CSC Cardiac Subspecialty Certification 3

Question 1

A patient presents with acute inferior STEMI. Which lead pattern is MOST specific for right ventricular involvement?

Accepted Answer

ST elevation in V4R

Answer

ST elevation in lead V4R (right-sided lead) is the most sensitive and specific marker for right ventricular MI.

Question 2

In the management of acute decompensated heart failure with cardiogenic shock, which hemodynamic profile (Forrester classification) defines 'cold and wet'?

Accepted Answer

Low CI, high PCWP

Answer

The 'cold and wet' profile (Forrester Class IV) is defined by low cardiac index (<2.2 L/min/m²) and elevated PCWP (>18 mmHg), reflecting reduced perfusion and congestion.

Question 3

Which finding on cardiac catheterization is diagnostic of constrictive pericarditis versus restrictive cardiomyopathy?

Accepted Answer

Discordant ventricular pressure changes with respiration

Answer

Discordant interventricular pressure changes during respiration (RV pressure rises while LV pressure falls with inspiration) is the hemodynamic hallmark of constrictive pericarditis.

Question 4

A patient with dilated cardiomyopathy (LVEF 28%) and LBBB (QRS 155 ms) is on maximally tolerated medical therapy. Which device therapy has the STRONGEST evidence for mortality reduction?

Accepted Answer

Cardiac resynchronization therapy with defibrillator (CRT-D)

Answer

CRT-D is indicated for LVEF ≤35%, LBBB with QRS ≥150 ms on GDMT, providing both resynchronization benefit and sudden death protection.

Question 5

Which medication is CONTRAINDICATED in a patient with severe aortic stenosis presenting with acute pulmonary edema?

Accepted Answer

IV nitroglycerin

Answer

Nitroglycerin causes preload and afterload reduction; in severe AS, reducing preload can precipitate severe hypotension as fixed obstruction limits compensatory cardiac output increase.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty Certification 3