CSC CSC 4

Question 1

A patient with dilated cardiomyopathy and LBBB (QRS 158 ms) and EF of 25% is on optimal medical therapy. Which CRT criterion is not met if the patient is NYHA Class I?

Accepted Answer

Symptom threshold for Class I recommendation

Answer

Current guidelines recommend CRT for NYHA Class II–IV patients; Class I is generally not an indication, as mortality benefit requires a minimum symptom burden.

Question 2

Which pharmacologic stress agent is contraindicated in patients with severe reactive airway disease undergoing pharmacologic stress testing?

Accepted Answer

Adenosine

Answer

Adenosine causes severe bronchospasm via A2B receptor activation and is contraindicated in reactive airway disease; regadenoson (selective A2A agonist) is relatively safer but still used cautiously.

Question 3

A patient with known aortic stenosis has an aortic valve area of 0.7 cm² but a mean gradient of only 22 mmHg due to low cardiac output. How is this best categorized?

Accepted Answer

Low-flow, low-gradient severe aortic stenosis

Answer

Low-flow, low-gradient severe AS occurs when reduced stroke volume limits gradient despite truly severe valve obstruction; dobutamine stress echo helps distinguish true from pseudosevere AS.

Question 4

A 55-year-old athlete presents with syncope during exercise. ECG shows epsilon waves and T-wave inversions in V1–V3. Which diagnosis is most likely?

Accepted Answer

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

Answer

ARVC classically presents with epsilon waves, T-wave inversions in right precordial leads, and exercise-induced ventricular arrhythmias due to fibrofatty RV replacement.

Question 5

Which anticoagulation strategy is recommended for a patient with AF and a CHA₂DS₂-VASc score of 2 who requires bridging therapy before elective surgery?

Accepted Answer

No bridging required for most AF patients on warfarin

Answer

The BRIDGE trial demonstrated that forgoing bridging anticoagulation in AF patients was non-inferior to LMWH bridging, with lower bleeding risk and no increase in thromboembolism.

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC - Cardiac Subspecialty Certification Exam Practice Test

CSC CSC 4