CSC Cardiac Subspecialty 5

Question 1

A patient with pulmonary arterial hypertension (PAH, Group 1) has WHO functional class III symptoms. Vasoreactivity testing with inhaled nitric oxide shows mean PAP decrease to 32 mmHg with cardiac output increase. What does this indicate?

Accepted Answer

Positive vasoreactivity test; candidate for long-term calcium channel blocker therapy

Answer

A positive vasoreactivity test (mPAP decrease ≥10 mmHg to <40 mmHg with increased or unchanged cardiac output) identifies patients likely to benefit from high-dose CCBs.

Question 2

A 55-year-old man undergoes pharmacologic nuclear stress testing with regadenoson. Which adverse effect specific to regadenoson should be monitored for in patients with reactive airway disease?

Accepted Answer

Bronchospasm due to adenosine receptor activation

Answer

Regadenoson activates A2A adenosine receptors but can also stimulate A2B receptors in bronchial smooth muscle, potentially causing bronchospasm in susceptible patients.

Question 3

A 67-year-old presents with severe mitral regurgitation (ERO 0.45 cm², regurgitant volume 65 mL) due to a flail posterior leaflet. He is asymptomatic with LVEF 58% and LV end-systolic dimension 39 mm. What is the most appropriate management?

Accepted Answer

Mitral valve surgery, preferably repair, given severe MR with flail leaflet

Answer

Severe primary MR with a flail leaflet, even in asymptomatic patients, carries a high risk of LV dysfunction and warrants referral to a mitral valve repair center.

Question 4

Which statement best describes the mechanism of action of sacubitril/valsartan (Entresto) in heart failure with reduced ejection fraction?

Accepted Answer

Neprilysin inhibition preventing BNP/ANP breakdown combined with AT1 receptor blockade

Answer

Sacubitril inhibits neprilysin (preventing natriuretic peptide degradation) while valsartan blocks AT1 receptors, reducing preload, afterload, and fibrosis.

Question 5

A 62-year-old woman with no cardiac history presents with acute anterior ST elevation MI. Primary PCI is performed at 90 minutes after first medical contact. Post-PCI TIMI flow is 3, but echocardiography shows apical ballooning with hyperkinetic basal segments. What is the most likely diagnosis?

Accepted Answer

Takotsubo (stress) cardiomyopathy mimicking STEMI

Answer

Apical ballooning with basal hyperkinesis (reverse pattern) in the distribution of multiple coronary territories, despite patent arteries, is the hallmark of Takotsubo cardiomyopathy.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty 5