CSC CSC 2 — Questions and Answers
Question 1: A patient with acute decompensated heart failure has a pulmonary capillary wedge pressure (PCWP) of 28 mmHg and a cardiac index of 1.8 L/min/m². Which hemodynamic profile best describes this patient?
- Warm and dry
- Cold and wet (Correct answer)
- Warm and wet
- Cold and dry
Correct answer: Cold and wet
A low cardiac index (<2.2) with elevated filling pressures (PCWP >18 mmHg) defines the 'cold and wet' profile, indicating low perfusion and congestion.
Question 2: Which echocardiographic finding is most consistent with cardiac tamponade physiology?
- Right ventricular hypertrophy
- Diastolic collapse of the right atrium and right ventricle (Correct answer)
- Left atrial enlargement with mitral regurgitation
- Systolic anterior motion of the mitral valve
Correct answer: Diastolic collapse of the right atrium and right ventricle
Diastolic collapse of the right atrium (>1/3 of systole) and right ventricle are hallmark echo findings of tamponade physiology due to elevated pericardial pressure.
Question 3: A 58-year-old man presents with exertional chest pain. Coronary angiography shows 60% stenosis of the LAD. Which test best determines the hemodynamic significance of this lesion?
- Stress echocardiography
- Cardiac MRI with gadolinium
- Fractional flow reserve (FFR) (Correct answer)
- CT coronary angiography
Correct answer: Fractional flow reserve (FFR)
FFR ≤0.80 identifies a physiologically significant stenosis and guides revascularization decisions more accurately than anatomic severity alone.
Question 4: Which antiarrhythmic drug is contraindicated in patients with Wolff-Parkinson-White (WPW) syndrome presenting with atrial fibrillation?
- Amiodarone
- Adenosine
- Digoxin (Correct answer)
- Procainamide
Correct answer: Digoxin
Digoxin (and other AV nodal blockers like verapamil and adenosine) can accelerate conduction through the accessory pathway in WPW, potentially precipitating ventricular fibrillation.
Question 5: A patient with hypertrophic obstructive cardiomyopathy (HOCM) develops worsening dyspnea despite maximum medical therapy. The LVOT gradient is 65 mmHg at rest. What is the next best intervention?
- ICD implantation
- Cardiac transplantation
- Septal reduction therapy (myectomy or alcohol ablation) (Correct answer)
- Addition of digoxin
Correct answer: Septal reduction therapy (myectomy or alcohol ablation)
Septal reduction therapy (surgical myectomy or alcohol septal ablation) is indicated for symptomatic HOCM with resting LVOT gradient ≥50 mmHg refractory to medical therapy.
Question 6: Which ECG finding is pathognomonic for hyperkalemia at dangerous levels (K⁺ >7.0 mEq/L)?
- Prolonged QTc interval
- Sine wave pattern with widened QRS (Correct answer)
- ST-segment depression in lateral leads
- Peaked P waves in lead II
Correct answer: Sine wave pattern with widened QRS
Severe hyperkalemia produces a sine wave pattern from merging of widened QRS with T waves, signaling imminent ventricular fibrillation.
Question 7: In a patient with New York Heart Association Class III heart failure with reduced ejection fraction (HFrEF, EF 28%), which device therapy has been shown to reduce all-cause mortality?
- Implantable loop recorder
- Cardiac resynchronization therapy (CRT) in appropriate candidates (Correct answer)
- Wearable cardioverter-defibrillator
- Implantable hemodynamic monitor alone
Correct answer: Cardiac resynchronization therapy (CRT) in appropriate candidates
CRT reduces mortality and improves symptoms in HFrEF patients with LBBB and QRS duration ≥150 ms who remain symptomatic on optimal medical therapy.
CSC CSC 2
A patient with acute decompensated heart failure has a pulmonary capillary wedge pressure (PCWP) of 28 mmHg and a cardiac index of 1.8 L/min/m².
Which hemodynamic profile best describes this patient?