CMC Certification Cardio Vascular 4 — Questions and Answers
Question 1: Which drug is the preferred agent for acute rate control of atrial fibrillation with rapid ventricular response in a patient with decompensated heart failure and reduced EF?
- IV metoprolol
- IV diltiazem
- IV digoxin
- IV amiodarone (Correct answer)
Correct answer: IV amiodarone
IV amiodarone is preferred for rate control in AF with decompensated HFrEF because it avoids the negative inotropic effects of beta-blockers and non-dihydropyridine calcium channel blockers.
Question 2: A 55-year-old with dilated cardiomyopathy (EF 28%) and LBBB with QRS duration 165 ms is on optimized medical therapy. Which device therapy is indicated?
- Implantable loop recorder
- Single-chamber ICD
- Cardiac resynchronization therapy with defibrillator (CRT-D) (Correct answer)
- Dual-chamber pacemaker only
Correct answer: Cardiac resynchronization therapy with defibrillator (CRT-D)
CRT-D is indicated for HFrEF with EF ≤35%, LBBB morphology, and QRS ≥150 ms on GDMT with NYHA class II-III symptoms, improving survival and symptoms.
Question 3: Which feature on coronary CT angiography most accurately predicts a hemodynamically significant stenosis beyond anatomic narrowing?
- Calcification score >400 Agatston units
- Positive remodeling index
- CT-derived fractional flow reserve (CT-FFR) ≤0.80 (Correct answer)
- Stenosis ≥50% by visual estimation
Correct answer: CT-derived fractional flow reserve (CT-FFR) ≤0.80
CT-FFR ≤0.80 derived from coronary CTA identifies functionally significant lesions causing ischemia with accuracy comparable to invasive FFR.
Question 4: What is the most common inherited arrhythmia syndrome causing sudden cardiac death due to ventricular fibrillation with a structurally normal heart?
- Catecholaminergic polymorphic ventricular tachycardia (CPVT)
- Long QT syndrome type 1
- Brugada syndrome (Correct answer)
- Short QT syndrome
Correct answer: Brugada syndrome
Brugada syndrome, caused most commonly by SCN5A mutations, presents with coved-type ST elevation in V1-V3 and causes VF-related sudden death in structurally normal hearts.
Question 5: A patient undergoes primary PCI for STEMI. Post-procedure TIMI flow is 3 but has persistent chest pain and ST elevation. What is the most likely explanation?
- Coronary artery spasm
- Stent thrombosis
- No-reflow phenomenon (Correct answer)
- Right ventricular infarction
Correct answer: No-reflow phenomenon
No-reflow occurs when epicardial flow is restored but microvascular obstruction prevents myocardial perfusion, causing persistent symptoms despite TIMI 3 flow.
Question 6: In a patient with acute decompensated heart failure, which finding on BNP or NT-proBNP level most reliably guides diuretic therapy titration during hospitalization?
- Single admission BNP >500 pg/mL
- NT-proBNP >5000 pg/mL on day 1
- Serial BNP reduction of ≥30% from admission to discharge (Correct answer)
- NT-proBNP normalization to <125 pg/mL
Correct answer: Serial BNP reduction of ≥30% from admission to discharge
A ≥30% reduction in BNP from admission to discharge correlates with successful decongestion and predicts lower 30-day readmission and mortality risk.
Question 7: Which complication is most specifically associated with inferior STEMI extending to the right ventricle?
- Pulmonary edema with elevated PCWP
- Hypotension responsive to IV fluids with clear lungs (Correct answer)
- Acute mitral regurgitation from papillary muscle rupture
- Left bundle branch block
Correct answer: Hypotension responsive to IV fluids with clear lungs
RV infarction causes hypotension due to RV failure with low LV preload; the lungs remain clear because LV filling is reduced, and IV fluid loading improves cardiac output.
CMC Certification Cardio Vascular 4
Which drug is the preferred agent for acute rate control of atrial fibrillation with rapid ventricular response in a patient with decompensated heart failure and reduced EF?