1000 Flashcards Cardiac Medicine Certification (CMC) Exam
Define acute coronary syndrome (ACS) and ACS refers to a spectrum of myocardial ischemia caused by reduced
identify its three major clinical presentations. coronary blood flow due to plaque rupture and thrombosis. The three
major presentations are unstable angina (UA), non-ST elevation
myocardial infarction (NSTEMI), and ST-elevation myocardial infarction
(STEMI). STEMI involves complete coronary occlusion with ST
elevation, NSTEMI causes myocardial necrosis without ST elevation,
and UA causes ischemia without detectable myocardial injury
biomarkers.
A patient presents with crushing chest pain NSTEMI. Elevated troponin confirms myocardial injury, while absence
radiating to the left arm and diaphoresis. Troponin of ST elevation differentiates NSTEMI from STEMI. Immediate treatment
is elevated but no ST elevation is present. What is includes antiplatelet therapy, anticoagulation, nitrates, beta blockers,
the most likely diagnosis? and risk stratification for possible catheterization.
What is the pathophysiology of stable angina? Stable angina occurs when fixed atherosclerotic coronary artery
narrowing limits oxygen supply during exertion or stress. Myocardial
oxygen demand exceeds supply, causing transient ischemia and chest
discomfort relieved by rest or nitroglycerin.
Page 1 of 125
,1000 Flashcards Cardiac Medicine Certification (CMC) Exam
The most sensitive and specific biomarker for Cardiac troponin (Troponin I or Troponin T).
myocardial injury is __________.
Differentiate between right-sided and left-sided Left-sided heart failure primarily causes pulmonary congestion with
heart failure. dyspnea, crackles, orthopnea, and pulmonary edema. Right-sided
heart failure leads to systemic venous congestion causing peripheral
edema, jugular venous distention (JVD), hepatomegaly, ascites, and
weight gain.
What ECG changes are typically seen in Peaked T waves, widened QRS complexes, prolonged PR interval,
hyperkalemia? flattened P waves, sine-wave appearance, and potentially ventricular
arrhythmias or cardiac arrest in severe cases.
Troponin elevation always indicates acute False. Troponin elevation indicates myocardial injury but not always
myocardial infarction. Explain. acute MI. Causes include myocarditis, pulmonary embolism, renal
failure, sepsis, heart failure, tachyarrhythmias, and cardiac trauma.
Clinical correlation and ECG findings are essential.
What is the hallmark auscultatory finding in aortic A harsh crescendo-decrescendo systolic murmur best heard at the
stenosis? right second intercostal space radiating to the carotids. Severe cases
may also present with pulsus parvus et tardus.
Page 2 of 125
,1000 Flashcards Cardiac Medicine Certification (CMC) Exam
A patient develops sudden severe chest pain Aortic dissection. Immediate blood pressure control and emergent
radiating to the back with unequal blood imaging such as CT angiography are required because rupture risk is
pressures in both arms. What condition should be life-threatening.
suspected?
What are the classic symptoms of infective Fever, new or changing heart murmur, fatigue, petechiae, splinter
endocarditis? hemorrhages, Osler nodes, Janeway lesions, and embolic phenomena.
Blood cultures and echocardiography are essential for diagnosis.
Define cardiogenic shock. Cardiogenic shock is a state of inadequate tissue perfusion due to
severe cardiac dysfunction, usually from extensive myocardial
infarction. Findings include hypotension, cool clammy skin, oliguria,
altered mental status, and elevated filling pressures.
Which medication class reduces mortality in ACE inhibitors, beta blockers, aldosterone antagonists, SGLT2
systolic heart failure? inhibitors, and ARNI therapy significantly reduce mortality in heart
failure with reduced ejection fraction (HFrEF).
Page 3 of 125
, 1000 Flashcards Cardiac Medicine Certification (CMC) Exam
What is pulsus paradoxus and with which cardiac Pulsus paradoxus is an exaggerated inspiratory drop in systolic blood
condition is it commonly associated? pressure greater than 10 mmHg. It is commonly associated with cardiac
tamponade, severe asthma, and constrictive pericarditis.
Beck's triad in cardiac tamponade includes Jugular venous distention.
hypotension, muffled heart sounds, and __________.
A patient with atrial fibrillation has an irregularly Atrial fibrillation causes ineffective atrial contraction leading to blood
irregular rhythm. Why does AF increase stroke stasis, especially in the left atrial appendage, promoting thrombus
risk? formation that may embolize to the brain causing ischemic stroke.
What is the difference between HFrEF and HFrEF involves reduced ejection fraction due to impaired systolic
HFpEF? contraction. HFpEF involves preserved ejection fraction but impaired
ventricular relaxation and filling, often caused by hypertension or
ventricular hypertrophy.
Which heart sound is commonly associated with An S3 gallop, caused by rapid ventricular filling into a dilated ventricle,
heart failure? is commonly associated with systolic heart failure.
Nitroglycerin should always be given in right False. Nitroglycerin can significantly reduce preload and precipitate
ventricular infarction. Explain. severe hypotension in right ventricular infarction because RV output
depends heavily on preload.
What coronary artery is most commonly involved The right coronary artery (RCA) is most commonly involved in inferior
in inferior wall myocardial infarction? wall MI. ECG leads II, III, and aVF typically show ST elevation.
Page 4 of 125
Define acute coronary syndrome (ACS) and ACS refers to a spectrum of myocardial ischemia caused by reduced
identify its three major clinical presentations. coronary blood flow due to plaque rupture and thrombosis. The three
major presentations are unstable angina (UA), non-ST elevation
myocardial infarction (NSTEMI), and ST-elevation myocardial infarction
(STEMI). STEMI involves complete coronary occlusion with ST
elevation, NSTEMI causes myocardial necrosis without ST elevation,
and UA causes ischemia without detectable myocardial injury
biomarkers.
A patient presents with crushing chest pain NSTEMI. Elevated troponin confirms myocardial injury, while absence
radiating to the left arm and diaphoresis. Troponin of ST elevation differentiates NSTEMI from STEMI. Immediate treatment
is elevated but no ST elevation is present. What is includes antiplatelet therapy, anticoagulation, nitrates, beta blockers,
the most likely diagnosis? and risk stratification for possible catheterization.
What is the pathophysiology of stable angina? Stable angina occurs when fixed atherosclerotic coronary artery
narrowing limits oxygen supply during exertion or stress. Myocardial
oxygen demand exceeds supply, causing transient ischemia and chest
discomfort relieved by rest or nitroglycerin.
Page 1 of 125
,1000 Flashcards Cardiac Medicine Certification (CMC) Exam
The most sensitive and specific biomarker for Cardiac troponin (Troponin I or Troponin T).
myocardial injury is __________.
Differentiate between right-sided and left-sided Left-sided heart failure primarily causes pulmonary congestion with
heart failure. dyspnea, crackles, orthopnea, and pulmonary edema. Right-sided
heart failure leads to systemic venous congestion causing peripheral
edema, jugular venous distention (JVD), hepatomegaly, ascites, and
weight gain.
What ECG changes are typically seen in Peaked T waves, widened QRS complexes, prolonged PR interval,
hyperkalemia? flattened P waves, sine-wave appearance, and potentially ventricular
arrhythmias or cardiac arrest in severe cases.
Troponin elevation always indicates acute False. Troponin elevation indicates myocardial injury but not always
myocardial infarction. Explain. acute MI. Causes include myocarditis, pulmonary embolism, renal
failure, sepsis, heart failure, tachyarrhythmias, and cardiac trauma.
Clinical correlation and ECG findings are essential.
What is the hallmark auscultatory finding in aortic A harsh crescendo-decrescendo systolic murmur best heard at the
stenosis? right second intercostal space radiating to the carotids. Severe cases
may also present with pulsus parvus et tardus.
Page 2 of 125
,1000 Flashcards Cardiac Medicine Certification (CMC) Exam
A patient develops sudden severe chest pain Aortic dissection. Immediate blood pressure control and emergent
radiating to the back with unequal blood imaging such as CT angiography are required because rupture risk is
pressures in both arms. What condition should be life-threatening.
suspected?
What are the classic symptoms of infective Fever, new or changing heart murmur, fatigue, petechiae, splinter
endocarditis? hemorrhages, Osler nodes, Janeway lesions, and embolic phenomena.
Blood cultures and echocardiography are essential for diagnosis.
Define cardiogenic shock. Cardiogenic shock is a state of inadequate tissue perfusion due to
severe cardiac dysfunction, usually from extensive myocardial
infarction. Findings include hypotension, cool clammy skin, oliguria,
altered mental status, and elevated filling pressures.
Which medication class reduces mortality in ACE inhibitors, beta blockers, aldosterone antagonists, SGLT2
systolic heart failure? inhibitors, and ARNI therapy significantly reduce mortality in heart
failure with reduced ejection fraction (HFrEF).
Page 3 of 125
, 1000 Flashcards Cardiac Medicine Certification (CMC) Exam
What is pulsus paradoxus and with which cardiac Pulsus paradoxus is an exaggerated inspiratory drop in systolic blood
condition is it commonly associated? pressure greater than 10 mmHg. It is commonly associated with cardiac
tamponade, severe asthma, and constrictive pericarditis.
Beck's triad in cardiac tamponade includes Jugular venous distention.
hypotension, muffled heart sounds, and __________.
A patient with atrial fibrillation has an irregularly Atrial fibrillation causes ineffective atrial contraction leading to blood
irregular rhythm. Why does AF increase stroke stasis, especially in the left atrial appendage, promoting thrombus
risk? formation that may embolize to the brain causing ischemic stroke.
What is the difference between HFrEF and HFrEF involves reduced ejection fraction due to impaired systolic
HFpEF? contraction. HFpEF involves preserved ejection fraction but impaired
ventricular relaxation and filling, often caused by hypertension or
ventricular hypertrophy.
Which heart sound is commonly associated with An S3 gallop, caused by rapid ventricular filling into a dilated ventricle,
heart failure? is commonly associated with systolic heart failure.
Nitroglycerin should always be given in right False. Nitroglycerin can significantly reduce preload and precipitate
ventricular infarction. Explain. severe hypotension in right ventricular infarction because RV output
depends heavily on preload.
What coronary artery is most commonly involved The right coronary artery (RCA) is most commonly involved in inferior
in inferior wall myocardial infarction? wall MI. ECG leads II, III, and aVF typically show ST elevation.
Page 4 of 125
