CSC Cardiac Subspecialty 2

Question 1

A patient with hypertrophic obstructive cardiomyopathy (HOCM) has a dynamic outflow tract gradient of 55 mmHg at rest. Which maneuver would INCREASE the gradient?

Accepted Answer

Valsalva maneuver (strain phase)

Answer

The Valsalva strain phase reduces venous return, decreasing LV volume and worsening LVOT obstruction in HOCM.

Question 2

In the PARTNER trial, transcatheter aortic valve replacement (TAVR) compared to surgical AVR showed which key finding in intermediate-risk patients at 2 years?

Accepted Answer

TAVR and SAVR had similar rates of death and disabling stroke

Answer

PARTNER 2A demonstrated non-inferiority of TAVR versus SAVR for the primary endpoint of death or disabling stroke in intermediate-risk patients.

Question 3

A 65-year-old presents with new-onset atrial fibrillation and a CHA₂DS₂-VASc score of 3. Which anticoagulation strategy is most appropriate?

Accepted Answer

Oral anticoagulation with a DOAC or warfarin

Answer

A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants oral anticoagulation to reduce stroke risk in AF.

Question 4

On right heart catheterization, a patient has PCWP of 28 mmHg, PA mean of 42 mmHg, and cardiac output of 3.1 L/min. What is the transpulmonary gradient and what does it suggest?

Accepted Answer

TPG = 14 mmHg, suggesting combined pre- and post-capillary pulmonary hypertension

Answer

TPG = mPAP − PCWP = 42 − 28 = 14 mmHg; a TPG >12 mmHg with elevated PCWP indicates combined pre- and post-capillary pulmonary hypertension.

Question 5

Which echocardiographic finding is most consistent with cardiac tamponade physiology?

Accepted Answer

Right ventricular diastolic collapse and respiratory variation in mitral inflow >25%

Answer

RV diastolic collapse and >25% respiratory variation in mitral inflow velocities are classic echocardiographic signs of tamponade.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty 2