CSC Case Studies & Practical Application 2

Question 1

A 58-year-old man presents with exertional chest pain and dyspnea. Echo shows LVEF 35%, moderate MR, and dilated LV. Coronary angiography reveals 3-vessel disease. What is the most appropriate next step?

Accepted Answer

Perform CABG with concurrent mitral annuloplasty

Answer

In patients with ischemic cardiomyopathy and moderate functional MR, CABG combined with mitral annuloplasty is preferred when revascularization is planned.

Question 2

A 45-year-old woman with known bicuspid aortic valve is found to have an ascending aorta measuring 4.8 cm on surveillance imaging. She is asymptomatic. What is the recommended management?

Accepted Answer

Elective surgical repair is indicated at this size for bicuspid AV

Answer

Guidelines recommend surgical repair of the ascending aorta at ≥4.5–5.0 cm in patients with bicuspid aortic valve, lower than the threshold for tricuspid valves.

Question 3

A 70-year-old man with hypertension presents with acute-onset tearing back pain. CT shows a Stanford Type B aortic dissection without malperfusion. BP is 160/90 mmHg. What is the initial treatment?

Accepted Answer

IV labetalol to achieve SBP <120 mmHg and HR <60 bpm

Answer

Uncomplicated Stanford Type B dissections are managed medically with aggressive blood pressure and heart rate control as the primary intervention.

Question 4

A 62-year-old woman presents with progressive dyspnea. Echo reveals severe aortic stenosis with AVA 0.7 cm², mean gradient 52 mmHg, and LVEF 60%. She has COPD and prior stroke. STS score is 8%. What is preferred treatment?

Accepted Answer

TAVR via transfemoral approach

Answer

TAVR is preferred for high-surgical-risk patients with severe symptomatic AS, and transfemoral TAVR is the default approach when anatomy permits.

Question 5

A 55-year-old man with HFrEF (EF 30%) on optimal medical therapy develops symptomatic ventricular tachycardia. He previously declined ICD. Amiodarone has been ineffective. What is the next best step?

Accepted Answer

Catheter ablation of VT

Answer

Catheter ablation is recommended for recurrent, drug-refractory VT in patients with structural heart disease.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Case Studies & Practical Application 2