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Cardiac Subspecialty Certification Flashcards

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  1. Which hemodynamic parameter defines pulmonary arterial hypertension (PAH) by current guidelines?

    Answer: Mean PAP >20 mmHg at rest with PCWP ≤15 mmHg and PVR ≥3 WU

    Updated 2022 ESC/ERS guidelines define PAH as mean PAP >20 mmHg, PCWP ≤15 mmHg, and PVR ≥3 Wood Units on right heart catheterization.

  2. A patient develops accelerated idioventricular rhythm (AIVR) 90 minutes after successful primary PCI for inferior STEMI. What is the MOST appropriate management?

    Answer: Observation only; AIVR is a benign reperfusion rhythm

    AIVR is a common reperfusion arrhythmia following successful PCI, typically self-limiting and benign, requiring no specific treatment.

  3. Which cardiac biomarker rises EARLIEST after acute myocardial infarction onset?

    Answer: Myoglobin

    Myoglobin rises within 1–3 hours of myocardial injury and is the earliest biomarker to become detectable, though it lacks cardiac specificity.

  4. A patient with known coronary artery disease develops torsades de pointes (TdP) while receiving dofetilide. His QTc is 580 ms. What is the MOST important immediate intervention?

    Answer: IV magnesium sulfate 2 g over 15 minutes

    IV magnesium sulfate is the first-line treatment for TdP regardless of serum magnesium level; it stabilizes the cardiac membrane and suppresses early afterdepolarizations.

  5. A 55-year-old woman has an echocardiogram showing severe mitral regurgitation with LVEF 58% and LV end-systolic diameter of 42 mm. She is asymptomatic. Which management is MOST appropriate per current ACC/AHA guidelines?

    Answer: Mitral valve surgery is reasonable if repair is likely

    Current guidelines support mitral valve surgery for severe primary MR in asymptomatic patients when repair is likely and performed at a heart valve center of excellence, even before EF falls.

  6. Which stress imaging modality has the HIGHEST sensitivity for detecting ischemia in a patient with a left bundle branch block (LBBB)?

    Answer: Pharmacologic vasodilator stress with nuclear imaging or CMR

    Exercise-induced septal perfusion defects are common false positives in LBBB; pharmacologic vasodilator stress (adenosine/regadenoson) avoids heart rate–dependent septal artifacts.

  7. In a patient with hypertrophic cardiomyopathy and recurrent syncope despite beta-blocker therapy, which invasive option is preferred when septal thickness is ≥30 mm and anatomy is suitable?

    Answer: Surgical septal myectomy

    Surgical septal myectomy (Morrow procedure) is the gold standard treatment for obstructive HCM with severe symptoms refractory to medical therapy, especially with marked septal hypertrophy.