PANCE Cardiovascular System 4 — Questions and Answers
Question 1: A 65-year-old man with hypertension and diabetes presents with exertional dyspnea and preserved ejection fraction (60%). BNP is elevated. What is the most likely diagnosis?
- Dilated cardiomyopathy
- Heart failure with preserved ejection fraction (HFpEF) (Correct answer)
- Restrictive cardiomyopathy
- Constrictive pericarditis
Correct answer: Heart failure with preserved ejection fraction (HFpEF)
HFpEF is characterized by symptoms of heart failure with EF ≥50%, commonly seen in elderly patients with hypertension and diabetes who have impaired diastolic relaxation.
Question 2: A 40-year-old woman presents with exertional dyspnea and a loud S1 with an opening snap. Echocardiogram shows a mitral valve area of 1.2 cm². What is the preferred intervention?
- Mitral valve replacement
- Percutaneous mitral balloon valvuloplasty (Correct answer)
- Beta-blocker therapy alone
- Anticoagulation alone
Correct answer: Percutaneous mitral balloon valvuloplasty
Percutaneous mitral balloon valvuloplasty is the procedure of choice for symptomatic severe mitral stenosis with favorable valve morphology (pliable, non-calcified leaflets).
Question 3: A 30-year-old marathon runner collapses during a race. His ECG shows deep T-wave inversions in V1-V4 and epsilon waves. What is the most likely diagnosis?
- Hypertrophic cardiomyopathy
- Brugada syndrome
- Arrhythmogenic right ventricular cardiomyopathy (ARVC) (Correct answer)
- Long QT syndrome
Correct answer: Arrhythmogenic right ventricular cardiomyopathy (ARVC)
ARVC is characterized by epsilon waves, T-wave inversions in right precordial leads, and fatty replacement of the right ventricular myocardium, causing ventricular arrhythmias.
Question 4: A patient post-MI develops a new harsh holosystolic murmur at the left sternal border with a thrill. Echo shows a step-up in oxygen saturation from right atrium to right ventricle. What is the diagnosis?
- Acute mitral regurgitation
- Ventricular septal defect (Correct answer)
- Papillary muscle rupture
- Free wall rupture
Correct answer: Ventricular septal defect
Post-MI ventricular septal defect causes a left-to-right shunt with oxygen step-up from RA to RV and presents with a harsh holosystolic murmur and thrill.
Question 5: A 58-year-old man with peripheral artery disease has an ankle-brachial index (ABI) of 0.55. He has rest pain. Next best step?
- Start cilostazol and increase walking
- Anticoagulation with heparin
- Referral for revascularization (Correct answer)
- Compression stockings
Correct answer: Referral for revascularization
An ABI <0.6 with rest pain indicates critical limb ischemia (CLI), which requires urgent revascularization to prevent limb loss.
Question 6: A 25-year-old woman with MVP presents with palpitations. Holter monitor shows frequent PVCs. She is anxious about her condition. First-line treatment is:
- Flecainide
- Beta-blocker (Correct answer)
- Catheter ablation
- Amiodarone
Correct answer: Beta-blocker
Beta-blockers are first-line for symptomatic PVCs in MVP as they suppress ectopy, reduce anxiety-triggered adrenergic activity, and have a favorable safety profile.
Question 7: Which EKG pattern is associated with right ventricular strain in pulmonary embolism?
- Tombstone ST elevation in V1-V4
- S1Q3T3 pattern (Correct answer)
- Delta wave in lateral leads
- Osborn J-waves
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) reflects acute right ventricular strain from massive pulmonary embolism.
PANCE Cardiovascular System 4
A 65-year-old man with hypertension and diabetes presents with exertional dyspnea and preserved ejection fraction (60%).
BNP is elevated.
What is the most likely diagnosis?