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

Updated 2022 ESC/ERS guidelines define PAH as mean PAP >20 mmHg, PCWP ≤15 mmHg, and PVR ≥3 Wood Units on right heart catheterization.

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

AIVR is a common reperfusion arrhythmia following successful PCI, typically self-limiting and benign, requiring no specific treatment.

Question 3

Which cardiac biomarker rises EARLIEST after acute myocardial infarction onset?

Accepted Answer

Myoglobin

Answer

Myoglobin rises within 1–3 hours of myocardial injury and is the earliest biomarker to become detectable, though it lacks cardiac specificity.

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

IV magnesium sulfate is the first-line treatment for TdP regardless of serum magnesium level; it stabilizes the cardiac membrane and suppresses early afterdepolarizations.

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

Current guidelines support mitral valve surgery for severe primary MR in asymptomatic patients when repair is likely and performed at a heart valve center of excellence, even before EF falls.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Cardiac Subspecialty Certification 5