CSC Cardiac Subspecialty Certification 5

Question 1

Which hemodynamic parameter defines pulmonary arterial hypertension (PAH) by current guidelines?

Accepted Answer

Mean PAP >20 mmHg at rest with PCWP ≤15 mmHg and PVR ≥3 WU

Answer

Mean PAP >25 mmHg at rest with PCWP ≤15 mmHg

Answer

Systolic PAP >40 mmHg on echocardiography

Answer

Mean PAP >20 mmHg with any PCWP

Question 2

A patient develops accelerated idioventricular rhythm (AIVR) 90 minutes after successful primary PCI for inferior STEMI. What is the MOST appropriate management?

Accepted Answer

Observation only; AIVR is a benign reperfusion rhythm

Answer

Immediate DC cardioversion

Answer

IV amiodarone infusion

Answer

IV lidocaine bolus

Question 3

Which cardiac biomarker rises EARLIEST after acute myocardial infarction onset?

Accepted Answer

Myoglobin

Answer

Troponin I

Answer

CK-MB

Answer

BNP

Question 4

A patient with known coronary artery disease develops torsades de pointes (TdP) while receiving dofetilide. His QTc is 580 ms. What is the MOST important immediate intervention?

Accepted Answer

IV magnesium sulfate 2 g over 15 minutes

Answer

Synchronized cardioversion followed by IV amiodarone

Answer

IV adenosine 6 mg bolus

Answer

Oral potassium supplementation only

Question 5

A 55-year-old woman has an echocardiogram showing severe mitral regurgitation with LVEF 58% and LV end-systolic diameter of 42 mm. She is asymptomatic. Which management is MOST appropriate per current ACC/AHA guidelines?

Accepted Answer

Mitral valve surgery is reasonable if repair is likely

Answer

Continue surveillance; intervene only when EF drops below 50%

Answer

Start vasodilator therapy to delay surgery

Answer

Cardiac resynchronization therapy

Question 6

Which stress imaging modality has the HIGHEST sensitivity for detecting ischemia in a patient with a left bundle branch block (LBBB)?

Accepted Answer

Pharmacologic vasodilator stress with nuclear imaging or CMR

Answer

Exercise treadmill nuclear perfusion imaging (SPECT)

Answer

Dobutamine stress echocardiography

Answer

Exercise stress echocardiography

Question 7

In a patient with hypertrophic cardiomyopathy and recurrent syncope despite beta-blocker therapy, which invasive option is preferred when septal thickness is ≥30 mm and anatomy is suitable?

Accepted Answer

Surgical septal myectomy

Answer

Alcohol septal ablation

Answer

Dual-chamber pacemaker implantation

Answer

ICD implantation only