This document provides a summary of key points related to cardiology past papers. It discusses classifications of aortic dissection, appropriate tests for diagnosis, and medical versus surgical management approaches. Specific conditions covered include right heart failure, viral myocarditis, rheumatic fever, pericarditis related to chemotherapy, and management of heart failure patients. Drugs mentioned include sotalol, amiodarone, procainamide, and ivabradine. The document is intended as a study aid for cardiology examinations.

1. Key To Past Papers – Cardiology Part 2
Prepared By : Dr Abdul Wasay Baloch
PGR (Dip Card)
Punjab Institute of Cardiology (PIC)
Lahore
abdulwasay789@gmail.com
Sep – 2020
COURTESY: DR MUHAMMAD ARIF for his generous sharing of past papers answers

3. • A) Aortic Dissection, Debeky and Stanford classification
• B)Ecg, CXR, TTE,TEE, CT, MRI, Invasive aortogram
• C) medical management BB(labetolol), CCB, ACE,
vasodilators
• Surgical management
– Type A, surgery with graft
– Type B, Percutaneous EVAR

5. • A)
• B) Raised JVP on examination
– ECG infwall elevation with v4R Elevation,
– Echo findings of RV Infarction study
– PA Catheterization – high RA Pressure and low PCWP
• C) medical measure to stabilize
– Volume loading mantaining haemodynamics,
– Inotropes, Dobutamine is good choice
• D) typical pulmonary artery catheterization finding
– High RA pressure with low PCWP

7. a. Viral myocarditis,
b. Three specific tests
a. ECG
b. CXR
c. Cardiac enzymes
d. Echocardiography
c. Causes of death in these patients
a. Pump failure,
b. Arrythmias

9. a. Right sided heart failure due to LHF
b. Two drug regimen
a. Heart failure medication
b. Anticoagulation
c. Antiarythmic e.g amiodarone
c. Vt , cardiogenic shock

11. A) Peri partum CMP, reason is mostly idiopathic
B) Risk factor, multiparity, preclampsia, eclmapsia, african
descent, low socioecomonical status, postpartum
hypertension, tocolytics with B agonists
C) Prognosis is variable, about 70% are recovered with
normal heart function in 6 months, rest face clinical
deterioration

12. Reference Topol Textbook

14. a. Rheumatic fever, because Sydenham chorea is sole feature for RF
without any other cause
b. Diagnosis
Jones criteria major, minor
Aschoff nodules are pathognomic for diagnosis
ECG – sinus bradycardia, PR Prolongation
Labs, ESR. ASO titir raised
Echocardiography AS, MR, Carditis
Biopsies, endocarial biopsy is helpful in distinguishing from acute and chronic RF
c. Follow up required
Complications, arythmias, AF
Echo after 3 months to see the complications
Infective Endocarditis
Prophylactics for Rheumatic fever recurrence,
Prognosis poor in untreated cases

16. a. Transient constrictive pericarditis because of
chemotherapy
b. Drugs used for breast CA therapy are cardiotoxic that
impairs cardiac functions. For further go, a
multidisplinary approach is needed for this patient
c. This type of pericarditis is called transient constrictive
pericarditis and inflamation can be reduced by prompt
treatment within 3 to 6 months so that this may not
evolve to chronic constrictive pericarditis

18. a. Life style modification, add of statin
b. anticoagulation is not recommended in patients with
obesity related factors like atherosclerosis.

20. a. Patient is on the optimum medication after discharge,
however the rate of patient is 54 and B Blocker in the
treatment may further reduces the heart. It may cause
Heart Block. Need to adjust the b blocker to low dose
or shift to other agent that may not cause decrease in
Heart rate.
b. ARNI is indicated for the patients with HFrEF and
symptomatic patients who have tolerated the
ACE/ARB
This patient may not benefit from addition of ARNI

23. a. Ivabradine is If channel inhibitor newer drug that is use in Heart
failure in the patients who have tolerated B Blocker. This patient
have heart rate of 84 and exercise testing has increased to 140.
b. This patient is candidate for ivbradine because of
a. Symptomatic NYHA class
b. HR is more than 70
c. Patient has tolerated B Blocker

25. a. VT diagnosis criteria
b. Sotalol, amiodarone are used to avoid recurrence
ICD is indicated in patients with Sustained VT
Amiodaranoe and Lignocaine are agents of choice for acute sustained vt with
poor lv functions
Procainamide is reasonable in initial treatment of monomorphic VT
DCC if haemodynamically compromised patient

27. a. Risk factors
a. Modifiable risk factors, obesity, hypertension, smoking, sedentary
life style,
b. Non modifiable, age, family hx, Previous MI, DM, HTN, familial
hypercholestrolemia, prtein C, S deficiency , homocysteinuria,
Factor 5 laden deficiency, antiphospholipid syndrome,thyroid
disease
b. Drugs at discharge,
a. Aspirin, cloidogrel, statins, B Blocker, ACE if previous transmural MI,
Diuretics, CCB, nitrates if symptomatic

29. a. D/D : Pulmonary kocks, Heart failure, TIA, Mixed mitral
disease , atrial fibrillation, constrictive pericarditis,
Tuberculoma,
b. CBC, Sputum for AFB, CXR, ECG, Echo 2d & TEE in case
of mitral stenosis,ABG’s, CT Brain, CT Chest, Carotid
doppler,

31. a. WBC raised, ESR , other work up needed :Blood culture,
TEE, Cineflouroscopy
b. Staph epidermidis will be present most likely in culture
c. Condition of surgery in prosthetic valve

32. Ref Topol

34. a. D/D
a. PPCMP
b. Pulmonary Embolism
c. Mitral regurgitation
d. Criteria for diganosis is Hx & Echo findings are suggestive
of HF,
b. Standard Heart failure treatment BB, ACE/ARB.,
Diuretics, inotropes if severe HF/Cardiogenic shock
c. Indications for Biventricular Pacing
a. QRS more than 120 ms
b. Lv EF <35
c. NYHA class 3 , 4,
d. Symptomatic despite of OGMT

35. a. Diastolic dysfunctions, pericardial thickening, flattening of LV Post wall, septal
bounce, abnormal respirophasic septal shif,ivc pelthora, expiratory diastolic
flow reversal
b. Clinical signs of cardiac tamponad p443

36. a. local trauma, pneumothorax, arrhythmias, and cardiac
perforation, emphysema, infection, abscess, haematoma,
injury to main arteries, carotid artery & subclavian artery,
haemothorax, cardiac tamponad,
b. ABC, Hx, Ex, Inv, fluid challenge in case lungs are clear,
Carotid sinus massage
– Vagal maneuvers. ...
– Cardioversion. ... If haemodynamically unstable
– Medications. ... Adenosine is drug of choice if undrlying no
acessary pathway, verapamil, digoxin, BB, amiodarone in case of
wpw, flecanide safer in pregnancy.
– Catheter ablation/RFA if accessary pathway after EP study &
ruling out ACS

37. • A.
• Heart failure.
• Constrictive pericarditis (JVP increases on inspiration - called Kussmaul's sign).
• Cardiac tamponade.
• Fluid overload - eg, renal disease.
• Superior vena cava obstruction (no pulsation).
• B.

38. • A
• b

39. a. Hypothyroidism
b. Serum T3,T4,TSH
c. Detailed hx, examination, investigation (T3, T4, TSH,
ecg, echo, thyroid scan), medical management with
thyroxine and theophylline, fro cosmectic reasons and
obstructive symptoms, like dysphagia and hoarseness
of voice surgical treatment may be warranted

40. a. TOF
b. Echocardiography, Cardiac MRI (gold standard)
c. Hx, Ex, Investigation, Palliative care, Surgery(primary
treatment)
a. Total repair
b. Reintervention of Pulmonaic valve repair

42. a. Auscultatory findings of HOCM
a. S1 is norma precedeed by s4
b. S2 is normal or paradoxical split
c. Harsh cresendo decresendo murmur best heard at L sternal border
b.

43. a. Types of ASD
a. Ostium secondum 75%
b. Ostium primum 20%
c. Sino septal ASD 10%
b. Exercise intolerance, fatigue, dyspnea, svt, afib,a
flutter , paradoxical embolism causing TIA/stroke
c. Intervention is recommended if
a. Haemodynamically significant shunt, evidence of RH Dilatation,
possible paradoxical embolims and associated symptoms

44. a. Carney complex - Carney complex is a rare genetic disorder characterized by multiple benign
tumors (multiple neoplasia) most often affecting the heart, skin and endocrine system and abnormalities in skin
coloring (pigment) resulting in a spotty appearance to the skin of affected areas.
b. Classical triad of cardiac myxoma
c. Images of diagnosis
• Ecg
• Echo
• Raionucloid imaging
• CT
• CMRI

45. a. Causes of Constrictive Pericarditis
b. Lab Test
a. CBC
b. Sputum for afb
c. Esr
d. Immune studies
e. Work up for malignancy
f. Echo
g. CXR
h. CT
i. MRI

46. a) Etiology
1.Infectious
2.Non Infectious
p117

48. Clinical presentation of Myocarditis

49. • A)

50. • B) persistent benefit in mortality and morbidity. In mild to moederate HF, BB
are very much indicated as they prolong diastole for better coronary filling and
studies have proven their role in mortality reductionn. BB also decrease
sympathetic outflow and act as antianginal and anti arythmic agents. Study
has proved Metoprolos has mortality reducing agent
• C) Role of Digoxin in HF

51. P 648
Braunwald ed

52. a. Middiastolic murmur with opening snap,loud s1, pre
accentuation of sytolic murmur, diastolic rumble, loud
P2 in case of Pulmonary Htn,
b. Thromboembolic phenomenon may be the cause of
this condition in mitral valve disease, seconary to a fib
c. TTE will confirm the diagnosis and TEE will be helpful
to lcoate clot in LA and LAA

53. a. Hypertrophic Obstructive cardiomyopathy
b. Echocardiography
c. Echo
Finding
Super normal ejection frection

54. a. Note
a. Pulses Alterans - arterial pulse waveform showing alternating strong and weak beats. It is almost
always indicative of left ventricular systolic impairment, and carries a poor prognosis.
b. Pulses paradoxes- abnormally large decrease in stroke volume, systolic blood pressure and pulse
wave amplitude during inspiration. E.g cardiac tamponade, chronic sleep apnea, croup, and
obstructive lung disease (e.g. asthma, COPD).
b. CRT - is treatment to help your heart beat with the right rhythm. It uses a pacemaker to
restore the normal timing pattern of the heartbeat. The CRT pacemaker coordinates how
timing of the upper heart chambers (atria) and the lower heart chambers (ventricles)
c. Complication of Prosthetic valve - thromboembolism, prosthesis-patient mismatch,
structural valve dysfunction, endocarditis, and hemolysis

55. a. Atrial Myxoma

56. • B.

57. a. Carotid artery atherosclerosis leading to embolism
b. Carotid angiography is gold standard, however duplex
ultrasound is widely used for diagnosis
c. Treatment option
a. Medical
a. Risk modification
b. Antiplatelets
c. Statins
d. Antihypertensive
b. Surgical
a. Carotid endartectomy
c. Percutaenous carotid intervention

58. a. Non-compaction cardiomyopathy (NCC), is a rare congenital cardiomyopathy that affects
both children and adults.[1] It results from the failure of myocardial development
during embryogenesis.[During development, the majority of the heart muscle is a sponge-like
meshwork of interwoven myocardial fibers
b. Other name for this condition is, hypertrabeculation syndrome, spongy myocardium
c. Thickened endocardial layers, prominent trabeculations, deep recess, ratio compacted to non
caompacted > 2:1
d. Inflammation of heart is caused by known infectious agents, viruses, bacteria, fungi or
parasites, and by toxic materials from the environment, water, food, air, toxic gases, smoke,
and pollution, or by an unknown origin. Myocarditis is induced by infection of heart muscle
by virus like sarcoidosis and immune diseases.

59. a. Failure to relax of LV during diastole due to Stiffing of
ventricles result in abnormal ventricular filling during
diastole is called as DHF. Causes are ischemia,
hypertension, obesity, old age aortic stenosis
b. Echocardiography 2D is best diagnostic test with
Doppler used to assess characteristics of diastollic
transmitral and pulmonary venous flow pattern,
chamber size, wall thickness
c. B blocker, and diuretics, dihydropyridines CCB

60. a. Constrictive pericarditis leading to Pericardial effusion
b. Pericardial knock/rub
c. Decreased breath sounds at bases due to effusion
d. ECG will show low voltage to normal, Echo findings will be
a. Pericardial thickening
b. Flattening of LV
c. Abnormal respirophasic septal shift
d. IVC Plethora
e. Septal bounce
f. High E Velocity
g. Annulus paradoxes
Courtesy to Dr Waseem for his generous contribution for key

62. a. Complications include thromboembolism, prosthesis-patient mismatch, structural valve
dysfunction, endocarditis, and hemolysis. Prosthetic valve endocarditis, fistula formation
b. Diff bw bronchial and cardiac asthama

63. a. Hypertrophic obstructive Cardiomyopathy
b. Prominent a wave in JVP, precordial heave, displaced apical
pulse, palpable s4, bifid carotid pulse, normal s1 but after
s4, S2 may be paradoxically split, harsh cresendo
decrescendo systolic murmur ECG Findings :non specific,
Right Left atrial enlagement, Q waves in the inferolateral
leads, voltage criteria for large –ve precordial T wave, Left
axis deviation, short PR interval with slurred upstroke
c. HCM is associated with autosomal dominant inheritance
d. ECG, Echo, Doppler Echo, ETT, MRI, Cardiac Catheterization

64. a. HOCM – consequence of diminished cerebral blood
flow due to inadequate cardiac output. Commonly
associated with exertion or arrythmia
b. Findings
a. Examination Findings : raised JVP, laterally displaced apical impulse,
precordial heave, palpable S4, bifid carotid pulse, Paradoxical S2
split, harsh crescendo decrescendo systolic murmur
b. ECG :

65. c. Typically inherited with autosomal dominant pattern
d. Other test to diagnose
Ø Echocardiography
Ø Doppler Echo
Ø Exercise stress testing
Ø MRI
Ø Cardiac catheterization

66. a. Staph epidermidis
b. Indications for surgery in native valve

67. c.

68. a. Pericardial effusion leading to cardiac tamponade
b. Echo findings, presence of pericadial effusion, diastolic
collapse of RA, RV, LA, equalization of pressure of all
four chambers, loss of respiratory variations of IVC,
IVC Plethora, exaggerated variations of av inflow
c. Hx, examination, investigations, treatment ( Medical
and surgical) and treating the cause
a. Medical IV fluids, ionotropes if hypotensive
b. Surgical, urgent pericardiocentesis is most important treatment method, pig
tale insertion for continuous drainage of fluids afterward

69. a. Life long anticoagulation
b. list of points
c. Interpretation

70. Ref Topol p 316

71. a. Pulmonary embolism/Fat Embolism
b. Detailed hx, examination, inv, treatment, non pharmacological meausres(
elastic stocking, early mobilization, intermittent pneumatic compression, medical
( anticoagulation , iv fluids, heparin, thrombolytic/fibrinolytic) and
interventional (IVC filter) and surgical embolectomy VTE Prophylaxis with
Rivaroxaban/Enoxaparin s/c
c. Cardiac enzymes, ECG(S1Q3T3, sinus tachycardia earliest, RBBB transient),
BNP, ABG’s, D Dimers, CXR, Echo(Dilated RA RV PA Pulmonary plethora
McConnel sign), Doppler Echo (TR), VQ scan, CTPA (standard modality of inv),
Pulmonary angiography( Gold standard), MRA alternative to CT

72. a. HOCM
b. Risk factors asses

73. c. Medical (a blocker, BB, CCB nondihydropyridines, ACE
and ARBS have unclear role, Non pharmacological
(septal Myomectomy, Alcohol septal ablation), Dual
chamber pacing, Risk factor stratification for sudden
cardiac death and implantation of ICD acc to risk factor
stratification
Ref Topol p116

75. a. CHADSVASC = 9 , annual risk 15.2
b. HAS BLED score is 3, and is of high risk of bleeding
c. Rivaroxaban , Apixaban
Has bled
interpre
t

78. a. Braod QRS complex, bradycardia, sine wave of hyperkalemia,
b. Valsartan, Epleronone, Sacubitril causing potassium retention and
hyperkalemia
c. Stopping or switching the culprits drugs, calcium gluconate iv as
cardiotonic, B2 agonist salbutamol inhalation, infusion pump of
insulin with glucose iv , ion exchange resins kay axelate, dialysis,

80. a. Sinus bradycardia, siuns pauses
b. Carotid hypersensitivity syndrome
c. Medical treatment with a agonist phenylepherine,
Transvenous dual chamber pacemaker
Courtesy to Dr Waseem for his generous contribution for key

82. a. Prosthetic valve thrombosis
b. Echo findings
c. Thrombolysis/fibrinolysis
d. Redo surgery after stabilization with explanation ,
surgery (debridement and valve replacement for left
sided) if thrombolysis is unsucessful

85. a. LA Myxoma, (older age and no previous cardiac
disease)
b. MS
c. ECHO, Doppler Echo, CT and MRI
d. Surgical Resection

86. Ref topol p 456

87. a)
b)

89. a. Symptomatic patient NYHA FC 3,4 HF, moderate server MS
favorable for PTMC in the absence of Mod or servere MR ,
subvalvular disease and clot in LAA
b. Valvular a fib - Mod to severe MS, prosthetic mitral valve,
MVP with atrial fibrillation. If there is old hx of TIA, MS with
severe pulmonary hypertension, clot in LA or LAA
c. A fib, pulmonary hypertension, TIA, CVA, pul edema,
dysphagia, hoarseness of voice due to compression of left
recurrent laryngeal nerve.
d. LA myxoma, Mitral stenosis, ASD, VSD, TS

90. a. Tricuspid IE
b. CBC, ECG, Culture, Echo, Doppler echo, TEE, anemia,
ESR, CRP, microhematuria in urine analysis
c. Antibiotics acc to C&S, antipyretics, surgery

91. a. stop drug causing, ABC, ABG’s , insulin infusion with
glucose, Ventolin nebs, Postassium ion exchange resins
i.e keyaxelate, Calcium gluconate for cardiac toxicity,
dialysis if not responded
b. PR depression , wide QRS, sine wave, severe
bradycardia or av blcoks,
c. VF, VT, Asystole, heart blocks, metabolic acidosis

92. ****

93. a. Detailed hx, examination, investigation, Echo,
thrombolysis, thrombectomy with balloon angioplasty
is the preferred choice of treatment .
b. Acute stent thrombosis,
c. possible due to drug discontinuation, drug resistance,
or procedure related factors (mal position,
undersizing, edge dissection)
d. Proper sizing, pre dilation, proper placement of stent.
Infusion glycogen 2b 3a inhibitor, changing clopidogrel
with prasugrel or ticagrelor, patient education

94. Q1 – 60 years old male who has AWMi 3 months ago, presented with sob NYHA3,
Ecg shows old ant wall mi, on M Mod echo reveals dilated LA 55mm, EF45%.
Doppler examination
1. what is likely pulmonary wedge pressure
2 how would you explain Doppler echo in this patient
3 How will you manage the case

95. Q 2 - Write short note on risk factors for CAD in
woman and their modification?

96. Q3 – 32 year old female with multiparity, presented in ER with severe chest pain
and peripheral edema, complains of palpitation after 2 weeks of delivery.
1. what is most likely diagnosis
2 what finding you will expect on physical examination
3 what would her ecg reveal
4 how will you manage this case
1) Ac Pulmonary embolism
2) Physical examination reveals, sob, orthopnea, pnd, chest
pain, sinus tachycardia, Hypotension,
3) Sinus tachycardia, s1q3t3, transient RBBB
4) Hx, examination, investigation, stabilization, risk factor
stratification, anticoagulation, systemic embolization,
catheter based therapies, surgical embolectomy, IVC filters
for long term management

97. Q4 – 62 year male with massive ALWMI, on 6th day drops his bp form 160 to
100 sbp and feels week , on examination pansystolic murmur heard over the L
sternal edge and basal crepitations.
1 what complications has taken place VSD
2 what abnormality you find in ecg
3 how will you manage this patient
1. VSR
2. Ecg will show av nodal or infranodal conduction delay in
40% of the patients
3. Hx, examination , investigation, stablization ,
surgical closure is the treatment of choice
vasodilator therapy, mechanical support, IABP
percutaneous closure of vsr

98. Q5 write short note on specific complications of prosthetic valve along with brief
management of each complication?
• Atrial fibrillation
• Conduction disturbances
• Endocarditis
• Hemolysis
• Thrombosis
• Dehiscence
• Patient prosthesis mismatch
• Pannus formation
• Embolic stroke
• Mechanical failure

99. Q6 – 48 yeasr old man heave smoker, with ho intermittant
claudication had ant wall MI 10 days ago, presented with severe
angina, angiography shows TVD and depressed LV. He is advised CABG
1 how will you counsel the risk of surgery?

100. Q7 – a 60 years ol DM HTN, on irregular medication presents in ER with
sweating , dyspnea in the middle of night, on examination bilateral rales, pulse
110, unable to lie flat, ecg shows QRS 120ms RBS normal, echo reveals EF
32%.
1what is your diagnosis
2how will you manage in ER
3 Long term solution CRT
1. Acute heart failure
2. Acute management includes stabilization with diuretics,
oxygenation, nebulization, and long term management on
ACE/ARB, B Blocker, Nitroglycerine, Sodium prusside,
digoxin, ivabradine,
3. Long term management for this patient , if medical therapy
fails , recommendation for CRT

101. Q 8 write notes on
1 CRT with special ref to CRT P
2 CRT p , CRT D
3 Indication of ICD
1. A CRT-P is an implantable cardiac resynchronization therapy
(CRT) pacemaker for patients with heart failure. The device
monitors the heart's rhythm, detects irregularities and
corrects them with electrical impulses. A CRT-D is a
special device for heart failure patients who are also at high
risk for sudden cardiac death. While functioning like a
normal pacemaker to treat slow heart rhythms, a CRT-D
device also delivers small electrical impulses to the left and
right ventricles to help them contract at the same time

102. • 3.

103. Q9 – cardiac catheterization is relatively safe but has well defined risk of
morbidity and mortality
1 what are risk and complication of Cardiac catheterization
2 what are relative contraindication to diagnostic catheterization
• 1.
• Page 779 for complication of LHC

104. • 2.

105. Q10 – write short note on CCF and mention latest treatment
modalities
1. Congestive cardiac failure (CCF), also known as congestive heart failure (CHF)
or simply heart failure, refers to the clinical syndrome caused by inherited or
acquired abnormalities of heart structure and function, causing a
constellation of symptoms and signs that lead to decreased quality and
quantity of life.
2. Treatment modalities of CHF. Oxygenation, Nitroglycerine, Sodium
nitroprusside, nesiritide, Diuretics, Ultrafilteration , vasopressin antagonist,
Temporary mechanical circulatory support,
3. use of ACE/ARBs. B Blocker/aldosterone
antagonist/Digoxin/ivabradine/ARNI/Electrolyte supplementaion as chronic
mantainace therapy
4. Device therapy ICD, CRT D/P
5. Mechanical circulatory support and Orthoptic heart transplantation are
currently under trials and reserved for NHYA Class 4

114. b)

115. b)
a)

116. a)

117. b)

118. a)

119. b)

120. a. Flash pulmonary edema is the development of respiratory distress related to the rapid accumulation
of fluid within the lung interstitium (the tissue and space around the air sacs of the lungs) secondary to
elevated cardiac filling pressures
b. .
c. Adenosine is the drug of choice in haemodynamically stable patients, DCC is the treatment of choice in
all haemodynamically compromised patients,
b)

121. causes of ST-segment elevation include left
ventricular hypertrophy, pericarditis, ventricular-
paced rhythms, hypothermia, hyperkalemia and
other electrolyte imbalances, and left ventricular
aneurysm, LBBB pseudo elvation
a)
b)

122. a)

123. b)

124. a)
b)

125. a)

126. b)

128. a. WBC raised and ESR on CBC, CXR showing puld edema
b. Staph epidermidis in blood culture
c. Bacteremia after OMGT, symptomatic heart failure
patients, perivalvualr leak causing pul edema

131. • Hx, Ex, labs, cardiac enzyemes, echo cardiography,
doppler echo, Aspirin, clopidogrel, morphine, oxygen,
risk assessment, monitoring, P PCI/ thrombolysis/
fibrinolysis, post fibrionolysis assessment, monitoring
and standard anti ischemic therapy and follow up

132. a)

133. b)

135. a. Hyperlipidemia, hypertenison, obesity, tobaco,
sedentary lifestyle,
b. Dual antiplatelets, statin, B Blocker, CCB, ACE/ARB,
Nitrates

137. a. Mitral stenosis, mixed mitral disease, Pulmonary
kocks, RHD, CHF, rarely LA Myxoma, atrial fibrillation,
embolic phemomenon
b. Detailed hx, examination, investigation baseline,TFT,
sputum for afb, cultures and senistivity, echo, doppler
echo, carotid doppler, CT Brain, TEE, stablization of the
patient, definite management of treating the
underlying pathology

139. Flecanid is the choice of drug for cardio version to normal sinus
rythem in the presence of no structural heat disease.
a)
b)
c)

140. B Blocker, CCB, ACE/ARB, Nitriglycerine, Diuretics, combination of hydralazine and nitrates
a)
b)

143. a. Pulmonary hypertension,

144. c) Management includes treating symptoms and
preventing sudden cardiac death
• A blcoker, CCB, Disopyramide, ACE, ARB, surgery ( septal
myomectomy, alcohol septal ablation, ICD)
a)
b)

145. a)
b)

146. c)

147. a)

148. b)
c)

149. a. Carney complex is a rare genetic disorder characterized by multiple benign tumors (multiple neoplasia)
most often affecting the heart, skin and endocrine system and abnormalities in skin coloring (pigment)
resulting in a spotty appearance to the skin of affected areas
b. The classic triad includes embolism, intracardiac obstruction, and constitutional symptoms.
Approximately 80% of individuals present with one component of the triad, yet up to 10% may be
asymptomatic even with mitral myxomas, arising from both atrial and ventricular sides of the anterior
mitral leaflet
c. Echo/TTE, TEE, CT , PET, Cardiac MRI

150. A, b )
c)
hypotenison/hypert
ension, heamorhagic
cva, old age, poor
socio ecnomical
status

151. A&B )

153. a. Jones criteria
b. B Blocker improves heart abilit to relax, decrease production of
harmful substance that cause HF, coronay filling improvement,
mortality reducing agent, improves heart pumping ability. In general, it
improves LV functions, decrease hospital admission and arrythmias
source: webmed
c. Digoxin

154. a. Opening snap, loud S1, low pitched rumbling Mid
diastolic murmur of Mitral stenosis
b. Atrial fibrillation leading to embolic phenomenon
c. TTE/TEE is the test of choice for diagnosis and may
show valvular pathology and LAA thrombus
Courtesy to Dr Arif & Dr Waseem for his generous contribution for key

155. a)

157. b)

158. c)

159. a. Most of the time, constrictive pericarditis occurs due to things that cause inflammation to develop
around the heart, such as: Heart surgery. Radiation therapy to the chest. Tuberculosis in Pakistan.
Other causes include, idiopathic, autoimmune diseases, neoplastic diseases, uremic pericarditis
b. Clinical Features
c. ECG & Echo Findings

160. Echo
Findings

161. a. Specialized strategies for patients with refractory HFrEF include intravenous vasodilator and
inotropic therapy, ivrabradine, ARNI, CRT , ultrafiltration, mechanical circulatory
support, surgery including cardiac transplantation, and palliative care.
b. Uncontrolled high blood pressure can lead to complications including: Heart attack or stroke. High blood
pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart
attack, stroke or other complications. Aneurysm, SAH, Retinal Haemorrhage, ARF,
c. Systolic vs Diastolic HF
– Systolic heart failure happens when the left ventricle of your heart can’t contract completely. That means your heart won’t
pump forcefully enough to move your blood throughout your body in an efficient way.
– Diastolic heart failure occurs when your left ventricle can no longer relax between heartbeats because the tissues have become
stiff. When your heart can’t fully relax, it won’t fill up again with blood before the next beat.

162. a. Short notes
a. PULSUS ALTERNANS is a physical finding with arterial pulse waveform showing alternating strong and weak
beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis
b. PULSUS PARADOXUS, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke
volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less
than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus.
b. CARDIAC RESYNCHRONIZATION THERAPY (CRT) is treatment to help your heart beat with
the right rhythm. It uses a pacemaker to restore the normal timing pattern of the heartbeat.
The CRT pacemaker coordinates how timing of the upper heart chambers (atria) and the
lower heart chambers (ventricles).
c. COMPLICATIONS include thromboembolism, prosthesis-patient mismatch,
structural valve dysfunction, endocarditis, and hemolysis

163. • Tachy arythmias
• VSR
• Acute MR
ventricular free wall rupture
• Ventricular pseudoaneurysm
• Ventricular aneursym
• RV failure
• LV Failure
• Dynamic LVOT Obstruction
• Embolic complications
• Inflamatory complications e.g Dressler syndrome

164. Clincial
Features
Investig

165. Treatment