CSC Cardiac Subspecialty 4

Question 1

A 72-year-old with chronic AF is on warfarin (INR 2.4) and undergoes elective percutaneous coronary intervention with drug-eluting stent placement. He has no prior bleeding history. What antithrombotic regimen is recommended at discharge?

Accepted Answer

Dual therapy with warfarin + P2Y12 inhibitor for 1-6 months, then warfarin monotherapy

Answer

Current guidelines recommend dual antithrombotic therapy (OAC + P2Y12) for most AF patients after PCI to balance thrombotic and bleeding risk.

Question 2

On echocardiography, a patient has E velocity of 120 cm/s, E/A ratio of 2.4, deceleration time of 140 ms, and E/e' of 18. What grade of diastolic dysfunction does this represent?

Accepted Answer

Grade III (restrictive filling)

Answer

Grade III diastolic dysfunction (restrictive filling) is characterized by E/A >2, shortened deceleration time (<160 ms), and elevated E/e' (>14), reflecting markedly elevated filling pressures.

Question 3

A patient with acute decompensated heart failure is started on intravenous dobutamine. What is the PRIMARY mechanism by which dobutamine improves cardiac output?

Accepted Answer

Beta-1 adrenergic receptor stimulation increasing myocardial contractility

Answer

Dobutamine primarily acts on beta-1 adrenergic receptors to increase inotropy and heart rate, thereby augmenting cardiac output.

Question 4

Which ECG pattern is pathognomonic for acute pericarditis?

Accepted Answer

Diffuse ST elevation with reciprocal changes in aVR and PR depression

Answer

Acute pericarditis classically shows diffuse saddle-shaped ST elevation with PR depression in most leads and reciprocal PR elevation in aVR.

Question 5

A 45-year-old with familial hypercholesterolemia (LDL 210 mg/dL on maximum-dose statin + ezetimibe) has an ASCVD risk >20%. What is the most appropriate next escalation of lipid-lowering therapy?

Accepted Answer

Add a PCSK9 inhibitor (evolocumab or alirocumab)

Answer

PCSK9 inhibitors reduce LDL by 50-60% and are indicated for patients with ASCVD or FH who remain above target on maximally tolerated statin + ezetimibe.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty 4