Free ACS-CARDIAC Practice Questions

Question 1

A patient with exertional dyspnea has LVEF 30%, a calcified aortic valve, valve area 0.78 cm², mean gradient 24 mm Hg, and stroke-volume index 27 mL/m². During low-dose dobutamine, stroke volume increases by 32%, valve area increases to 1.24 cm², and mean gradient reaches 29 mm Hg. Doppler alignment and LVOT measurements have been verified. How should the stenosis be characterized from this response?

Accepted Answer

Pseudo-severe aortic stenosis with demonstrable flow reserve

Answer

True severe aortic stenosis without demonstrable flow reserve

Answer

Indeterminate aortic stenosis because the mean gradient remains below 40 mm Hg

Answer

True severe aortic stenosis with demonstrable flow reserve

Question 2

A 68-year-old with prior cardiac surgery presents with ascites and elevated jugular venous pressure. LVEF is 60%. During spontaneous breathing, the interventricular septum shifts with respiration. Medial mitral annular e′ is 11 cm/s and lateral e′ is 6 cm/s. Hepatic venous Doppler shows prominent diastolic flow reversal during expiration. Which diagnosis best explains this combination?

Accepted Answer

Constrictive pericarditis

Answer

Cardiac amyloidosis

Answer

Pulmonary arterial hypertension

Answer

Severe tricuspid regurgitation

Question 3

Seconds after transcatheter aortic valve deployment, systolic blood pressure falls to 65 mm Hg and new anterior ST elevation appears. TEE shows new severe anteroseptal and anterolateral hypokinesis. The prosthesis is seated, its mean gradient is 7 mm Hg, paravalvular regurgitation is trivial, and no pericardial collection or dynamic LVOT obstruction is seen. Which concern should direct the team’s immediate rescue evaluation?

Accepted Answer

Acute coronary obstruction requiring immediate coronary assessment

Answer

Annular rupture with tamponade requiring pericardial drainage

Answer

Severe paravalvular regurgitation requiring additional valve expansion

Answer

Dynamic LVOT obstruction requiring reversal of ventricular underfilling

Question 4

At 28 weeks of pregnancy, an asymptomatic patient with a surgical bioprosthetic aortic valve undergoes surveillance echocardiography. Compared with her prepregnancy study, the mean gradient has increased from 14 to 25 mm Hg as stroke volume has increased. DVI is essentially unchanged at 0.46 versus 0.45, acceleration time remains about 70 ms, and the leaflets open fully. The preliminary report calls this new prosthetic obstruction. What is the most appropriate correction?

Accepted Answer

Describe a flow-related gradient increase without evidence of new obstruction.

Answer

Report moderate prosthetic stenosis using native aortic stenosis thresholds.

Answer

Retain the obstruction diagnosis and request urgent evaluation for valve thrombosis.

Answer

Attribute the rise to severe mismatch caused by gestational weight gain.

Question 5

Echocardiography in a 76-year-old shows increased LV wall thickness, biatrial enlargement, and relative apical sparing of longitudinal strain. Technetium-99m pyrophosphate imaging shows myocardial uptake equal to rib uptake, confirmed within the myocardium on SPECT. Serum immunofixation also identifies a monoclonal protein. What is the appropriate interpretation of the combined findings?

Accepted Answer

Do not assign amyloid type noninvasively; the monoclonal finding requires further evaluation.

Answer

Repeat scintigraphy; grade 3 uptake would establish ATTR despite the monoclonal protein.

Answer

Diagnose ATTR from grade 2 myocardial uptake without further amyloid typing.

Answer

Diagnose AL because the monoclonal protein identifies the deposited amyloid.

Question 6

In a patient with hypertrophic cardiomyopathy and systolic anterior mitral motion, Valsalva produces two apical continuous-wave Doppler envelopes. A late-peaking ejection signal reaches 3.8 m/s and corresponds to the subaortic acceleration localized by pulsed-wave Doppler. A longer holosystolic signal reaches 5.5 m/s when the beam follows the mitral regurgitant jet. The aortic valve opens normally and proximal velocity is low. Using the simplified Bernoulli relation, which peak LVOT gradient and interpretation belong in the report?

Accepted Answer

Approximately 58 mm Hg, indicating clinically important provocable obstruction

Answer

Approximately 121 mm Hg, indicating clinically important provocable obstruction

Answer

Approximately 15 mm Hg, remaining below the diagnostic threshold for obstruction

Answer

Approximately 29 mm Hg, remaining below the diagnostic threshold for obstruction

Question 7

Mitral regurgitation in a patient with posterior leaflet prolapse begins halfway through systole. A carefully measured peak PISA effective regurgitant orifice area is 0.46 cm². A separate volumetric assessment gives a regurgitant volume of 34 mL and regurgitant fraction of 32%; neither the LV nor LA is enlarged. There is no other significant valve lesion or shunt. What best reconciles the large peak orifice with the smaller total regurgitant burden?

Accepted Answer

Brief regurgitant duration limits total volume despite a large peak orifice.

Answer

The eccentric jet is partly excluded from volumetric measurements.

Answer

Normal chamber sizes mean the PISA value is a measurement error.

Answer

The prolapse mechanism makes peak PISA more representative than the volumetric assessment.

Question 8

Right-heart catheterization is performed to clarify pulmonary hypertension in a patient with unexplained exertional dyspnea. Technically satisfactory end-expiratory measurements show mean pulmonary artery pressure 36 mm Hg, pulmonary artery wedge pressure 22 mm Hg, and cardiac output 4.0 L/min. There is no intracardiac shunt. Which pulmonary vascular resistance and hemodynamic classification are correct?

Accepted Answer

3.5 Wood units; combined postcapillary and precapillary pulmonary hypertension

Answer

5.5 Wood units; combined postcapillary and precapillary pulmonary hypertension

Answer

9.0 Wood units; precapillary pulmonary hypertension

Answer

3.5 Wood units; isolated postcapillary pulmonary hypertension

Question 9

During mitral transcatheter edge-to-edge repair, one device reduces severe MR to moderate MR with a mean transmitral gradient of 3 mm Hg. A second device is grasped but not released: MR becomes mild, the mean gradient rises to 9 mm Hg, and carefully aligned 3D planimetry shows a combined residual opening of 1.2 cm². Heart rate remains 68/min and blood pressure is unchanged. What should the echocardiographer recommend before release?

Accepted Answer

Reassess the second grasp for excessive mitral inflow obstruction before releasing the device.

Answer

Release the second device because reducing MR to mild takes priority over the gradient increase.

Answer

Keep the second grasp and use pressure half-time as the decisive estimate of residual valve area.

Answer

Accept the higher gradient as increased forward flow after MR reduction rather than clinically important narrowing.

Question 10

An adult repaired for tetralogy of Fallot with a transannular patch has progressive RV enlargement. The pulmonary regurgitant jet is broad at its origin but its continuous-wave Doppler signal decelerates rapidly and ends before late diastole. Diastolic flow reversal is present in both branch pulmonary arteries. RVOT systolic velocity is 1.8 m/s, and no residual VSD is detected. How should the brief regurgitant signal be interpreted?

Accepted Answer

Severe pulmonary regurgitation can end early as pulmonary artery and RV pressures equalize.

Answer

Its short duration favors mild pulmonary regurgitation with isolated restrictive RV physiology.

Answer

An occult residual VSD is causing the RV enlargement and branch pulmonary artery reversal.

Answer

Residual RVOT obstruction has produced predominantly systolic RV pressure overload.

Free ACS-CARDIAC Practice Questions

Domain 1: Assimilating History, Clinical, and Echocardiographic Findings 10% of exam

Question 1

Domain 2: Assessing Cardiovascular Heart Disease 39% of exam

Question 2

Question 3

Question 4

Domain 3: Assessing Valvular Heart Disease 18% of exam

Question 5

Question 6

Domain 4: Evaluating Structural Heart and Interventional Procedures 17% of exam

Question 7

Question 8

Domain 5: Utilizing Advanced and Multi-Modality Imaging 11% of exam

Question 9

Domain 6: Assessing Congenital Heart Disease 5% of exam

Question 10

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