CSC Cardiac Subspecialty Certification 4

Question 1

A patient with mitral stenosis has a mitral valve area of 0.9 cm² and mean gradient of 12 mmHg at rest. She is in sinus rhythm with no significant mitral regurgitation. Which intervention is MOST appropriate?

Accepted Answer

Percutaneous mitral balloon commissurotomy (PMBC)

Answer

PMBC is the preferred intervention for severe symptomatic mitral stenosis with favorable valve morphology (Wilkins score ≤8) and no significant MR or LA thrombus.

Question 2

Which blood pressure goal is recommended during the first 24 hours in a patient with acute aortic dissection (Type A) awaiting surgical repair?

Accepted Answer

SBP <120 mmHg and HR <60 bpm

Answer

Target SBP <120 mmHg and HR <60 bpm with IV beta-blockers (e.g., esmolol, labetalol) to reduce aortic wall stress before urgent surgical repair.

Question 3

A 45-year-old with no cardiac history has a resting 12-lead ECG showing ST segment elevation in V1–V2 with a right bundle branch block pattern. He denies symptoms. Which condition should be PRIMARILY suspected?

Accepted Answer

Brugada syndrome

Answer

Spontaneous Type 1 Brugada pattern (coved ST elevation ≥2 mm in V1–V2 with RBBB morphology) in an asymptomatic patient is diagnostic of Brugada syndrome.

Question 4

In a patient with long QT syndrome type 2 (LQT2), which environmental trigger is MOST likely to provoke a potentially fatal arrhythmia?

Accepted Answer

Auditory stimuli (e.g., loud sounds, alarm clocks)

Answer

LQT2 is caused by HERG (IKr) channel mutations and arrhythmias are most commonly triggered by auditory stimuli, particularly sudden loud noises.

Question 5

A patient on warfarin for mechanical aortic valve (INR 2.8) needs urgent non-cardiac surgery. Which bridging strategy is MOST appropriate?

Accepted Answer

Stop warfarin; bridge with IV unfractionated heparin

Answer

Mechanical heart valves carry high thromboembolic risk; IV unfractionated heparin bridging is recommended when warfarin must be stopped for urgent surgery.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty Certification 4