Ischemic heart disease – myocardial infarction MCQs With Answer

Ischemic heart disease – myocardial infarction MCQs With Answer is a focused review designed for B. Pharm students to strengthen clinical pharmacology and cardiology concepts. This concise, keyword-rich introduction covers pathophysiology of ischemic heart disease, ECG changes in myocardial infarction, cardiac biomarkers like troponin, and evidence-based drug therapy including thrombolytics, antiplatelets, and anticoagulants. These MCQs emphasize mechanism of action, indications, contraindications, dosing considerations, and adverse effects relevant to pharmacy practice. Ideal for exam prep and revision, the questions deepen understanding of acute management and prevention strategies. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which biomarker is most specific and sensitive for diagnosing acute myocardial infarction?

• CK-MB
• Troponin I/T
• Myoglobin
• LDH

Correct Answer: Troponin I/T

Q2. In ST-elevation myocardial infarction (STEMI), the primary reperfusion strategy of choice within the first 120 minutes when PCI is available is:

• Primary percutaneous coronary intervention (PCI)
• Immediate coronary artery bypass grafting (CABG)
• Thrombolytic therapy at bedside
• Intravenous unfractionated heparin alone

Correct Answer: Primary percutaneous coronary intervention (PCI)

Q3. Which ECG change is classically seen in early acute transmural myocardial infarction?

• Pathological Q waves without ST changes
• ST-segment elevation in contiguous leads
• Diffuse PR prolongation
• Low voltage QRS complexes

Correct Answer: ST-segment elevation in contiguous leads

Q4. Aspirin reduces mortality in acute MI primarily by:

• Vasodilation of coronary arteries
• Inhibition of platelet cyclooxygenase and TXA2 synthesis
• Tight control of blood pressure
• Reducing myocardial oxygen demand by lowering heart rate

Correct Answer: Inhibition of platelet cyclooxygenase and TXA2 synthesis

Q5. Which fibrinolytic agent is fibrin-specific and associated with lower systemic plasminogen activation compared to streptokinase?

• Streptokinase
• Alteplase (tPA)
• Urokinase
• Sarpogrelate

Correct Answer: Alteplase (tPA)

Q6. The main contraindication to thrombolytic therapy in acute MI is:

• Left ventricular hypertrophy
• Recent (within 3 months) ischemic stroke or intracranial hemorrhage
• Hypercholesterolemia
• Mild uncontrolled hypertension (BP 150/90 mmHg)

Correct Answer: Recent (within 3 months) ischemic stroke or intracranial hemorrhage

Q7. Which antiplatelet agent is a reversible P2Y12 receptor inhibitor commonly used in ACS?

• Clopidogrel
• Prasugrel
• Ticagrelor
• Dipyridamole

Correct Answer: Ticagrelor

Q8. Which anticoagulant is often used during PCI because of predictable pharmacokinetics and lower risk of heparin-induced thrombocytopenia?

• Unfractionated heparin (UFH)
• Low molecular weight heparin (e.g., enoxaparin)
• Bivalirudin
• Warfarin

Correct Answer: Bivalirudin

Q9. Beta-blockers reduce infarct size and mortality in MI by:

• Increasing afterload
• Decreasing heart rate and myocardial oxygen demand
• Enhancing platelet aggregation
• Direct thrombolysis

Correct Answer: Decreasing heart rate and myocardial oxygen demand

Q10. Which ACE inhibitor effect is particularly beneficial post-MI for remodeling prevention?

• Vasoconstriction
• Inhibition of angiotensin II–mediated remodeling
• Increased aldosterone secretion
• Increased sympathetic tone

Correct Answer: Inhibition of angiotensin II–mediated remodeling

Q11. In the setting of suspected MI, oxygen therapy is indicated when:

• All patients receive routine high-flow oxygen
• Pulse oximetry shows SpO2 <90% or patient is hypoxic
• Blood pressure is elevated above 140/90 mmHg
• Troponin is negative

Correct Answer: Pulse oximetry shows SpO2 <90% or patient is hypoxic

Q12. Which lipid-lowering drug class is recommended early after MI for secondary prevention?

• Bile acid sequestrants
• Statins
• Fibrates
• Niacin

Correct Answer: Statins

Q13. The therapeutic window for effective fibrinolysis in STEMI is generally considered:

• Within 12–24 hours of symptom onset
• Within 6–12 hours only
• Within 30 minutes only
• Within 12 hours, ideally within first 3 hours

Correct Answer: Within 12 hours, ideally within first 3 hours

Q14. CK-MB is useful in reinfarction detection because:

• It never rises after MI
• It returns to baseline faster than troponin
• It is more specific than troponin
• It is unaffected by skeletal muscle injury

Correct Answer: It returns to baseline faster than troponin

Q15. Which adverse effect is commonly associated with nitrates used in acute MI?

• Bradycardia
• Flushing and headache
• Severe hyperkalemia
• Platelet dysfunction

Correct Answer: Flushing and headache

Q16. Morphine in acute MI is used primarily to:

• Lower LDL cholesterol
• Provide analgesia and reduce sympathetic drive
• Act as an antiplatelet
• Lyse thrombus

Correct Answer: Provide analgesia and reduce sympathetic drive

Q17. Which finding suggests right ventricular infarction in context of inferior MI?

• ST-elevation in leads V1–V4
• Hypotension with clear lungs and elevated jugular venous pressure
• Pulmonary edema with hypertension
• High-pitched S1 heart sound

Correct Answer: Hypotension with clear lungs and elevated jugular venous pressure

Q18. Dual antiplatelet therapy (DAPT) after PCI commonly consists of aspirin plus:

• Warfarin
• Clopidogrel, prasugrel, or ticagrelor
• Dipyridamole
• Heparin

Correct Answer: Clopidogrel, prasugrel, or ticagrelor

Q19. Which scoring system estimates short-term mortality risk in ACS patients?

• Framingham risk score
• TIMI risk score
• CHADS2 score
• BMI index

Correct Answer: TIMI risk score

Q20. The mechanism of action of clopidogrel involves:

• Reversible inhibition of COX-1
• Irreversible P2Y12 ADP receptor blockade after hepatic activation
• Inhibition of glycoprotein IIb/IIIa receptor
• Direct thrombin inhibition

Correct Answer: Irreversible P2Y12 ADP receptor blockade after hepatic activation

Q21. Which complication is most commonly responsible for sudden death after MI?

• Ventricular arrhythmias (ventricular fibrillation)
• Left ventricular aneurysm
• Dressler syndrome
• Pericardial effusion

Correct Answer: Ventricular arrhythmias (ventricular fibrillation)

Q22. Which medication is contraindicated in right ventricular infarction due to risk of severe hypotension?

• IV fluids
• Nitrates
• Low dose aspirin
• Heparin

Correct Answer: Nitrates

Q23. Glycoprotein IIb/IIIa inhibitors act by blocking:

• ADP receptors on platelets
• Fibrinogen binding to platelet GPIIb/IIIa receptors
• Thromboxane A2 synthesis
• Vitamin K–dependent clotting factors

Correct Answer: Fibrinogen binding to platelet GPIIb/IIIa receptors

Q24. Early administration of which drug class reduces the risk of remodeling and heart failure post-MI?

• Beta-agonists
• ACE inhibitors or ARBs
• Calcium channel blockers
• Thrombolytics only

Correct Answer: ACE inhibitors or ARBs

Q25. A paradoxical contraindication to beta-blocker use in acute MI is:

• Heart rate of 90 bpm
• Signs of acute heart failure with pulmonary edema
• Bradycardia and hypotension or cardiogenic shock
• Mild chest pain

Correct Answer: Bradycardia and hypotension or cardiogenic shock

Q26. Which lipid parameter lowering is most strongly correlated with reduced recurrent MI risk?

• Increase in HDL cholesterol
• Reduction in LDL cholesterol
• Decrease in triglycerides only
• Increase in total cholesterol

Correct Answer: Reduction in LDL cholesterol

Q27. In NSTEMI management, immediate PCI is indicated when the patient:

• Is asymptomatic with negative troponin
• Has ongoing ischemia, hemodynamic instability, or high-risk features
• Has simple, stable angina only
• Has normal ECG and no risk factors

Correct Answer: Has ongoing ischemia, hemodynamic instability, or high-risk features

Q28. Which drug is a direct thrombin inhibitor sometimes used as an alternative anticoagulant in PCI?

• Fondaparinux
• Dabigatran
• Bivalirudin
• Argatroban

Correct Answer: Bivalirudin

Q29. The classic time course of troponin after MI shows:

• Rise within 3–4 hours, peak 24–48 hours, remain elevated for 7–10+ days
• Immediate peak at onset and fall within 12 hours
• No elevation in myocardial infarction
• Rise only after 7 days

Correct Answer: Rise within 3–4 hours, peak 24–48 hours, remain elevated for 7–10+ days

Q30. Which medication is preferred to reverse bleeding from thrombolytic therapy?

• Protamine sulfate
• Vitamin K
• Aminocaproic acid (antifibrinolytic)
• Fresh frozen plasma only

Correct Answer: Aminocaproic acid (antifibrinolytic)

Q31. In pharmacology of MI, which side effect is classic for ticagrelor compared to clopidogrel?

• Higher rate of gastrointestinal ulcers
• Dyspnea and bradyarrhythmias
• Severe neutropenia
• Hypoglycemia

Correct Answer: Dyspnea and bradyarrhythmias

Q32. Which hemodynamic parameter indicates cardiogenic shock following MI?

• Elevated cardiac output with low PCWP
• Low blood pressure with evidence of end-organ hypoperfusion and low cardiac output
• High urine output and warm extremities
• Isolated tachycardia without hypotension

Correct Answer: Low blood pressure with evidence of end-organ hypoperfusion and low cardiac output

Q33. Which medication reduces mortality when given within 24 hours after MI and is part of standard therapy unless contraindicated?

• High-dose corticosteroids
• Aspirin
• Oral anticoagulant indefinitely
• Oral nitrates long-term only

Correct Answer: Aspirin

Q34. Door-to-balloon time target for primary PCI to treat STEMI is ideally:

• Within 90 minutes
• Within 6 hours
• Within 24 hours
• Within 5 minutes

Correct Answer: Within 90 minutes

Q35. Which condition predisposes to a false elevation of troponin unrelated to MI?

• Severe renal failure
• Hypothyroidism
• Low body weight
• Hypercholesterolemia

Correct Answer: Severe renal failure

Q36. Which drug class is indicated to prevent ventricular remodeling and reduce mortality in patients with reduced ejection fraction after MI?

• Calcium channel blockers
• ACE inhibitors or mineralocorticoid receptor antagonists
• Short-acting nitrates only
• Oral iron supplements

Correct Answer: ACE inhibitors or mineralocorticoid receptor antagonists

Q37. The MONA protocol in initial MI management stands for:

• Morphine, Oxygen, Nitrates, Aspirin
• Metoprolol, Ointment, Nitrate, Antibiotic
• Magnesium, Oxygen, Nitrite, Atropine
• Monitor, Observe, No therapy, Assess

Correct Answer: Morphine, Oxygen, Nitrates, Aspirin

Q38. Which arrhythmia is most likely within the first 24 hours of MI and may be transient?

• Atrial fibrillation only after 2 weeks
• Ventricular fibrillation or ventricular tachycardia
• Complete heart block never occurs
• Sinus arrhythmia exclusively

Correct Answer: Ventricular fibrillation or ventricular tachycardia

Q39. Fondaparinux acts by selectively inhibiting:

• Factor Xa via antithrombin III activation
• Thrombin directly
• Platelet aggregation at GP IIb/IIIa
• Vitamin K epoxide reductase

Correct Answer: Factor Xa via antithrombin III activation

Q40. Which clinical syndrome occurring weeks after MI is immune-mediated pericarditis characterized by fever, pericardial pain, and pleural effusions?

• Dressler syndrome
• Cardiac tamponade immediately after MI
• Reinfarction syndrome
• Ventricular aneurysm only

Correct Answer: Dressler syndrome

Q41. In patients on chronic oral anticoagulation who present with MI and need PCI, management requires:

• Continuing warfarin without adjustment and no additional antiplatelet
• Careful coordination of anticoagulation and antiplatelet therapy to balance bleeding and thrombosis
• Stopping all antithrombotic therapy permanently
• Immediate high-dose thrombolysis regardless of bleeding risk

Correct Answer: Careful coordination of anticoagulation and antiplatelet therapy to balance bleeding and thrombosis

Q42. Which of the following is a mechanical complication of transmural MI occurring within days and presenting with acute pulmonary edema and new holosystolic murmur?

• Left ventricular free wall rupture
• Papillary muscle rupture leading to acute mitral regurgitation
• Atrial septal defect from MI
• Pericardial effusion without hemodynamic effect

Correct Answer: Papillary muscle rupture leading to acute mitral regurgitation

Q43. Which class of drugs should be avoided in acute inferior MI with bradycardia due to risk of worsening conduction?

• Beta-blockers
• ACE inhibitors
• Statins
• Antiplatelets

Correct Answer: Beta-blockers

Q44. Primary prevention measures that reduce incidence of ischemic heart disease include:

• Smoking cessation, blood pressure control, lipid management, diabetes control
• Only increasing dietary fat intake
• Avoiding exercise entirely
• Exclusive use of herbal supplements

Correct Answer: Smoking cessation, blood pressure control, lipid management, diabetes control

Q45. Which drug used in ACS is associated with risk of immune-mediated thrombocytopenia and requires platelet monitoring?

• Clopidogrel
• Glycoprotein IIb/IIIa inhibitors and heparin (HIT risk with heparin)
• Statins
• Nitrates

Correct Answer: Glycoprotein IIb/IIIa inhibitors and heparin (HIT risk with heparin)

Q46. Reperfusion injury after prolonged ischemia can cause which paradoxical effect?

• Further myocardial damage due to oxidative stress and calcium overload
• Complete and immediate healing of myocardium
• Total resistance to arrhythmias
• Prevention of scar formation

Correct Answer: Further myocardial damage due to oxidative stress and calcium overload

Q47. Which diagnostic imaging modality is most useful to assess left ventricular function and wall motion after MI?

• Chest X-ray
• Transthoracic echocardiography (TTE)
• Plain ECG only
• Abdominal ultrasound

Correct Answer: Transthoracic echocardiography (TTE)

Q48. A pharmacist counseling a post-MI patient about statins should emphasize:

• Statins are optional and have no role in secondary prevention
• Importance of adherence, potential myopathy signs, and drug interactions (e.g., with CYP3A4 inhibitors)
• Statins cause immediate symptomatic relief of chest pain
• Stopping statins during acute illness is mandatory

Correct Answer: Importance of adherence, potential myopathy signs, and drug interactions (e.g., with CYP3A4 inhibitors)

Q49. Which enzyme inhibitor is used acutely to reduce preload and relieve ischemia by venodilation in MI?

• ACE inhibitor
• Alpha-1 blocker
• Nitrate (e.g., IV nitroglycerin)
• Loop diuretic only

Correct Answer: Nitrate (e.g., IV nitroglycerin)

Q50. For B. Pharm students, understanding drug–drug interactions in MI is crucial. Combining nitrates with which class is contraindicated due to severe hypotension risk?

• Beta-blockers
• Phosphodiesterase-5 (PDE5) inhibitors like sildenafil
• Statins
• Antiplatelets

Correct Answer: Phosphodiesterase-5 (PDE5) inhibitors like sildenafil

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