Chapter 19 Test — Pericarditis, Myocarditis and Pulmonary Embolism

FALSE statement regarding the ECG in acute pericarditis is:

A 26-year-old man presents with sharp retrosternal chest pain that is worse on lying flat and relieved by sitting forward. His 12-lead ECG is shown. What is the most likely diagnosis?

The schematic shown highlights the two cardinal ECG abnormalities of Stage 1 acute pericarditis. Which of these two findings is the most specific for pericarditis?

In Stage 1 acute pericarditis, lead aVR characteristically behaves in the opposite direction to every other lead. Which combination is expected in aVR?

The illustration shows the four sequential ECG stages of acute pericarditis. A patient first seen three weeks after an episode of pleuritic chest pain has diffuse T wave inversion but normal ST segments. Which statement about this finding is correct?

A 29-year-old woman presents with central chest pain that is worse when she lies flat. She had a flu-like illness two weeks ago and has no other medical history. Her 12-lead ECG is shown. What is the diagnosis?

A 21-year-old asymptomatic male athlete has an ECG for pre-participation screening. It shows 1 mm of concave ST elevation in V2–V5 with notching at the J point, and the appearance is unchanged from an ECG taken two years ago. Which single feature most strongly favours benign early repolarisation over acute pericarditis?

A 67-year-old man presents with an anterior myocardial infarction and receives thrombolytic therapy. Three days later he develops chest pain that is worse on lying down; examination is normal except for a friction rub. His ECG shows evolving changes of the anterior infarct plus new PR-segment depression and 1 mm ST elevation in all the limb leads. Which of the following is the most likely diagnosis?

A 55-year-old woman has 1 hour of chest pain with breathlessness and low-grade fever. She had an anterior wall myocardial infarction 6 weeks ago treated with fibrinolysis. Examination shows a raised JVP and a friction rub in the 5th intercostal space. ECG shows diffuse ST elevation with PR depression. What is the most likely diagnosis?

A 55-year-old man who had an anterior STEMI three weeks ago now presents with fever, pleuritic chest pain and a pericardial friction rub. ESR and CRP are elevated and troponin is mildly raised. Which statement about this condition is FALSE?

A 62-year-old man with carcinoma of the lung presents to the emergency department with respiratory distress and hypotension. His ECG is shown. The most likely diagnosis is:

Low voltage on the ECG most characteristically indicates:

A 12-lead ECG shows uniformly low-voltage QRS complexes in both the limb and the chest leads. All of the following are recognised causes of this appearance EXCEPT:

The ECG shown was recorded in a 28-year-old man with chest pain and breathlessness two weeks after a viral upper respiratory illness; troponin is elevated and echocardiography shows global hypokinesis. Which statement about the ECG in this condition is TRUE?

A 25-year-old man had an upper respiratory infection one week ago. He now presents after an episode of syncope; his ECG shows complete (third-degree) AV block. Which is the most appropriate assessment?

What is the most reliable (definitive) diagnostic test for identifying myocarditis?

Myocarditis is most commonly caused by which of the following viral infections?

In acute pulmonary embolism, which of the following is the MOST frequent ECG finding?

The ECG pattern classically described in pulmonary embolism is:

The 12-lead ECG shown belongs to a 60-year-old man who became suddenly breathless and hypoxic on the fourth day after a hip replacement. Which interpretation best fits the tracing and the history?

The ECG shown was recorded in a 45-year-old woman who became acutely breathless after a long-haul flight. Her heart rate is 112/min. The precordial abnormality shown is best described as:

A 32-year-old woman presents 5 days after an uncomplicated caesarean section with sudden breathlessness, pleuritic chest pain and haemoptysis. Heart rate 118/min, respiratory rate 26/min, BP 100/70 mmHg, SpO2 89% on room air. Her ECG shows sinus tachycardia with an S1Q3T3 pattern. What is the most likely diagnosis?

A 58-year-old woman presents on the third day after a right total knee replacement with sudden pleuritic chest pain and dyspnoea. Heart rate 124/min, BP 92/60 mmHg, respiratory rate 28/min, SpO2 88% on air. ECG shows sinus tachycardia with a new S1Q3T3 pattern (illustrated); troponin I and NT-proBNP are raised; bedside echo shows right ventricular dilatation with septal flattening. Which single mechanism best explains her haemodynamic collapse?

A massive pulmonary embolism produces acute cor pulmonale. What pathological change would you expect in the heart of this patient?

In a patient with acute pulmonary thromboembolism, which change is typically observed in the left ventricle?

A 68-year-old man with known ischaemic heart disease presents to the emergency department with central chest pain. His ECG is shown. What is the diagnosis?