CSC CSC 3

Question 1

A patient with acute ST-elevation myocardial infarction (STEMI) presents 2 hours after symptom onset. The cath lab is available. What is the preferred reperfusion strategy?

Accepted Answer

Primary PCI within 90 minutes of first medical contact

Answer

Primary PCI is the preferred reperfusion strategy for STEMI when door-to-balloon time can be achieved within 90 minutes of first medical contact.

Question 2

Which valve lesion is most likely to produce a crescendo-decrescendo systolic murmur that radiates to the carotid arteries?

Accepted Answer

Aortic stenosis

Answer

Aortic stenosis produces a harsh crescendo-decrescendo (diamond-shaped) systolic ejection murmur best heard at the right upper sternal border with radiation to the carotids.

Question 3

A 72-year-old woman with severe symptomatic aortic stenosis is deemed high surgical risk. Which intervention is most appropriate?

Accepted Answer

Transcatheter aortic valve replacement (TAVR)

Answer

TAVR is the preferred intervention for severe symptomatic AS in high or prohibitive surgical risk patients and has shown non-inferiority to SAVR even in intermediate-risk patients.

Question 4

Which finding on a right heart catheterization would suggest pulmonary arterial hypertension (PAH) rather than pulmonary venous hypertension (PVH)?

Accepted Answer

Mean PAP >25 mmHg with PCWP ≤15 mmHg

Answer

PAH is defined by mean PAP >25 mmHg with PCWP ≤15 mmHg and elevated pulmonary vascular resistance (>3 Wood units), distinguishing it from left heart disease-related PVH.

Question 5

A patient develops complete heart block after inferior STEMI. Which vessel is most likely occluded?

Accepted Answer

Right coronary artery

Answer

The RCA supplies the AV node in ~90% of patients; inferior STEMI from RCA occlusion commonly causes AV nodal blocks including complete heart block.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC CSC 3