the ED, conscious but with cool peripheries and has HR=222bpm.
He has been irritable and feeding poorly for 24h. CXR=borderline enlarged heart with clear lung
fields. ECG=regular narrow complex tachycardia, with difficulty identifying p wave. What is the
single most appropriate immediate tx?
a. Administer fluid bolus
b. Administer oxygen
c. Oral beta-blockers
d. Synchronized DC cardio-version
e. Unilateral carotid sinus massage
answer: D
Hypotension (cool peripheries) we should go for DC conversion
A 47yo man with hx of IHD complains of chest pain with SOB on exertion over the past few days.
ECG normal, Echo= increased EF and decreased septal wall thickness. What is the most likely dx?
a. Dilated CM
b. Constrictive pericarditis
c. Amyloidosis
d. Subacute endocarditis
Diagnosis: A with Bad recall… candidate probably made an incorrect recall of decreased EF and increased septal wall thickness
Dilated CM
Clinical presentation may be abrupt, with acute pulmonary oedema, systemic or pulmonary emboli, or even sudden death, but more often patients present with progressive symptoms of congestive cardiac failure (CCF) including exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, and fatigue.
Echo: chamber enlargement, global hypokinesis, depressed EF, MR and TR, mural thrombi