CCS Treatment Planning & Management 2

Question 1

A patient with HFrEF (EF 30%) is already on optimal doses of ACE inhibitor and beta-blocker. What is the next recommended addition to reduce mortality?

Accepted Answer

Add spironolactone (MRA)

Answer

Mineralocorticoid receptor antagonists (MRAs) like spironolactone or eplerenone are guideline-recommended as a third pillar of HFrEF therapy to further reduce mortality.

Question 2

Which anticoagulant strategy is preferred for a patient with non-valvular atrial fibrillation and a CrCl of 40 mL/min?

Accepted Answer

Apixaban at reduced dose

Answer

Apixaban at reduced dose (2.5 mg BID) is preferred in moderate renal impairment because it has the most evidence for safety and efficacy at CrCl 25–49 mL/min.

Question 3

A patient post-STEMI has a residual EF of 28% after 3 months of optimal medical therapy. Which device therapy should be discussed?

Accepted Answer

Implantable cardioverter-defibrillator (ICD)

Answer

An ICD is indicated for primary prevention of sudden cardiac death when EF remains ≤35% at least 40 days post-MI on optimal medical therapy.

Question 4

Which medication should be avoided in a patient with symptomatic hypotension (SBP 80 mmHg) and acute decompensated heart failure?

Accepted Answer

Oral ACE inhibitor

Answer

Oral ACE inhibitors are contraindicated in acute decompensated HF with symptomatic hypotension because they further reduce preload and afterload, worsening perfusion.

Question 5

A patient with stable angina and diabetes has a three-vessel CAD with SYNTAX score of 33. What revascularization strategy does current evidence favor?

Accepted Answer

CABG

Answer

High SYNTAX scores (≥33) in three-vessel CAD, especially with diabetes, favor CABG over PCI based on improved survival and lower MACCE rates.

(CCS) Certified Cardiovascular Specialist Practice Test

(CCS) Certified Cardiovascular Specialist Practice Test

CCS Treatment Planning & Management 2