CSC Case Studies & Practical Application 4

Question 1

A 42-year-old woman with SLE presents with dyspnea and echo showing thickened mitral and aortic leaflets with regurgitation but no vegetations. Blood cultures are negative. What is the most likely diagnosis?

Accepted Answer

Libman-Sacks endocarditis

Answer

Libman-Sacks endocarditis is a nonbacterial thrombotic endocarditis associated with SLE, characterized by sterile vegetations typically on both sides of the valve leaflets.

Question 2

A 68-year-old man with prior CABG presents with recurrent angina. Stress imaging reveals ischemia in the LAD territory. Angiography shows patent LIMA-LAD graft with a 90% stenosis of the proximal LAD native vessel proximal to the anastomosis. What is the preferred strategy?

Accepted Answer

PCI of the native LAD proximal lesion

Answer

PCI of the native coronary artery proximal to a patent bypass graft anastomosis is preferred over redo surgery when feasible, avoiding graft manipulation.

Question 3

A 25-year-old man with Marfan syndrome is found to have an aortic root diameter of 4.7 cm on annual surveillance. He is asymptomatic. Which management is most appropriate?

Accepted Answer

Elective aortic root replacement

Answer

Guidelines recommend prophylactic aortic root replacement in Marfan syndrome when the aortic root diameter reaches ≥4.5 cm, or when growth rate exceeds 0.5 cm/year.

Question 4

A 70-year-old man with known severe AS (AVA 0.65 cm²) and EF 25% presents with mean gradient of only 28 mmHg. What test best differentiates true severe AS from pseudo-severe AS in this context?

Accepted Answer

Dobutamine stress echocardiography

Answer

Dobutamine stress echocardiography distinguishes true severe AS (AVA remains low at higher flow) from pseudo-severe AS (AVA increases with dobutamine) in low-flow, low-gradient AS.

Question 5

A 52-year-old woman with HCM and LVOT gradient of 75 mmHg at rest has NYHA class III symptoms despite maximally tolerated disopyramide and metoprolol. What intervention should be considered next?

Accepted Answer

Septal reduction therapy (surgical myectomy or alcohol septal ablation)

Answer

Septal reduction therapy (surgical myectomy preferred, or alcohol septal ablation) is indicated for drug-refractory obstructive HCM with severe symptoms.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Case Studies & Practical Application 4