Cardiology MCQs

Cardiology MCQs

Surgical correction for congenitally corrected transposition of great arteries is:

1. Jatene operation
2. Mustard operation
3. Senning operation
4. Double switch operation

Correct answer: 4. Double switch operation

Definitive surgical correction of c-TGA is known as double switch. Atrial switch is by a modified Senning procedure for rerouting the pulmonary and systemic venous return. Arterial switch is done for correction of ventriculoarterial discordance [Sharma R, Bhan A, Juneja R, Kothari SS, Saxena A, Venugopal P. Double switch for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg. 1999 Mar;15(3):276-81; discussion 281-2].

Most common valvular abnormality seen in congenitally corrected transposition of great arteries is of:

1. Systemic AV valve
2. Pulmonary valve
3. Aortic valve
4. Mitral valve

Correct answer: 1. Systemic AV valve

Since the atrioventricular (AV) valves are a property of the ventricles, the systemic right ventricle in this case has a tricuspid valve. In up to 70% of cases it is displaced inferiorly, the Ebstein’s anomaly. It is an important cause of systemic AV valve regurgitation. Systemic AV valve disease was the only independent predictor of death in congenitally corrected transposition of the great arteries in certain series [Prieto LR, Hordof AJ, Secic M, Rosenbaum MS, Gersony WM. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation 1998;98:997-1005].

Which of the following is not a boundary of the Koch’s triangle?

1. Eustachian valve
2. Coronary sinus
3. Tendon of Todaro
4. Septal tricuspid leaflet

Correct answer: 1. Eustachian valve

Eustachian valve is the valve of the inferior vena cava. All the others are the boundaries of Koch’s triangle. Atrioventricular node is situated at the apex of Koch’s triangle [Shanubhogue S, Mohamed T, Shankar N. Morphometry of the triangle of Koch and position of the coronary sinus opening in cadaveric fetal hearts. Indian Heart J. 2017 Jan-Feb;69(1):125-128].

Which of the following is used in the treatment of chronic thromboembolic pulmonary hypertension?

1. Vericiguat
2. Ranolazine
3. Riociguat
4. Vernakalant

Correct answer: 3. Riociguat

Riociguat is a soluble guanylate cyclase stimulator useful in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) [Ghofrani HA, D’Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Mayer E, Simonneau G, Wilkins MR, Fritsch A, Neuser D, Weimann G, Wang C; CHEST-1 Study Group. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med. 2013 Jul 25;369(4):319-29].  Vericiguat is a new medication for heart failure with reduced ejection fraction (HFrEF). It is an oral soluble guanylate cyclase stimulator. Ranolazine is an antianginal agent with antiarrhythmic properties. Vernakalant was an antiarrhythmic agent used for conversion of atrial fibrillation.

Paradoxical splitting of second heart sound may be heard in all of the following EXCEPT:

1. Aortic stenosis
2. Left bundle branch block
3. Left ventricular pacing
4. Right ventricular ectopic beat

Correct answer: 3. Left ventricular pacing

Paradoxical or reverse splitting of second heart sound can occur in right ventricular pacing and the other conditions listed above [Towne WD, Rahimtoola SH, Sinno MZ, Loeb HS, Rosen KM, Gunnar RM. The effects of right atrial and ventricular pacing on the auscultatory findings in patients with mitral valve prolapse. Circulation. 1975 Jun;51(6):988-96]. In paradoxical splitting of second heart sound, split closes in inspiration while it is heard in expiration.

Idarucizumab is a monoclonal antibody fragment used to reverse the effect of:

1. Digoxin
2. Dabigatran
3. Sulodexide
4. Heparin

Correct answer: 2. Dabigatran

Idarucizumab reverses the anticoagulant effect of direct thrombin inhibitor dabigatran [Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, Dubiel R, Huisman MV, Hylek EM, Kamphuisen PW, Kreuzer J, Levy JH, Sellke FW, Stangier J, Steiner T, Wang B, Kam CW, Weitz JI. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015 Aug 6;373(6):511-20]. Heparin antidote is protamine sulphate.

ST segment elevation in aVR more than that in V1 is suggestive of:

1. Left circumflex coronary artery occlusion
2. Left anterior descending coronary artery occlusion
3. Left main coronary artery occlusion
4. Right coronary artery occlusion

Correct answer: 2. Left main coronary artery occlusion

ST segment elevation can occur in left main occlusion as well as in proximal LAD occlusion. But in left main occlusion, ST elevation in aVR is more than that in V1 [Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, Hina K, Kita T, Sakakibara N, Tsuji T. Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1). J Am Coll Cardiol. 2001 Nov 1;38(5):1348-54].

Which of the following is NOT a feature of athlete’s heart?

1. Sinus arrhythmia
2. Sinus tachycardia
3. Early repolarization syndrome
4. Wandering atrial pacemaker

Correct answer: 2. Sinus tachycardia

Sinus bradycardia is the usual hallmark of athlete’s heart. Most of the ECG changes due to increased parasympathetic tone disappear on exercise ECG, usually indicating their benign nature [Fagard R. Athlete’s heart. Heart. 2003 Dec;89(12):1455-61].

Omecamtiv mecarbil, a drug for heart failure with reduced ejection fraction is a:

1. Angiotensin Receptor-Neprilysin Inhibitor
2. Cardiac myosin activator
3. Angiotensin converting enzyme inhibitor
4. Bradykinin inhibitor

Correct answer: 2. Cardiac myosin activator

GALACTIC-HF trial evaluated omecamtiv mecarbil, a cardiac myosin activator in heart failure with reduced ejection fraction [Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, Adams KF, Anand I, Arias-Mendoza A, Biering-Sørensen T, Böhm M, Bonderman D, Cleland JGF, Corbalan R, Crespo-Leiro MG, Dahlström U, Echeverria LE, Fang JC, Filippatos G, Fonseca C, Goncalvesova E, Goudev AR, Howlett JG, Lanfear DE, Li J, Lund M, Macdonald P, Mareev V, Momomura SI, O’Meara E, Parkhomenko A, Ponikowski P, Ramires FJA, Serpytis P, Sliwa K, Spinar J, Suter TM, Tomcsanyi J, Vandekerckhove H, Vinereanu D, Voors AA, Yilmaz MB, Zannad F, Sharpsten L, Legg JC, Varin C, Honarpour N, Abbasi SA, Malik FI, Kurtz CE; GALACTIC-HF Investigators. Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure. N Engl J Med. 2021 Jan 14;384(2):105-116].