CMC CMC Cardiac Diagnostics & Imaging 2 — Questions and Answers
Question 1: What is the normal range for left ventricular ejection fraction (LVEF) in adults?
- 30–40%
- 40–55%
- 55–70% (Correct answer)
- 70–85%
Correct answer: 55–70%
Normal LVEF is 55–70%, reflecting adequate systolic function with more than half the ventricular volume ejected per beat.
Question 2: Diastolic dysfunction identified on echocardiography primarily reflects impairment of which cardiac process?
- Reduced systolic ejection fraction
- Impaired ventricular relaxation and filling (Correct answer)
- Valvular regurgitation severity
- Pericardial effusion volume
Correct answer: Impaired ventricular relaxation and filling
Diastolic dysfunction reflects abnormal myocardial relaxation causing elevated filling pressures, which can exist even with preserved EF.
Question 3: During a stress echocardiogram, the appearance of new regional wall motion abnormalities indicates what?
- Normal stress response
- Myocardial ischemia from inadequate coronary perfusion (Correct answer)
- Hypertrophic cardiomyopathy pattern
- Pericarditis
Correct answer: Myocardial ischemia from inadequate coronary perfusion
New wall motion abnormalities during stress indicate regions of myocardium becoming ischemic from flow-limiting coronary stenoses.
Question 4: The echocardiographic hallmark of cardiac tamponade is which finding?
- Left ventricular hypertrophy
- Pericardial effusion with diastolic collapse of right-sided chambers (Correct answer)
- Dilated left ventricle with reduced EF
- Severe mitral stenosis with LA enlargement
Correct answer: Pericardial effusion with diastolic collapse of right-sided chambers
Cardiac tamponade is diagnosed by pericardial effusion causing diastolic collapse of the right atrium and ventricle due to elevated intrapericardial pressure.
Question 5: On a standard Bruce protocol exercise stress test, what constitutes a positive result for ischemia?
- Any 0.5mm ST depression
- ≥1mm horizontal or downsloping ST depression at 80ms after the J point (Correct answer)
- Any ST elevation regardless of leads
- Sinus tachycardia above 150 bpm only
Correct answer: ≥1mm horizontal or downsloping ST depression at 80ms after the J point
≥1mm horizontal or downsloping ST depression at 80ms post-J point in ≥1 lead is the standard diagnostic criterion for exercise-induced ischemia.
Question 6: What primary advantage does transesophageal echocardiography (TEE) offer over standard transthoracic echocardiography?
- No patient preparation required
- Superior visualization of posterior cardiac structures including the left atrium and mitral valve (Correct answer)
- Completely non-invasive with no discomfort
- Better right ventricular pressure estimation
Correct answer: Superior visualization of posterior cardiac structures including the left atrium and mitral valve
TEE places the transducer in the esophagus immediately posterior to the heart, providing high-resolution images of posterior structures.
CMC CMC Cardiac Diagnostics & Imaging 2
What is the normal range for left ventricular ejection fraction (LVEF) in adults?