CCS Clinical Procedures & Protocols 5

Question 1

During pulmonary vein isolation (PVI) for atrial fibrillation ablation, esophageal temperature monitoring is used to prevent which serious complication?

Accepted Answer

Atrio-esophageal fistula

Answer

Atrio-esophageal fistula is a rare but often fatal complication of AF ablation caused by thermal injury to the posterior left atrial wall adjacent to the esophagus.

Question 2

A patient presents with signs of cardiac tamponade following a recent myocardial infarction. Pulsus paradoxus is measured at 18 mmHg. What is the hemodynamic mechanism responsible for pulsus paradoxus in tamponade?

Accepted Answer

Ventricular interdependence compressing the LV during inspiration

Answer

In tamponade, inspiratory RV filling expands the RV within the fixed pericardial space, compressing the LV (ventricular interdependence) and reducing LV stroke volume and systolic BP.

Question 3

Optical coherence tomography (OCT) is used during PCI. Compared to IVUS, what is the primary advantage of OCT?

Accepted Answer

Superior near-field resolution for detailed strut-level imaging

Answer

OCT provides 10-fold higher axial resolution (~15 µm) than IVUS, enabling detailed visualization of stent struts, tissue coverage, and plaque morphology.

Question 4

A patient with severe mitral regurgitation due to posterior leaflet prolapse is deemed suitable for MitraClip (transcatheter edge-to-edge repair). Which echocardiographic view is essential for guiding the transseptal puncture and clip deployment?

Accepted Answer

Midesophageal bicaval view on TEE

Answer

The midesophageal bicaval view on TEE clearly visualizes the atrial septum and guides optimal transseptal puncture height for MitraClip delivery.

Question 5

A post-cardiac surgery patient develops a new pericardial effusion with hemodynamic compromise 4 weeks after surgery. What is the most likely diagnosis and recommended treatment?

Accepted Answer

Dressler syndrome (post-pericardiotomy syndrome); NSAIDs and colchicine

Answer

Post-pericardiotomy (Dressler) syndrome is an immune-mediated pericarditis with effusion occurring weeks after cardiac surgery, treated with NSAIDs and colchicine.

(CCS) Certified Cardiovascular Specialist Practice Test

(CCS) Certified Cardiovascular Specialist Practice Test

CCS Clinical Procedures & Protocols 5