CCS Treatment Planning & Management 3 — Questions and Answers
Question 1: A 72-year-old with severe symptomatic aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg) is deemed high surgical risk. What is the preferred treatment?
- Balloon aortic valvuloplasty as definitive therapy
- Transcatheter aortic valve replacement (TAVR) (Correct answer)
- Surgical aortic valve replacement (SAVR)
- Medical management with diuretics
Correct answer: Transcatheter aortic valve replacement (TAVR)
TAVR is the preferred treatment for severe symptomatic AS in high-surgical-risk and intermediate-risk patients, with outcomes equivalent or superior to SAVR.
Question 2: Which medication reduces hospitalizations in chronic HFpEF (EF ≥50%) and has received FDA approval for this indication?
- Carvedilol
- Sacubitril/valsartan
- Empagliflozin (Correct answer)
- Ivabradine
Correct answer: Empagliflozin
SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce cardiovascular death and HF hospitalizations in HFpEF and have FDA approval for this indication.
Question 3: A patient with chronic stable angina has a positive stress test and FFR of 0.78 in the LAD. What does this FFR value indicate?
- Hemodynamically significant stenosis; revascularization beneficial (Correct answer)
- Non-significant stenosis; medical therapy preferred
- Normal coronary flow; no further testing needed
- Borderline value requiring repeat testing in 6 months
Correct answer: Hemodynamically significant stenosis; revascularization beneficial
FFR ≤0.80 indicates hemodynamically significant stenosis where PCI reduces angina and improves outcomes compared to medical therapy alone.
Question 4: A patient develops complete heart block after inferior STEMI. Which artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
The RCA supplies the AV node in approximately 90% of patients; inferior STEMI from RCA occlusion commonly causes transient AV block.
Question 5: For a patient with hypertrophic obstructive cardiomyopathy (HOCM) and severe symptoms refractory to disopyramide and beta-blockers, what is the next step?
- Add verapamil to beta-blocker
- Implant an ICD
- Refer for septal reduction therapy (myectomy or ASA) (Correct answer)
- Begin amiodarone for rate control
Correct answer: Refer for septal reduction therapy (myectomy or ASA)
Septal reduction therapy—surgical myectomy or alcohol septal ablation—is recommended for HOCM patients with severe symptoms refractory to maximal medical therapy.
Question 6: A patient presents with acute pericarditis. Which combination therapy is recommended for the initial episode?
- Aspirin alone for 2 weeks
- Colchicine plus NSAIDs for 3 months (Correct answer)
- Prednisone alone for 4 weeks
- NSAIDs alone for 6 weeks
Correct answer: Colchicine plus NSAIDs for 3 months
Colchicine added to NSAIDs (or aspirin) for 3 months reduces recurrence rates by ~50% and is guideline-recommended for initial acute pericarditis.
Question 7: Which is the preferred antiarrhythmic drug for rhythm control in a patient with atrial fibrillation and significant left ventricular hypertrophy (LVH) but no coronary artery disease?
- Flecainide
- Propafenone
- Amiodarone (Correct answer)
- Sotalol
Correct answer: Amiodarone
Significant LVH increases the risk of QT prolongation and torsades with most antiarrhythmics; amiodarone is preferred because it is safer in structural heart disease.
CCS Treatment Planning & Management 3
A 72-year-old with severe symptomatic aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg) is deemed high surgical risk.
What is the preferred treatment?