CSC Case Studies & Practical Application 5

Question 1

A 67-year-old man post-anterior STEMI develops new hypotension, elevated JVP, clear lung fields, and new holosystolic murmur. Echo shows a ventricular septal defect. What is the next best step?

Accepted Answer

Intra-aortic balloon pump and emergent surgical VSD repair

Answer

Post-MI VSD with cardiogenic shock requires hemodynamic stabilization with IABP and emergent surgical repair, as mortality is very high without prompt intervention.

Question 2

A 60-year-old woman with known ATTR cardiac amyloidosis presents with progressive HFpEF and atrial fibrillation. What therapy has been shown to improve survival in transthyretin amyloid cardiomyopathy?

Accepted Answer

Tafamidis

Answer

Tafamidis stabilizes transthyretin tetramers and has demonstrated significant reductions in cardiovascular mortality and hospitalizations in ATTR cardiomyopathy (ATTR-ACT trial).

Question 3

A 55-year-old man with non-ischemic cardiomyopathy (EF 28%) on optimal GDMT develops NSVT on Holter monitoring. He has no syncope. What is the primary indication for ICD implantation in this patient?

Accepted Answer

EF ≤35% despite ≥3 months of GDMT is the primary indication

Answer

ICD implantation is indicated for primary prevention of SCD in non-ischemic cardiomyopathy when EF remains ≤35% after ≥3 months of optimal GDMT, regardless of NSVT.

Question 4

A 73-year-old woman presents with dyspnea. Right heart catheterization shows PCWP 28 mmHg, mPAP 42 mmHg, PVR 2.1 WU, and cardiac output 3.8 L/min. What type of pulmonary hypertension does she have?

Accepted Answer

Group 2: PH due to left heart disease

Answer

Elevated PCWP (>15 mmHg) with elevated mPAP defines Group 2 pulmonary hypertension due to left heart disease, the most common cause of PH.

Question 5

A 49-year-old man undergoes PCI of the RCA with a drug-eluting stent. Two weeks later he requires urgent tooth extraction. What antiplatelet strategy is most appropriate?

Accepted Answer

Continue both aspirin and P2Y12 inhibitor throughout the dental procedure

Answer

Within 3–6 months of DES implantation, DAPT should not be interrupted for minor surgical procedures; continuing both agents during tooth extraction is acceptable.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC Case Studies & Practical Application 5