ITE Cardiovascular Disease 2 — Questions and Answers
Question 1: A 58-year-old man with hypertension presents with sudden-onset tearing chest pain radiating to the back. BP is 180/100 in the right arm and 150/85 in the left arm. Which imaging study is most appropriate?
- Transthoracic echocardiogram
- CT angiography of the chest (Correct answer)
- Coronary angiography
- Ventilation-perfusion scan
Correct answer: CT angiography of the chest
CT angiography is the gold standard for diagnosing aortic dissection, which is suggested by the tearing pain and blood pressure differential between arms.
Question 2: A patient with known mitral stenosis develops sudden onset palpitations. ECG shows no P waves and irregularly irregular rhythm. What is the immediate concern?
- Ventricular tachycardia
- Systemic thromboembolism (Correct answer)
- Cardiac tamponade
- Complete heart block
Correct answer: Systemic thromboembolism
Atrial fibrillation in mitral stenosis significantly increases the risk of left atrial thrombus formation and systemic embolism, including stroke.
Question 3: Which medication class is the preferred initial treatment for heart failure with reduced ejection fraction (HFrEF) to reduce mortality?
- Loop diuretics
- Beta-blockers and ACE inhibitors (Correct answer)
- Calcium channel blockers
- Digoxin
Correct answer: Beta-blockers and ACE inhibitors
Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) and ACE inhibitors/ARBs are proven to reduce mortality in HFrEF and are the cornerstone of therapy.
Question 4: A 65-year-old woman presents with exertional dyspnea and a harsh systolic crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids. Echocardiogram shows an AVA of 0.7 cm². What is the next step?
- Medical management with ACE inhibitor
- Referral for aortic valve replacement (Correct answer)
- Cardiac catheterization to confirm
- Exercise stress test
Correct answer: Referral for aortic valve replacement
An AVA <0.8 cm² with symptoms defines severe symptomatic aortic stenosis, which requires valve replacement as definitive treatment.
Question 5: A 70-year-old man is found to have a 5.6 cm infrarenal abdominal aortic aneurysm on ultrasound during screening. He is asymptomatic. What is the recommended management?
- Repeat ultrasound in 5 years
- Intensive blood pressure control only
- Elective surgical repair (Correct answer)
- CT angiography and urgent repair
Correct answer: Elective surgical repair
AAAs ≥5.5 cm in men carry high rupture risk and warrant elective repair; this patient's 5.6 cm aneurysm meets the threshold.
Question 6: Which finding on ECG is most consistent with hyperkalemia in a patient with chronic kidney disease?
- Prolonged QT interval
- Tall peaked T waves (Correct answer)
- ST segment depression
- Prominent U waves
Correct answer: Tall peaked T waves
Hyperkalemia classically produces tall, narrow, peaked T waves as one of the earliest ECG manifestations.
Question 7: A patient with systolic heart failure (EF 30%) continues to have symptoms despite optimal doses of ACE inhibitor and beta-blocker. QRS duration is 155 ms on ECG. What therapy should be added?
- Digoxin
- Cardiac resynchronization therapy (CRT) (Correct answer)
- Ivabradine
- Amiodarone
Correct answer: Cardiac resynchronization therapy (CRT)
CRT is indicated in symptomatic HFrEF with LBBB morphology and QRS ≥150 ms despite optimal medical therapy, improving symptoms and mortality.
ITE Cardiovascular Disease 2
A 58-year-old man with hypertension presents with sudden-onset tearing chest pain radiating to the back.
BP is 180/100 in the right arm and 150/85 in the left arm.
Which imaging study is most appropriate?