CCS Diagnostic Testing & Imaging 3

Question 1

A patient with hypertrophic cardiomyopathy undergoes echocardiography. Which measurement best quantifies left ventricular outflow tract obstruction?

Accepted Answer

Peak LVOT gradient by Doppler

Answer

The peak LVOT pressure gradient measured by continuous wave Doppler directly quantifies the degree of dynamic obstruction in HCM.

Question 2

On a Holter monitor report, a patient shows RR intervals alternating between long and short cycles with a fixed relationship. This pattern is most consistent with:

Accepted Answer

Second-degree AV block Mobitz type I (Wenckebach)

Answer

Wenckebach block shows progressive PR prolongation with eventual non-conducted P wave, causing a characteristic grouped beating pattern on Holter.

Question 3

Which stress imaging modality is preferred for evaluating coronary artery disease in a patient with left bundle branch block?

Accepted Answer

Pharmacologic stress with vasodilator and nuclear imaging

Answer

LBBB causes septal motion abnormalities with exercise that can mimic ischemia on echo; vasodilator stress with nuclear imaging avoids this false-positive pattern.

Question 4

A coronary angiogram shows a lesion with 60% diameter stenosis. Fractional flow reserve (FFR) is measured at 0.78. What is the appropriate interpretation?

Accepted Answer

Hemodynamically significant — revascularization is indicated

Answer

An FFR ≤0.80 indicates hemodynamically significant ischemia, and revascularization of such lesions has been shown to improve outcomes.

Question 5

Which echocardiographic parameter is the best non-invasive estimate of left ventricular end-diastolic pressure?

Accepted Answer

E/e' ratio

Answer

The ratio of transmitral E velocity to mitral annular e' velocity (E/e') correlates strongly with invasively measured LVEDP.

(CCS) Certified Cardiovascular Specialist Practice Test

(CCS) Certified Cardiovascular Specialist Practice Test

CCS Diagnostic Testing & Imaging 3