ABIM Cardiovascular Disease

A 58-year-old man presents with 2 hours of crushing chest pain. ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. Which coronary artery is most likely occluded?

• ALeft anterior descending (LAD)
• BLeft circumflex (LCX)
• CRight coronary artery (RCA)
• DLeft main coronary artery

In a patient with inferior STEMI, which ECG finding best indicates right ventricular (RV) involvement?

• AST elevation in V1-V2
• BST elevation >= 1 mm in V4R
• CST depression in V5-V6
• DTall R waves in V1

Which ECG pattern represents a STEMI-equivalent 'de Winter' T waves?

• ATall peaked T waves in precordial leads with upsloping ST depression at the J point
• BBiphasic T waves in V2-V3 with positive-negative morphology
• CDeeply inverted symmetric T waves in V2-V4
• DDiffuse ST elevation with PR depression

A patient presents with chest pain that resolved. ECG shows biphasic T waves in V2-V3. Cardiac enzymes are negative. What is the most appropriate next step?

• ADischarge home with outpatient stress test in 1 week
• BUrgent coronary angiography
• CExercise stress test the next morning
• DStart aspirin and discharge

Which Sgarbossa criterion provides the MOST specific evidence of acute MI in the presence of LBBB?

• AConcordant ST elevation >= 1 mm in any lead
• BConcordant ST depression >= 1 mm in V1-V3
• CDiscordant ST elevation >= 5 mm
• DAll three carry equal weight

A 68-year-old with a paced rhythm presents with chest pain. Which finding most strongly suggests acute MI?

• ADiscordant ST elevation of 2 mm
• BQRS duration of 150 ms
• CConcordant ST elevation of 2 mm
• DDeep Q waves in paced leads

A patient with inferior STEMI has ST depression in V1-V2. What additional finding would support posterior wall involvement?

• ATall R wave in V1 (R/S ratio > 1)
• BDeep Q waves in V5-V6
• CT wave inversion in aVL
• DFirst-degree AV block

A 32-year-old man with syncope has an ECG showing coved ST elevation >= 2 mm with inverted T wave in V1-V2. Which diagnosis is most consistent?

• ABrugada syndrome type 1
• BBrugada syndrome type 2
• CEarly repolarization
• DAthletic heart

A 25-year-old collapses during exercise and is resuscitated. ECG shows a short PR (<120 ms), delta wave, and wide QRS. What is the mechanism of sudden cardiac death in this disorder?

• AAtrial fibrillation with rapid conduction down an accessory pathway causing ventricular f…
• BComplete heart block leading to asystole
• CTorsades de pointes from QT prolongation
• DCommotio cordis

A patient has a QT of 500 ms at a heart rate of 100 bpm. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?

• A445 ms
• B500 ms
• C577 ms
• D645 ms

Which drug most commonly causes acquired long QT syndrome and torsades de pointes?

• AMetoprolol
• BAmiodarone
• CMethadone
• DLisinopril

A patient develops polymorphic VT with QT prolongation and hypotension. Initial treatment of choice is:

• AAmiodarone 150 mg IV
• BIV magnesium sulfate 2 g bolus
• CLidocaine 1 mg/kg
• DProcainamide infusion

A patient with narrow-complex tachycardia at 180 bpm has stable blood pressure. After vagal maneuvers fail, which dose and route of adenosine is correct initially?

• A3 mg IV push, then 6 mg if needed
• B6 mg IV rapid push with 20 mL saline flush, then 12 mg, then 12 mg
• C18 mg IV slow push over 2 minutes
• D6 mg IM

A 72-year-old with new atrial fibrillation has hypertension, diabetes, and prior stroke. What is her CHA2DS2-VASc score and stroke prevention recommendation?

• AScore 3 — aspirin alone is sufficient
• BScore 5 — oral anticoagulation is indicated
• CScore 2 — no anticoagulation needed
• DScore 6 — warfarin is preferred over DOAC

A 60-year-old with AF for 6 months has an EF of 30% and symptoms despite rate control. Per 2023 ACC/AHA/ACCP/HRS AF guideline, which is Class I?

• AAmiodarone only
• BCatheter ablation to reduce HF hospitalization and mortality
• CMaze surgical ablation
• DDC cardioversion without anticoagulation

What is the maximum duration of atrial fibrillation during which TEE can be omitted before cardioversion if anticoagulation has not been therapeutic?

• A12 hours
• B24 hours
• C48 hours
• D72 hours

In primary prevention of sudden cardiac death, an ICD is indicated after ischemic cardiomyopathy when:

• AEF <= 35% on guideline-directed therapy > 3 months, and > 40 days post-MI
• BEF <= 45% immediately post-MI
• CAny NYHA class with EF <= 50%
• DOnly after a documented ventricular arrhythmia

Which is a Class I indication for secondary prevention ICD?

• ASingle episode of non-sustained VT
• BAborted cardiac arrest from VF not due to reversible cause
• CInducible VT on EP study with normal EF
• DSyncope with normal ECG

A 55-year-old has stable angina on maximally tolerated medical therapy. Coronary angiography shows a 70% mid-LAD lesion. Fractional flow reserve is 0.85. What is the most appropriate management?

• AProceed with PCI of the LAD
• BContinue medical therapy; the lesion is not hemodynamically significant
• CCABG of the LAD
• DRepeat angiography in 6 months

The instantaneous wave-free ratio (iFR) threshold for ischemia that supports revascularization is:

• AiFR <= 0.80
• BiFR <= 0.89
• CiFR <= 0.95
• DiFR >= 0.89

The ISCHEMIA trial (2020) demonstrated that in patients with stable CAD and moderate-to-severe ischemia:

• AInvasive strategy reduced all-cause mortality by 30%
• BInvasive and conservative strategies had similar rates of death and MI at 3.2 years
• CCABG was superior to PCI in all subgroups
• DConservative therapy was superior for cardiovascular mortality

A 55-year-old presents with NSTEMI. Coronary angiography shows a culprit RCA lesion. Which P2Y12 inhibitor offers the best efficacy in ACS per current guidelines?

• AClopidogrel 75 mg daily
• BTicagrelor 90 mg BID
• CAspirin monotherapy
• DDipyridamole

A patient with STEMI is being transported to a PCI-capable hospital. The goal for first medical contact-to-device time is:

• A<= 30 minutes
• B<= 60 minutes
• C<= 90 minutes for primary PCI
• D<= 180 minutes

What is the standard duration of dual antiplatelet therapy (DAPT) after drug-eluting stent placement for ACS per 2021 ACC/AHA/SCAI guidelines?

• A1 month minimum
• B3-6 months with consideration of de-escalation
• CAt least 12 months; shorter (<= 3-6 months) if high bleeding risk
• DLifelong DAPT

A patient with aortic stenosis has a peak jet velocity of 4.5 m/s, mean gradient 50 mmHg, and AVA 0.8 cm2. How is the severity classified?

• AMild AS
• BModerate AS
• CSevere high-gradient AS
• DLow-flow low-gradient AS

A 78-year-old with severe symptomatic AS has a calculated STS risk of 10%. Which valve replacement strategy is most appropriate?

• AMedical therapy alone
• BSurgical AVR (SAVR)
• CTranscatheter AVR (TAVR) is preferred
• DBalloon aortic valvuloplasty as definitive therapy

A 70-year-old with reduced EF (25%) and AVA 0.8 cm2 has a mean gradient of 25 mmHg. Dobutamine stress echo is performed. Which finding indicates true-severe low-flow, low-gradient AS?

• AAVA increases to > 1.2 cm2 with dobutamine
• BAVA remains <= 1.0 cm2 with mean gradient rising to >= 40 mmHg
• CNo increase in stroke volume with dobutamine
• DWall motion abnormalities develop

Which finding on echocardiography is MOST specific for severe aortic regurgitation?

• AJet width/LVOT width > 65%
• BPressure half-time > 500 ms
• CHolodiastolic flow reversal in the descending aorta
• DMild LV dilation

A patient with severe mitral stenosis (MVA 1.2 cm2) from rheumatic disease has favorable valve morphology (Wilkins score 7) and no LA thrombus. Treatment of choice is:

• AMitral valve replacement
• BPercutaneous balloon mitral valvuloplasty
• CLong-term diuretic therapy only
• DSurgical commissurotomy

For severe primary mitral regurgitation, which EROA threshold defines severe MR?

• A>= 0.20 cm2
• B>= 0.30 cm2
• C>= 0.40 cm2
• D>= 0.60 cm2

The COAPT trial supported MitraClip (transcatheter edge-to-edge repair) in which patient population?

• APrimary MR with preserved EF
• BSecondary MR with HF despite GDMT and LVEF 20-50%
• CSevere MR with cardiogenic shock
• DAsymptomatic severe MR

Using the modified Duke criteria, a patient with 3 blood cultures positive for Staphylococcus aureus and TEE showing an aortic valve vegetation has:

• APossible endocarditis (1 major + 1 minor)
• BDefinite endocarditis (2 major criteria)
• CRejected (not enough criteria)
• DNeeds pathology to confirm

Which is a Class I indication for surgery in infective endocarditis?

• ASmall vegetation < 5 mm without emboli
• BHeart failure from severe valve regurgitation or dysfunction
• CIsolated mild aortic regurgitation
• DPositive blood cultures on appropriate antibiotics

A 45-year-old with HCM has had syncope, LV wall thickness 32 mm, non-sustained VT on Holter, and a family history of SCD in a first-degree relative. What is the most appropriate management?

• ABeta-blocker alone and annual follow-up
• BImplantable cardioverter-defibrillator (ICD) for primary prevention
• CAlcohol septal ablation
• DDual-chamber pacing

A patient with HCM and severe LVOT obstruction (resting gradient 70 mmHg) has persistent symptoms despite maximally tolerated beta-blocker and disopyramide. Which is a septal reduction option?

• AAlcohol septal ablation or surgical myectomy
• BTranscatheter mitral valve replacement
• CMitral valve repair alone
• DHeart transplantation only

A 72-year-old with heart failure, low-voltage ECG, and echo showing biventricular wall thickening with 'speckled' myocardium has preserved EF. Technetium pyrophosphate scan grade 3 uptake. Which diagnosis is most likely?

• AHypertrophic cardiomyopathy
• BTransthyretin cardiac amyloidosis (ATTR)
• CHypertensive heart disease
• DNoncompaction cardiomyopathy

Which finding on cardiac MRI supports cardiac sarcoidosis?

• ASubendocardial late gadolinium enhancement in the coronary distribution
• BPatchy mid-wall or subepicardial late gadolinium enhancement, often septal
• CDiffuse subendocardial LGE with elevated T1 mapping (amyloid pattern)
• DNormal T2-weighted imaging in all phases

A 28-year-old in her third trimester develops acute HF with EF 25%. After delivery, she wants to breastfeed. Which is the safest guideline-directed HF therapy regimen?

• ALisinopril and losartan
• BHydralazine, nitrates, beta-blocker (metoprolol or carvedilol), and cautious diuretic
• CSacubitril-valsartan
• DSpironolactone

A woman with mechanical mitral valve in pregnancy. Which anticoagulation is recommended in the first trimester per guidelines?

• AWarfarin at all doses
• BLow-molecular-weight heparin dosed by anti-Xa levels OR continued warfarin if dose <= 5 m…
• CDOAC (apixaban)
• DAspirin alone

Which maternal cardiac condition in pregnancy corresponds to mWHO class IV (pregnancy contraindicated)?

• AMild mitral stenosis
• BPulmonary arterial hypertension (any etiology)
• CSuccessfully repaired ASD
• DMild aortic stenosis

A 65-year-old patient with ASCVD 10-year risk 18% and LDL 130 mg/dL is already on atorvastatin 80 mg with LDL now 90 mg/dL. Per 2022 ACC ECDP, next step if higher-intensity lipid lowering is desired:

• ASwitch to simvastatin 40 mg
• BAdd ezetimibe first, then PCSK9 inhibitor if goal not reached
• CStart niacin
• DIncrease atorvastatin dose to 120 mg

Per 2017 ACC/AHA hypertension guideline, what threshold defines Stage 1 hypertension?

• ASBP 120-129 and DBP < 80
• BSBP 130-139 or DBP 80-89
• CSBP >= 140 or DBP >= 90
• DSBP >= 160 or DBP >= 100

A 68-year-old man who has smoked for 40 years has never had imaging. USPSTF recommends one-time screening for:

• AAbdominal aortic aneurysm by ultrasound
• BPeripheral arterial disease by ankle-brachial index
• CCarotid stenosis by duplex ultrasound
• DRenal artery stenosis

A 72-year-old has calf cramping on walking 2 blocks. ABI is 0.70. Diagnosis?

• ANormal
• BMild-to-moderate peripheral artery disease with claudication
• CCritical limb-threatening ischemia
• DVenous insufficiency

A 50-year-old with Marfan syndrome presents with severe chest pain radiating to the back. CT chest shows a dissection flap extending from the ascending aorta to the descending aorta. Classification?

• AStanford type A (DeBakey I)
• BStanford type B (DeBakey III)
• CStanford type A (DeBakey II) — ascending only
• DIntramural hematoma

Initial pharmacologic management of acute type B aortic dissection should include:

• AIV hydralazine first-line
• BIV beta-blocker (esmolol or labetalol) to target HR < 60 and SBP 100-120
• CIV nitroprusside alone
• DIV diltiazem as monotherapy

Which is the most common cause of acute pericarditis in developed countries?

• AViral (often idiopathic)
• BTuberculosis
• CPost-MI (Dressler syndrome)
• DUremia