Which process accounts for most myocardial ischemia cases?

A) Coronary vasculitis

B) Atherosclerotic narrowing

C) Septal congenital defect

D) Primary myocardial infection

B. Atherosclerotic narrowing

A patient has severe substernal chest pain from transient myocardial ischemia, but cardiac myocytes do not undergo necrosis. What is this syndrome called?

A) Myocardial infarction

B) Stable myocarditis

C) Angina pectoris

D) Coagulative necrosis

C. Angina pectoris

An acute thrombotic occlusion of which coronary artery is classically called the “widowmaker”?

A) RCA

B) LCX

C) PDA

D) LAD

D. LAD

A patient has prolonged coronary ischemia causing death of cardiac muscle cells. Which diagnosis best describes this event?

A) Angina pectoris

B) Myocardial infarction

C) Prinzmetal angina

D) Sick sinus syndrome

B. Myocardial infarction

Which referred pain pattern is most typical for angina pectoris?

A) Right shoulder and wrist

B) Left arm or jaw

C) Epigastrium and umbilicus

D) Right flank and groin

B. Left arm or jaw

A patient with recurrent angina is started on medications that reduce ischemic symptoms by improving coronary supply-demand balance. Which front-line treatment pair matches these notes?

A) ACE inhibitor and aspirin

B) Digoxin and furosemide

C) CCBs and nitroglycerin

D) Heparin and warfarin

C. CCBs and nitroglycerin

A woman has episodic myocardial ischemia at rest due to transient coronary artery spasm rather than fixed exertional narrowing. Which diagnosis best fits?

A) Stable angina

B) Prinzmetal variant angina

C) Myocardial rupture

D) Sick sinus syndrome

B. Prinzmetal variant angina

A patient’s chest pain episodes occur from coronary artery spasm and may happen without exertion. Which mechanism best explains the ischemia?

A) Fixed 70% plaque narrowing

B) Coronary vasospasm

C) Ventricular septal rupture

D) Chronic venous congestion

B. Coronary vasospasm

Which patient group is at increased risk for coronary artery disease due to loss of estrogen-associated protection?

A) Premenopausal adolescents

B) Postmenopausal women

C) Pediatric females

D) Pregnant teenagers

B. Postmenopausal women

During myocardial ischemia, impaired aerobic metabolism causes buildup of a noxious metabolite in cardiac myocytes. Which metabolite is emphasized?

A) Lactate

B) Bilirubin

C) Creatinine

D) Ammonia

A. Lactate

A coronary occlusion begins causing irreversible ischemic myocyte injury. Which myocardial region is injured first?

A) Epicardial surface

B) Subendocardial zone

C) Papillary muscle tip only

D) Pericardial reflection

B. Subendocardial zone

A patient has an RCA occlusion and develops evidence of left ventricular myocardial injury. Which statement is most accurate?

A) RCA cannot affect LV

B) RCA always spares septum

C) RCA can damage LV

D) RCA affects only atria

C. RCA can damage LV

A coronary artery supplies the cardiac apex, anterior left ventricle, and anterior two-thirds of the interventricular septum. Which vessel is described?

A) RCA

B) LAD

C) LCX

D) PDA

B. LAD

A full-thickness myocardial infarct occurs after occlusion of a major surface coronary vessel. Which infarct-vessel pairing is correct?

A) Transmural, epicardial vessel

B) Subendocardial, pulmonary vessel

C) Transmural, endocardial capillary

D) Nontransmural, cardiac vein

A. Transmural, epicardial vessel

An infarct involves the full thickness of the ventricular wall because an epicardial coronary artery is occluded. Which infarct type is this?

A) Nontransmural infarct

B) Transmural infarct

C) Watershed infarct

D) Liquefactive infarct

B. Transmural infarct

A patient develops a nontransmural myocardial infarct in a partially occluded coronary artery. Which mechanism best matches this pattern?

A) Plaque disruption with thrombus

B) Pure coronary vasospasm

C) Septal congenital shunting

D) Viral myocardial invasion

A. Plaque disruption with thrombus

This leads to partial occlusion and causes non-ST elevation myocardial infarction (NSTEMI).

Why can thrombus formation in a partially occluded coronary artery precipitate infarction?

A) It reverses atherosclerosis

B) It restores coronary flow

C) It effectively completes occlusion

D) It prevents platelet activation

C. It effectively completes occlusion

Across myocardial infarction cases, which coronary vessel is most commonly involved?

A) LAD

B) RCA

C) LCX

D) PDA

A. LAD

In most people, which artery supplies the posterior one-third of the interventricular septum?

A) LAD

B) LCX

C) RCA

D) Internal thoracic

C. RCA

A patient dies 2–3 hours after a suspected MI, before gross necrosis is obvious. Which stain can help identify necrotic myocardium?

A) Congo red

B) PAS stain

C) Oil red O

D) Triphenyltetrazolium chloride

D. Triphenyltetrazolium chloride

A myocardial infarct is examined histologically after prolonged ischemia. Which necrosis pattern is expected in heart tissue?

A) Liquefactive necrosis

B) Coagulative necrosis

C) Caseous necrosis

D) Fat necrosis

B. Coagulative necrosis

A patient arrives with an acute MI. What is the first therapeutic goal?

A) Salvage myocardium by reperfusion

B) Prevent all future plaques

C) Diagnose chronic stable angina

D) Increase infarct demarcation

A. Salvage myocardium by reperfusion

A patient receives thrombolysis for an acute coronary clot. Shortly after flow returns, oxidative and inflammatory damage worsens myocyte injury. What complication occurred?

A) Prinzmetal angina

B) Reperfusion injury

C) Sick sinus syndrome

D) Stable exertional ischemia

B. Reperfusion injury

A patient with an inferior MI has nausea, vomiting, and diaphoresis. These symptoms suggest damage involving which ventricular region?

A) Anterior septal ventricle

B) Posteroinferior ventricle

C) Right atrial appendage

D) Lateral papillary base

B. Posteroinferior ventricle

Which symptom triad in acute MI points toward posteroinferior ventricular involvement in these notes?

A) Fever, cough, hemoptysis

B) Diaphoresis, nausea, vomiting

C) Syncope, seizure, aphasia

D) Jaundice, pruritus, ascites

B. Diaphoresis, nausea, vomiting

A patient has a transmural myocardial infarction with acute ST elevations on ECG. Which infarct-ECG pairing is correct?

A) Transmural infarct, STEMI

B) Transmural infarct, NSTEMI

C) Subendocardial infarct, STEMI

D) Subendocardial infarct, pericarditis

A. Transmural infarct, STEMI

A patient has myocardial necrosis limited mainly to the subendocardial zone without ST-segment elevation. Which infarct classification best fits?

A) STEMI

B) NSTEMI

C) Prinzmetal angina

D) Brugada syndrome

B. NSTEMI

Cardiac troponin is expected to begin rising after what time interval?

A) 10–20 minutes

B) 2–4 hours

C) 12–18 hours

D) 3–5 days

B. 2–4 hours

After an acute myocardial infarction, cardiac troponin rises within hours. When does it typically peak?

A) 4–6 hours

B) 8–12 hours

C) 24–48 hours

D) 7–10 days

C. 24–48 hours

A patient has a STEMI rather than an NSTEMI. Which complication category is relatively more common in STEMIs?

A) Arrhythmias

B) Renal stones

C) Biliary colic

D) Peptic ulcers

A. Arrhythmias

After an MI, two patients have similar infarct sizes but different long-term outcomes. Which factor best indicates a good prognosis?

A) Complete PR prolongation

B) Retention of LV function

C) Higher lactate accumulation

D) Persistent ventricular fibrillation

B. Retention of LV function

A patient’s SA node is damaged, and pacemaker activity shifts to junctional foci near the AV node. What is this condition called?

A) Long QT syndrome

B) Sick sinus syndrome

C) Brugada syndrome

D) Prinzmetal angina

B. Sick sinus syndrome

An ECG shows progressive elongation of the PR interval, indicating delayed atrioventricular conduction. What general conduction abnormality is suggested?

A) Ventricular fibrillation

B) Heart block

C) Short QT syndrome

D) Coronary vasospasm

B. Heart block

Long QT syndrome, short QT syndrome, and Brugada syndrome are grouped together because they primarily involve abnormal ion channel function. What are they called?

A) Cardiomyopathies

B) Channelopathies

C) Valvulopathies

D) Vasculitides

B. Channelopathies

A young man has syncope with a Brugada ECG pattern but no structural heart disease. Which ECG combination is classically associated?

A) ST elevation and RBBB

B) PR shortening and LVH

C) ST depression and LBBB

D) QT shortening and AV block

A. ST elevation and RBBB

A patient experiences sudden cardiac death. Which ECG rhythm most commonly precedes this event?

A) First-degree AV block

B) Ventricular fibrillation

C) Sinus bradycardia

D) Atrial flutter

B. Ventricular fibrillation

An adult with chronic systemic hypertension develops thickening of the left ventricular wall. What is the most common cause of LVH?

A) Pulmonary embolism

B) Hypertension

C) Tricuspid stenosis

D) Chronic bronchitis

B. Hypertension

A patient with long-standing elevated systemic arterial pressure develops increased left ventricular wall thickness. Which mechanism best explains the hypertrophy?

A) Pressure overload on LV

B) Volume loss from RV

C) Pulmonary venous spasm

D) Coronary plaque regression

A. Pressure overload on LV

What is the most common cause of RVH?

A) Systemic hypertension

B) Lung disorder causing PH

C) LAD atherosclerosis

D) Mitral valve prolapse

B. Lung disorder causing PH

A patient with pulmonary hypertension secondary to chronic lung disease develops ventricular hypertrophy. Which chamber is most directly affected?

A) Left atrium

B) Left ventricle

C) Right ventricle

D) Right atrium

C. Right ventricle

Which distinction separates angina from MI?

A) Angina lacks myocyte necrosis

B) Angina requires transmural necrosis

C) MI lacks prolonged ischemia

D) MI lasts under 15 seconds

A. Angina lacks myocyte necrosis

A patient has fixed coronary narrowing, exertional chest pain, lactate buildup, and no necrosis. Which diagnosis best integrates these findings?

A) Stable angina pectoris

B) Sick sinus syndrome

C) Ventricular fibrillation

D) Right ventricular hypertrophy

A. Stable angina pectoris

A coronary occlusion produces full-thickness necrosis and ST elevations. Which artery type is most likely acutely occluded?

A) Epicardial coronary artery

B) Pulmonary capillary

C) Endocardial venule

D) Coronary sinus branch

A. Epicardial coronary artery

A patient develops acute ventricular septal defect after myocardial infarction. Which direction of blood flow is expected immediately after rupture?

A) LV to RV

B) RV to LV

C) RA to LA

D) Aorta to LV

A. LV to RV

Several days after an MI, a patient develops acute pulmonary edema and a new systolic murmur due to rupture of a left ventricular papillary muscle. Which valve lesion is most likely

A) Aortic stenosis

B) Tricuspid regurgitation

C) Mitral regurgitation

D) Pulmonic stenosis

C. Mitral regurgitation

the papillary muscle that does the chorade tendinae strabilization and opening of the mitral leaflets is messed up

Which mechanical complication of MI is described as relatively least common in these notes but causes acute severe mitral regurgitation when it occurs?

A) Free-wall rupture

B) Papillary muscle rupture

C) Ventricular aneurysm

D) Mural thrombus

B. Papillary muscle rupture

A post-MI patient has free-wall rupture contained by adherent pericardium, forming a localized hematoma that communicates with the ventricular cavity. What is this lesion?

A) True ventricular aneurysm

B) Mural thrombus

C) False aneurysm

D) Infarct expansion

C. False aneurysm

Why is a post-MI false aneurysm clinically dangerous despite temporarily containing free-wall rupture?

A) It blocks AV conduction

B) It often still ruptures

C) It prevents LV filling

D) It causes aortic stenosis

B. It often still ruptures

A late complication of transmural infarction produces a ventricular wall outpouching bounded by scarred myocardium that bulges during systole. Which lesion is present?

A) False aneurysm

B) Mural thrombus

C) Ventricular septal rupture

D) True ventricular aneurysm

D. True ventricular aneurysm

Which feature best distinguishes a true ventricular aneurysm from a false aneurysm after MI?

A) No ventricular communication

B) Bounded by scarred myocardium

C) Made only of thrombus

D) Usually ruptures immediately

B. Bounded by scarred myocardium

A patient develops sharp chest pain and pericardial inflammation on the second or third day after a transmural MI. Which complication is most likely?

A) Cor pulmonale

B) Mural thrombus

C) Post-MI pericarditis

D) Sick sinus syndrome

C. Post-MI pericarditis

Early post-MI pericarditis after transmural infarction is best explained by which mechanism?

A) Underlying myocardial inflammation

B) Acute pulmonary hypertension

C) Mitral valve calcification

D) Primary atrial channelopathy

A. Underlying myocardial inflammation

A post-MI patient develops thinning, stretching, and dilation of the necrotic infarcted wall segment. Which complication is described?

A) Ventricular remodeling

B) Infarct expansion

C) Sick sinus syndrome

D) False aneurysm

B. Infarct expansion

Which infarct location is especially associated with infarct expansion in these notes?

A) Posterior RV infarct

B) Inferior atrial infarct

C) Lateral wall infarct

D) Anteroseptal infarct

D. Anteroseptal infarct

A patient with abnormal contraction of an infarcted ventricular wall develops intracardiac stasis and endocardial damage, creating a thrombogenic surface. Which complication is most likely?

A) Acute VSD

B) Mural thrombus

C) Long QT syndrome

D) Mitral stenosis

B. Mural thrombus

Mural thrombus after myocardial infarction is most directly promoted by which combination?

A) Hyperkalemia and hypoxia

B) Stasis and endocardial damage

C) Bradycardia and valve calcification

D) Vasospasm and pericarditis

B. Stasis and endocardial damage

After an MI, noninfarcted ventricular segments undergo hypertrophy and dilation to maintain hemodynamics. What is this process called?

A) False aneurysm

B) Ventricular remodeling

C) Papillary rupture

D) Paroxysmal rhythm

B. Ventricular remodeling

Why can ventricular remodeling eventually become harmful despite initially helping cardiac output?

A) It lowers oxygen demand

B) It removes scar tissue

C) Dilation raises oxygen demand

D) It prevents mural thrombus

C. Dilation raises oxygen demand

Which medication class can inhibit or reduce maladaptive ventricular remodeling after MI?

A) ACE inhibitors

B) Loop diuretics

C) Calcium supplements

D) Beta-lactams

A. ACE inhibitors

A patient with accumulated infarcts develops progressive congestive heart failure, cardiomegaly, LV hypertrophy, and LV dilation. Which diagnosis best fits?

A) Cor pulmonale

B) Chronic ischemic heart disease

C) Brugada syndrome

D) Acute Dressler syndrome

B. Chronic ischemic heart disease

Chronic ischemic heart disease causes progressive congestive heart failure through which mechanism?

A) Repeated ischemic injury accumulation

B) Primary pulmonary valve stenosis

C) Isolated atrial channelopathy

D) Acute right-to-left shunting

A. Repeated ischemic injury accumulation

Which histologic pattern best matches chronic ischemic heart disease?

A) Caseating granulomas

B) Hypertrophy, vacuolization, fibrosis

C) Liquefactive necrosis

D) Amyloid without myocyte hypertrophy

B. Hypertrophy, vacuolization, fibrosis

An arrhythmia originates from irritable foci in either the right or left atrium. Which term describes its anatomic origin?

A) Ventricular

B) Junctional

C) Supraventricular

D) Fascicular

C. Supraventricular

What is the most common cause of rhythm disorders involving the cardiac conduction system?

A) Ischemic injury

B) Vitamin deficiency

C) Valve calcification

D) Urea retention

A. Ischemic injury

How can ischemic injury cause rhythm disorders in the heart conduction system?

A) Direct damage or chamber dilation

B) Increased bile acid deposition

C) Reduced skeletal muscle tone

D) Primary renal salt loss

A. Direct damage or chamber dilation

An ECG shows an elongated PR interval with every atrial impulse still conducted to the ventricles. Which heart block is present?

A) First-degree block

B) Second-degree block

C) Third-degree block

D) Bundle branch reentry

A. First-degree block

Which conduction abnormality is defined by intermittent failure of atrial impulses to reach the ventricles?

A) First-degree block

B) Second-degree block

C) Sick sinus syndrome

D) Atrial fibrillation

B. Second-degree block

A patient has complete failure of atrioventricular signal transmission with atrial and ventricular dissociation. Which degree of heart block is implied?

A) First-degree block

B) Second-degree block

C) Third-degree block

C. Third-degree block

A patient’s ECG shows an irregularly irregular rhythm due to atrial myocytes depolarizing independently and sporadically. Which arrhythmia is most likely?

A) Ventricular fibrillation

B) Atrial fibrillation

C) First-degree block

D) Sick sinus syndrome

B. Atrial fibrillation

A heritable ion-channel disorder prolongs ventricular repolarization and increases susceptibility to malignant ventricular arrhythmias. Which syndrome is described?

A) Brugada syndrome

B) Sick sinus syndrome

C) Long QT syndrome

D) Cor pulmonale

C. Long QT syndrome

Why is long QT syndrome clinically dangerous?

A) It promotes malignant ventricular arrhythmias

B) It causes acute mitral regurgitation

C) It reverses coronary atherosclerosis

D) It prevents atrial depolarization

A. It promotes malignant ventricular arrhythmias

In patients lacking structural cardiac pathology, arrhythmias due to channelopathies are most commonly inherited in what pattern in these notes?

A) Autosomal recessive

B) X-linked recessive

C) Mitochondrial

D) Autosomal dominant

D. Autosomal dominant

Sudden cardiac death is defined as unexpected death from lethal arrhythmia without symptoms or within what symptom duration?

A) 1–24 hours

B) 2–3 days

C) 1–2 weeks

D) 3–6 months

A. 1–24 hours

Which rhythm mechanisms may directly cause sudden cardiac death in these notes?

A) Asystole or ventricular fibrillation

B) Sinus tachycardia or Wenckebach

C) First-degree block or LVH

D) Atrial flutter or PVCs

A. Asystole or ventricular fibrillation

Most sudden cardiac death cases result from ischemia-induced myocardial irritability causing which immediate problem?

A) Malignant ventricular arrhythmias

B) Acute mitral stenosis

C) Pulmonary valve rupture

D) Left-to-right atrial shunt

A. Malignant ventricular arrhythmias

What is the leading underlying cause of sudden cardiac death

A) Rheumatic valve disease

B) Coronary artery disease

C) Primary renal failure

D) Pulmonary embolism

B. Coronary artery disease

In left-sided hypertensive heart disease, pressure overload initially causes ventricular hypertrophy and stiffness. Which functional problem follows?

A) Impaired diastolic filling

B) Acute right-to-left shunt

C) Mitral valve perforation

D) Complete AV dissociation

A. Impaired diastolic filling

Why does left atrial enlargement occur in left-sided systemic hypertensive heart disease?

A) LV diastolic filling is impaired

B) RV rupture increases preload

C) Pulmonary valve stenosis reverses flow

D) Coronary plaques disappear

A. LV diastolic filling is impaired

Which microscopic finding best matches hypertensive heart disease?

A) Myocyte and nuclear enlargement

B) Caseating granulomas

C) Liquefactive necrosis

D) Epicardial hematoma only

A. Myocyte and nuclear enlargement

Hypertensive heart disease from systemic hypertension most commonly affects which chamber?

A) Right atrium

B) Right ventricle

C) Left atrium

D) Left ventricle

D. Left ventricle

Cor pulmonale is right-sided hypertensive heart disease caused by which primary hemodynamic burden?

A) RV pressure overload

B) LV volume overload

C) LA pressure loss

D) Aortic valve reflux

A. RV pressure overload

Which condition causes cor pulmonale by producing pulmonary hypertension and right ventricular pressure overload?

A) Emphysema

B) Systemic hypertension

C) Mitral valve prolapse

D) LAD thrombosis

A. Emphysema

Which finding best describes acute cor pulmonale?

A) Marked RV dilation without hypertrophy

B) Severe LV hypertrophy with fibrosis

C) Chronic LA enlargement only

D) Scarred LV systolic bulging

A. Marked RV dilation without hypertrophy

Which disease is noted as a common complication of left-sided heart disease?

A) Cor pulmonale

B) Brugada syndrome

C) Papillary rupture

D) Long QT syndrome

A. Cor pulmonale

A patient with left ventricular hypertrophy has an ECG axis shift related to increased LV mass. Which axis deviation may result?

A) Right-axis deviation

B) Left-axis deviation

C) Electrical alternans

D) Indeterminate only

B. Left-axis deviation

A patient with systemic hypertensive heart disease develops left atrial enlargement. Which arrhythmia is commonly associated with this complication?

A) Atrial fibrillation

B) Ventricular fibrillation

C) Brugada syndrome

D) Complete heart block

A. Atrial fibrillation

Which combination best matches left-sided hypertensive heart disease?

A) Systemic HTN, LVH, LA enlargement

B) Pulmonary HTN, RVH, emphysema

C) MI rupture, VSD, L→R shunt

D) Channelopathy, normal structure, arrhythmia

A. Systemic HTN, LVH, LA enlargement

Which combination best matches chronic cor pulmonale?

A) Pulmonary HTN, RV pressure overload, RVH

B) Systemic HTN, LV pressure overload, LVH

C) Transmural MI, scarred LV aneurysm

D) SA damage, junctional bradycardia

A. Pulmonary HTN, RV pressure overload, RVH

Which post-MI outpouching is a localized hematoma communicating with the ventricle and bounded by pericardial tissue?

A) False aneurysm

B) True ventricular aneurysm

C) Chronic IHD

D) Ventricular remodeling

A. False aneurysm

Which post-MI process involves thinning and stretching of the necrotic infarcted segment itself?

A) Ventricular remodeling

B) Infarct expansion

C) Sick sinus syndrome

D) Channelopathy

B. Infarct expansion

Which post-MI complication is most directly embolic in concern because a thrombus forms along damaged endocardium?

A) Mural thrombus

B) Post-MI pericarditis

C) Ventricular remodeling

D) Sick sinus syndrome

A. Mural thrombus

A patient with repeated myocardial ischemic damage develops progressive CHF and becomes a heart transplant candidate. Which diagnosis accounts for about half of transplant patients in these notes?

A) Chronic ischemic heart disease

B) Cor pulmonale

C) Brugada syndrome

D) Acute pericarditis

A. Chronic ischemic heart disease

Sudden cardiac death from myocardial ischemia most directly results from which immediate electrical complication?

A) Fatal ventricular arrhythmia

B) Acute left-to-right shunt

C) Progressive valve stenosis

D) Reversible myocyte swelling

A. Fatal ventricular arrhythmia

During an episode of angina pectoris, myocardial cells become swollen but later recover. Which injury pattern is most consistent with this presentation?

A) Caseous necrosis

B) Liquefactive necrosis

C) Irreversible contraction band necrosis

D) Reversible ischemic injury

D. Reversible ischemic injury

A patient has paroxysmal precordial chest discomfort caused by transient myocardial ischemia insufficient to kill myocytes. Which term best names this syndrome?

A) Angina pectoris

B) Unstable aneurysm

C) Cor pulmonale

D) Sick sinus syndrome

A. Angina pectoris

A patient reports chest pain that previously occurred only with exertion but now occurs at rest, lasts longer than 20 minutes, and is increasingly severe. Which diagnosis best fits?

A) Stable angina

B) Prinzmetal angina

C) Unstable crescendo angina

D) Silent ischemia

C. Unstable crescendo angina

Unstable or crescendo angina is most directly caused by which coronary plaque event?

A) Plaque disruption with thrombosis

B) Pure coronary vasospasm

C) Complete fibrotic scar formation

D) Chronic pulmonary vasoconstriction

A. Plaque disruption with thrombosis

Which clinical pattern best supports unstable angina rather than stable angina?

A) Exertional pain relieved by rest

B) Pain only after large meals

C) Rest pain lasting over 20 minutes

D) Brief pain with deep breathing

C. Rest pain lasting over 20 minutes

Stable angina is most commonly caused by which physiologic mismatch?

A) Supply-demand imbalance

B) Coronary embolic shower

C) Papillary muscle rupture

D) Primary channelopathy

A. Supply-demand imbalance

A patient with stable angina and a patient with Prinzmetal angina both receive drugs that relax vascular smooth muscle. Which treatment category applies to both?

A) Vasodilator drugs

B) Cytotoxic drugs

C) Antiviral drugs

D) Antifungal drugs

A. Vasodilator drugs