CCS Clinical Procedures & Protocols 3

Question 1

During cardiac catheterization, a patient's oxygen saturation step-up is detected at the right ventricular level. What is the most likely diagnosis?

Accepted Answer

Ventricular septal defect

Answer

An oxygen saturation step-up at the RV level indicates a left-to-right shunt at the ventricular level, consistent with a ventricular septal defect.

Question 2

Which parameter measured during right heart catheterization is most useful for diagnosing pulmonary arterial hypertension (PAH) versus pulmonary venous hypertension?

Accepted Answer

Pulmonary capillary wedge pressure (PCWP)

Answer

A PCWP ≤15 mmHg distinguishes pre-capillary PAH from post-capillary (pulmonary venous) hypertension caused by left heart disease.

Question 3

A cardiovascular specialist performs a pericardiocentesis for cardiac tamponade. After needle entry, which finding confirms intrapericardial position before catheter advancement?

Accepted Answer

Injection of agitated saline showing microbubbles in pericardial space on echo

Answer

Injecting agitated saline and visualizing microbubbles in the pericardial space on echocardiography confirms correct needle placement before catheter advancement.

Question 4

What is the recommended activated clotting time (ACT) target during percutaneous coronary intervention (PCI) when unfractionated heparin is used without a glycoprotein IIb/IIIa inhibitor?

Accepted Answer

250–350 seconds

Answer

The ACT target for PCI with unfractionated heparin alone is 250–350 seconds to balance anticoagulation efficacy and bleeding risk.

Question 5

A patient undergoing cardioversion for persistent atrial fibrillation has an INR of 1.8 despite warfarin therapy. What is the most appropriate next step according to current guidelines?

Accepted Answer

Perform TEE to rule out left atrial thrombus before cardioversion

Answer

TEE-guided cardioversion is an acceptable alternative to 3–4 weeks of therapeutic anticoagulation when the INR is subtherapeutic, as it can rule out left atrial appendage thrombus.

(CCS) Certified Cardiovascular Specialist Practice Test

(CCS) Certified Cardiovascular Specialist Practice Test

CCS Clinical Procedures & Protocols 3