CCS Clinical Procedures & Protocols 4

Question 1

A patient presents with complete heart block after inferior STEMI. Temporary transvenous pacing is initiated. What is the appropriate initial pacing rate and output setting?

Accepted Answer

Rate 60–80 bpm, output 3–5× capture threshold

Answer

Temporary pacing for complete heart block is typically set at 60–80 bpm with output 3–5 times the capture threshold to ensure reliable pacing.

Question 2

During fractional flow reserve (FFR) measurement, intravenous adenosine is infused to achieve maximal hyperemia. What FFR value is the threshold for revascularization based on landmark DEFER and FAME trials?

Accepted Answer

≤0.80

Answer

An FFR ≤0.80 is the validated threshold below which coronary revascularization improves outcomes compared with medical therapy alone.

Question 3

A patient with hypertrophic obstructive cardiomyopathy (HOCM) undergoes alcohol septal ablation. Which procedural complication is most feared?

Accepted Answer

Complete heart block requiring permanent pacemaker

Answer

Complete heart block requiring permanent pacemaker implantation occurs in up to 20% of alcohol septal ablation procedures due to damage to the conduction system.

Question 4

When performing intravascular ultrasound (IVUS)-guided PCI, which finding most reliably indicates adequate stent expansion?

Accepted Answer

Minimum stent area (MSA) ≥80% of the distal reference lumen area

Answer

MSA ≥80% of the distal reference lumen area is the primary IVUS criterion for adequate stent expansion and is associated with reduced restenosis and stent thrombosis.

Question 5

A patient with symptomatic bradycardia undergoes dual-chamber pacemaker implantation. Post-implant, the device is noted to pace the ventricle in every beat despite normal sinus activity. What programming adjustment should be made?

Accepted Answer

Extend the AV delay to promote intrinsic conduction

Answer

Extending the programmed AV delay allows intrinsic AV conduction to occur before the pacemaker delivers a ventricular output, minimizing unnecessary RV pacing.

(CCS) Certified Cardiovascular Specialist Practice Test

(CCS) Certified Cardiovascular Specialist Practice Test

CCS Clinical Procedures & Protocols 4