CSC Risk Assessment & Management 5 — Questions and Answers
Question 1: A patient with known coronary artery disease is scheduled for elective hip replacement. Preoperative stress testing is MOST indicated when:
- The patient has well-controlled hypertension
- The patient has poor functional capacity (<4 METs) and findings would change management (Correct answer)
- Any patient with known CAD regardless of functional status
- The patient is taking beta-blockers
Correct answer: The patient has poor functional capacity (<4 METs) and findings would change management
ACC/AHA guidelines recommend preoperative stress testing only when the patient has poor functional capacity AND the results would change perioperative management or revascularization strategy.
Question 2: In patients with long QT syndrome (LQTS), which genotype is associated with the HIGHEST risk of cardiac events during exercise or emotional stress?
- LQT1 (Correct answer)
- LQT2
- LQT3
- LQT4
Correct answer: LQT1
LQT1 patients carry the highest risk of arrhythmic events during exercise or sympathetic activation due to the loss of function in the IKs potassium channel.
Question 3: The Seattle Heart Failure Model (SHFM) is used to estimate which clinical endpoint in heart failure patients?
- Risk of hospitalization in the next 30 days
- 1-year and 5-year survival (Correct answer)
- Probability of response to CRT
- Risk of worsening renal function with diuresis
Correct answer: 1-year and 5-year survival
The Seattle Heart Failure Model estimates 1-, 2-, and 5-year survival in patients with systolic heart failure using clinical, laboratory, and medication data.
Question 4: In the context of TAVR risk stratification, the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) score of >8% classifies a patient as:
- Low risk
- Intermediate risk
- High risk (Correct answer)
- Extreme risk (prohibitive surgical risk)
Correct answer: High risk
An STS PROM score >8% has traditionally defined high surgical risk in the context of TAVR eligibility criteria used in pivotal trials.
Question 5: Which of the following best describes the role of C-reactive protein (hsCRP) in cardiovascular risk stratification?
- Replaces LDL cholesterol as the primary treatment target
- Reclassifies intermediate-risk patients when added to traditional risk factors (Correct answer)
- Directly causes atherosclerotic plaque rupture
- Predicts response to statin therapy across all risk groups
Correct answer: Reclassifies intermediate-risk patients when added to traditional risk factors
hsCRP adds incremental prognostic value to traditional risk factors and is used to reclassify intermediate-risk patients, as demonstrated in the JUPITER trial and pooled cohort guidelines.
Question 6: A patient with dilated cardiomyopathy, LVEF 30%, NYHA Class II symptoms, and LBBB with QRS duration of 155 ms is on optimal medical therapy. Which risk-reducing intervention is MOST indicated?
- Implantable cardioverter-defibrillator (ICD) alone
- Cardiac resynchronization therapy with defibrillator (CRT-D) (Correct answer)
- Catheter ablation of the left bundle branch
- Urgent cardiac transplant evaluation
Correct answer: Cardiac resynchronization therapy with defibrillator (CRT-D)
CRT-D is a Class I indication in patients with LVEF ≤35%, NYHA Class II-III symptoms, and LBBB with QRS ≥150 ms on GDMT, providing both mortality benefit and resynchronization.
Question 7: Which parameter from a cardiopulmonary exercise test (CPET) is the STRONGEST independent predictor of cardiovascular mortality in heart failure patients?
- Resting heart rate
- Peak VO2 (Correct answer)
- Anaerobic threshold
- Resting oxygen saturation
Correct answer: Peak VO2
Peak VO2 is the strongest independent predictor of cardiovascular mortality in heart failure and is used to guide cardiac transplant listing (threshold typically <12-14 mL/kg/min).
CSC Risk Assessment & Management 5
A patient with known coronary artery disease is scheduled for elective hip replacement.
Preoperative stress testing is MOST indicated when: