CMC Certification Cardio Vascular 3 — Questions and Answers
Question 1: A patient develops wide complex tachycardia at 180 bpm with AV dissociation on 12-lead ECG. What is the most likely diagnosis?
- Atrial flutter with aberrant conduction
- Antidromic AVRT
- Ventricular tachycardia (Correct answer)
- Hyperkalemia-induced rhythm
Correct answer: Ventricular tachycardia
AV dissociation during wide complex tachycardia is a definitive criterion for ventricular tachycardia and distinguishes it from supraventricular causes.
Question 2: What is the most common cause of sudden cardiac death in athletes under 35 years of age in the United States?
- Coronary artery disease
- Long QT syndrome
- Hypertrophic cardiomyopathy (Correct answer)
- Wolff-Parkinson-White syndrome
Correct answer: Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young US athletes, often due to ventricular fibrillation triggered by exertion.
Question 3: Which echocardiographic parameter best estimates left ventricular filling pressure non-invasively?
- E/A ratio alone
- E/e' ratio (Correct answer)
- Deceleration time of mitral E wave
- Isovolumic relaxation time (IVRT)
Correct answer: E/e' ratio
The E/e' ratio (ratio of mitral inflow E velocity to tissue Doppler e' velocity) correlates best with invasive left ventricular end-diastolic pressure.
Question 4: A patient with known HFrEF presents with worsening dyspnea. BNP is 900 pg/mL. Which intervention most directly reduces BNP release?
- Increasing diuretic dose
- Adding spironolactone
- Initiating sacubitril/valsartan (ARNI) (Correct answer)
- Increasing beta-blocker dose
Correct answer: Initiating sacubitril/valsartan (ARNI)
Sacubitril inhibits neprilysin, which degrades BNP; however, ARNI therapy reduces wall stress (the stimulus for BNP release) more than it elevates BNP by degradation inhibition, resulting in net clinical improvement and symptom reduction.
Question 5: Which ECG pattern is characteristic of Wellens syndrome and indicates critical LAD stenosis?
- Deep Q waves in V1-V4
- Biphasic or deeply inverted T waves in V2-V3 during pain-free state (Correct answer)
- ST elevation in V1-V6 with reciprocal changes
- Delta waves with short PR interval
Correct answer: Biphasic or deeply inverted T waves in V2-V3 during pain-free state
Wellens syndrome presents with characteristic biphasic or deeply inverted T waves in V2-V3 during a pain-free period, signifying critical proximal LAD stenosis and impending anterior MI.
Question 6: In a patient with paroxysmal atrial fibrillation and a CHA₂DS₂-VASc score of 3, which is the preferred long-term anticoagulation strategy?
- Aspirin 325 mg daily
- Aspirin plus clopidogrel
- Direct oral anticoagulant (DOAC) (Correct answer)
- Warfarin only if mechanical valve is present
Correct answer: Direct oral anticoagulant (DOAC)
A CHA₂DS₂-VASc score ≥2 in males or ≥3 in females warrants oral anticoagulation; DOACs are preferred over warfarin for non-valvular AF due to better safety and efficacy profiles.
Question 7: Which maneuver differentiates hypertrophic obstructive cardiomyopathy (HOCM) from valvular aortic stenosis on physical examination?
- The murmur of HOCM increases with standing, while AS murmur decreases (Correct answer)
- The murmur of HOCM decreases with squatting, while AS murmur increases with squatting
- Both murmurs behave identically with all maneuvers
- HOCM murmur is loudest at the apex; AS is loudest at the base
Correct answer: The murmur of HOCM increases with standing, while AS murmur decreases
Standing reduces preload and increases HOCM obstruction (louder murmur), while AS murmur decreases with reduced preload — a key bedside differentiator.
CMC Certification Cardio Vascular 3
A patient develops wide complex tachycardia at 180 bpm with AV dissociation on 12-lead ECG.
What is the most likely diagnosis?