CCS Clinical Procedures & Protocols 2

Question 1

During a diagnostic right heart catheterization, the pulmonary capillary wedge pressure (PCWP) is obtained by inflating the balloon on the Swan-Ganz catheter. What does an elevated PCWP (>18 mmHg) most directly reflect?

Accepted Answer

Left ventricular end-diastolic pressure

Answer

PCWP approximates left atrial pressure and thus left ventricular end-diastolic pressure, making it a key indicator of left-sided filling pressures.

Question 2

A patient undergoing coronary angiography develops contrast-induced nephropathy (CIN). Which pre-procedural intervention has the strongest evidence for reducing this risk?

Accepted Answer

Isotonic saline hydration

Answer

Adequate pre- and post-procedural isotonic saline hydration remains the most evidence-based strategy for preventing contrast-induced nephropathy.

Question 3

When performing a transesophageal echocardiogram (TEE) to evaluate a prosthetic mitral valve, which view best demonstrates the subvalvular apparatus and leaflet motion?

Accepted Answer

Transgastric long-axis view

Answer

The transgastric long-axis view provides the best alignment for Doppler interrogation and visualization of the subvalvular apparatus of the mitral valve.

Question 4

A 58-year-old patient with known coronary artery disease is scheduled for elective noncardiac surgery. His resting ECG shows a left bundle branch block (LBBB). Which stress test modality is most appropriate?

Accepted Answer

Adenosine nuclear perfusion imaging

Answer

Pharmacologic vasodilator stress (adenosine or regadenoson) with nuclear imaging is preferred in LBBB because exercise-induced septal perfusion defects can be false-positive.

Question 5

After successful primary PCI for STEMI, a patient develops cardiogenic shock refractory to vasopressors. Which mechanical circulatory support device provides the greatest reduction in left ventricular workload?

Accepted Answer

Veno-arterial ECMO (VA-ECMO)

Answer

VA-ECMO provides the highest level of hemodynamic support and cardiac output augmentation in refractory cardiogenic shock, though it does not directly unload the LV.

(CCS) Certified Cardiovascular Specialist Practice Test

(CCS) Certified Cardiovascular Specialist Practice Test

CCS Clinical Procedures & Protocols 2