CSC Case Studies & Practical Application 3

Question 1

A 72-year-old man with DM and CKD (eGFR 28) presents for elective PCI. He is on metformin. How should his metformin be managed peri-procedurally?

Accepted Answer

Hold metformin 48 hours before contrast and restart only after reassessing renal function

Answer

Metformin should be withheld 48 hours before contrast administration and restarted only after confirming stable renal function due to risk of lactic acidosis.

Question 2

A 50-year-old man presents with progressive exertional dyspnea. Echo shows severe mitral stenosis with MVA 0.9 cm², mean gradient 14 mmHg, pliable non-calcified leaflets, and mild MR. Wilkins score is 7. What is the treatment of choice?

Accepted Answer

Percutaneous mitral balloon valvotomy (PMBV)

Answer

A Wilkins score ≤8 with favorable anatomy (pliable leaflets, minimal MR, no significant calcification) makes PMBV the preferred intervention for severe MS.

Question 3

A 66-year-old woman with AF and CHA₂DS₂-VASc score of 5 is on warfarin. She requires elective hip replacement. Her cardiologist considers bridging therapy. What is the current recommendation?

Accepted Answer

Stop warfarin 5 days before; no bridging needed

Answer

The BRIDGE trial showed that forgoing heparin bridging in AF patients on warfarin undergoing elective surgery did not increase thromboembolism risk and reduced bleeding.

Question 4

A 34-year-old pregnant woman (28 weeks) with known severe MS and worsening pulmonary edema despite diuretics is evaluated. Echo confirms MVA 0.8 cm². What is the safest definitive intervention?

Accepted Answer

Percutaneous mitral balloon valvotomy with radiation shielding

Answer

PMBV is preferred for pregnant women with severe symptomatic MS refractory to medical therapy, with abdominal shielding to minimize fetal radiation exposure.

Question 5

A 78-year-old man with severe HFrEF (EF 20%) on optimal GDMT presents with worsening dyspnea at rest and recurrent hospitalizations. He is not a transplant candidate. What device therapy should be considered?

Accepted Answer

Destination therapy LVAD

Answer

Destination therapy LVAD is indicated for advanced HFrEF patients ineligible for transplant who remain severely symptomatic on optimal medical therapy.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Case Studies & Practical Application 3