CMC Certification Cardio Vascular 4

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?

Accepted Answer

IV amiodarone

Answer

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?

Accepted Answer

Cardiac resynchronization therapy with defibrillator (CRT-D)

Answer

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?

Accepted Answer

CT-derived fractional flow reserve (CT-FFR) ≤0.80

Answer

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?

Accepted Answer

Brugada syndrome

Answer

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?

Accepted Answer

No-reflow phenomenon

Answer

No-reflow occurs when epicardial flow is restored but microvascular obstruction prevents myocardial perfusion, causing persistent symptoms despite TIMI 3 flow.

CMC - Cardiac Medicine Certification Practice Test

CMC - Cardiac Medicine Certification Practice Test

CMC Certification Cardio Vascular 4