CCS Diagnostic Testing & Imaging 2 — Questions and Answers
Question 1: Which echocardiographic finding is most characteristic of cardiac tamponade?
- Right ventricular diastolic collapse (Correct answer)
- Left ventricular hypertrophy
- Mitral valve prolapse
- Aortic root dilation
Correct answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse occurs when pericardial pressure exceeds right ventricular diastolic pressure, a hallmark of cardiac tamponade.
Question 2: On a 12-lead ECG, ST-segment elevation in leads V1-V4 with reciprocal changes in inferior leads most likely indicates:
- Anterior STEMI (Correct answer)
- Inferior STEMI
- Pericarditis
- Left bundle branch block
Correct answer: Anterior STEMI
ST elevation in V1-V4 corresponds to the anterior wall territory supplied by the left anterior descending artery.
Question 3: A patient undergoes exercise stress testing and achieves 85% of maximum predicted heart rate. The test is terminated due to 2mm horizontal ST depression. How is this result classified?
- Positive for ischemia (Correct answer)
- Negative for ischemia
- Inconclusive
- Normal variant
Correct answer: Positive for ischemia
Horizontal or downsloping ST depression ≥1mm during exercise is a positive finding for myocardial ischemia.
Question 4: Which nuclear imaging agent is most commonly used for myocardial perfusion imaging?
- Technetium-99m sestamibi (Correct answer)
- Thallium-201
- Fluorine-18 FDG
- Indium-111
Correct answer: Technetium-99m sestamibi
Technetium-99m sestamibi (Cardiolite) is the most widely used tracer for myocardial perfusion SPECT imaging due to its favorable imaging characteristics.
Question 5: What is the primary advantage of cardiac MRI over echocardiography for evaluating myocardial viability?
- Late gadolinium enhancement detects scar tissue with high spatial resolution (Correct answer)
- MRI can be performed during exercise
- MRI provides real-time imaging
- MRI has no contraindications
Correct answer: Late gadolinium enhancement detects scar tissue with high spatial resolution
Late gadolinium enhancement MRI identifies irreversible myocardial injury with superior spatial resolution, distinguishing viable from non-viable myocardium.
Question 6: In a patient with suspected aortic stenosis, which Doppler parameter provides the most direct measurement of stenosis severity?
- Peak aortic jet velocity (Correct answer)
- Pulmonary artery pressure
- E/A ratio
- Tissue Doppler imaging velocity
Correct answer: Peak aortic jet velocity
Peak aortic jet velocity measured by continuous wave Doppler is the primary parameter for grading aortic stenosis severity.
Question 7: Which finding on coronary CT angiography indicates high-risk plaque most associated with acute coronary syndrome?
- Positive remodeling with low-attenuation plaque (Correct answer)
- Calcified plaque with stable morphology
- High-attenuation plaque >130 HU
- Absence of plaque
Correct answer: Positive remodeling with low-attenuation plaque
Positive remodeling combined with low-attenuation (lipid-rich) plaque on CTA represents vulnerable plaque at high risk for rupture and ACS.
CCS Diagnostic Testing & Imaging 2
Which echocardiographic finding is most characteristic of cardiac tamponade?