Q1095. A 65-year-old man is admitted with an extensive anterior STEMI and undergoes successful primary PCI. On the third day, he suddenly develops severe breathlessness, hypotension and pulmonary oedema. His blood pressure is 82/54 mmHg, and a new harsh pansystolic murmur with a palpable thrill is heard along the lower left sternal border. Echocardiography identifies a new ventricular septal defect with left-to-right flow.
Which right-heart catheterisation finding would most strongly support this diagnosis?
A. Giant V waves in the pulmonary capillary wedge pressure trace without a right-sided oxygen saturation step-up.
B. Equalisation of diastolic pressures in all cardiac chambers with a dip-and-plateau pattern.
C. An oxygen saturation step-up between the right atrium and right ventricle.
D. A markedly reduced pulmonary capillary wedge pressure with no intracardiac shunt.
E. A prominent right atrial pressure waveform without increased right ventricular oxygen saturation.
Which right-heart catheterisation finding would most strongly support this diagnosis?
A. Giant V waves in the pulmonary capillary wedge pressure trace without a right-sided oxygen saturation step-up.
B. Equalisation of diastolic pressures in all cardiac chambers with a dip-and-plateau pattern.
C. An oxygen saturation step-up between the right atrium and right ventricle.
D. A markedly reduced pulmonary capillary wedge pressure with no intracardiac shunt.
E. A prominent right atrial pressure waveform without increased right ventricular oxygen saturation.
Q1096. A 63-year-old woman presents with two hours of central chest pain and sweating. Her pulse is 88 beats/min and blood pressure is 132/80 mmHg. The 12-lead ECG demonstrates 3 mm horizontal ST-segment depression in leads V1–V3, with tall, broad R waves and upright T waves in V2–V3. There is no ST-segment elevation in any of the 12 standard leads. These changes raise suspicion of an acute myocardial infarction that may be poorly represented on the standard ECG.
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What is the most appropriate next step to establish the ECG diagnosis?
Anonymous Quiz
7%
A. Arrange CT pulmonary angiography to exclude pulmonary vascular obstruction.
56%
B. Record posterior chest leads V7–V9 to identify posterior ST elevation.
19%
C. Repeat the standard ECG after an exercise stress test.
15%
D. Record right-sided chest leads V3R–V6R to investigate right ventricular infarction.
4%
E. Wait for the three-hour troponin result before obtaining additional ECG leads.
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شوفوا يا جماعة الـ LAD
ينقسم Septal و Anterior
لو لقينا الـ ECG changes في
V1 - V2 = Septal
V3 - V4 = Anterior
لو لقيناه في VV1- V4
معناها Anteroseptal STEMI ونشكوا ان LAD متصكر
معناها الجزء المتضرر من القلب هو Left ventricle مع interventricluar septum
ينقسم Septal و Anterior
لو لقينا الـ ECG changes في
V1 - V2 = Septal
V3 - V4 = Anterior
لو لقيناه في VV1- V4
معناها Anteroseptal STEMI ونشكوا ان LAD متصكر
معناها الجزء المتضرر من القلب هو Left ventricle مع interventricluar septum
Q1105. A 45-year-old man presents with a 2-day history of sharp retrosternal chest pain that becomes worse during deep inspiration and when lying flat. The pain improves when he sits forward. He reports a recent history of fever, sore throat and general malaise. Examination reveals a pericardial friction rub. ECG shows widespread concave ST-segment elevation, while serial high-sensitivity troponin measurements show no significant rise or fall.
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Which is the most likely diagnosis?
Anonymous Quiz
0%
A. Acute ST-elevation myocardial infarction involving multiple coronary territories.
91%
B. Acute pericarditis causing widespread inflammatory ST-segment changes.
3%
C. Pulmonary embolism causing acute right ventricular strain and ischaemia.
3%
D. Aortic dissection causing acute coronary malperfusion and chest pain.
3%
E. Unstable angina caused by an acute coronary atherosclerotic plaque.
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