ABIM COMPLETE EXAMINATION TEST
QUESTIONS WITH VERIFIED SOLUTIONS
●● When to add beta blocker in CHF patients
Answer: When they are euvolemic
●● Indications for AICD
Answer: - EF less than or equal to 35% + NYHA Class 2 or 3
- EF less than or equal to 30% + NYHA Class 1
●● Indication for adding CRT (cardiac resynchronization therapy) to
AICD
Answer: QRS > 150 ms
●● Timeline to reassess EF for patients on guideline-directed therapy
post MI
Answer: 40 days
●● Timeline to reassess EF for patients on guideline-directed therapy in
patients who are NOT post-MI
Answer: 3 months
,●● When to add Entresto for CHF patients?
Answer: At diagnosis
●● Limiting factor to adding Entresto
Answer: Hypotension (SBP < 100)
●● What trial compared Entresto to ACEI?
Answer: Paradigm
●● What is Ivabradine?
Answer: Na channel inhibitor
●● When to add ivabradine
Answer: CHF patient with HR > 70 despite maximal beta blocker
therapy
●● When to add SGLT-2 inhibitors in CHF patients
Answer: - Low EF
- Persistently elevated BNP
- On optimal medical therapy
- Has AICD and CRT
,●● SBP requirement to start SGLT-2 inhibitor in CHF pt
Answer: SBP > 95
●● GFR requirement to start SGLT-2 inhibitor in CHF pt
Answer: GFR > 30
●● Indications for AVR in AORTIC STENOSIS
Answer: - Presence of symptoms (SAD, presyncope)
- EF < 50% in an asymptomatic patient
- concomitant cardiac surgical procedure for another indication (such as
simultaneous CABG or ascending aortic surgery)
●● Late-peaking systolic murmur, a diminished or absent aortic
component of the S2, and a weak and delayed carotid upstroke
Answer: AORTIC STENOSIS
●● Management of acute aortic regurgitation
Answer: EMERGENT SURGERY
●● Patient with acute aortic regurgitation has surgery delayed, what do
you do?
Answer: Nitroprusside
Dobutamine
, NEVER ANSWER IABP!!!!!
●● Indications for SAVR in chronic aortic regurgitation
Answer: - symptoms
- EF < 50%
- undergoing other cardiac surgery
- End-systolic diameter > 50 mm + EF > 50%
●● Management of acute mitral regurgitation
Answer: EMERGENT SURGERY
●● Patient with acute mitral regurgitation has surgery delayed, what do
you do?
Answer: Vasodilator therapy (nitroprusside)
IABP
●● Indications for mitral valve repair
Answer: - Symptomatic + EF > 30%
- Asymptomatic + EF 30-60% or LVESD >/= 40 mm
- Undergoing another cardiac procedure
QUESTIONS WITH VERIFIED SOLUTIONS
●● When to add beta blocker in CHF patients
Answer: When they are euvolemic
●● Indications for AICD
Answer: - EF less than or equal to 35% + NYHA Class 2 or 3
- EF less than or equal to 30% + NYHA Class 1
●● Indication for adding CRT (cardiac resynchronization therapy) to
AICD
Answer: QRS > 150 ms
●● Timeline to reassess EF for patients on guideline-directed therapy
post MI
Answer: 40 days
●● Timeline to reassess EF for patients on guideline-directed therapy in
patients who are NOT post-MI
Answer: 3 months
,●● When to add Entresto for CHF patients?
Answer: At diagnosis
●● Limiting factor to adding Entresto
Answer: Hypotension (SBP < 100)
●● What trial compared Entresto to ACEI?
Answer: Paradigm
●● What is Ivabradine?
Answer: Na channel inhibitor
●● When to add ivabradine
Answer: CHF patient with HR > 70 despite maximal beta blocker
therapy
●● When to add SGLT-2 inhibitors in CHF patients
Answer: - Low EF
- Persistently elevated BNP
- On optimal medical therapy
- Has AICD and CRT
,●● SBP requirement to start SGLT-2 inhibitor in CHF pt
Answer: SBP > 95
●● GFR requirement to start SGLT-2 inhibitor in CHF pt
Answer: GFR > 30
●● Indications for AVR in AORTIC STENOSIS
Answer: - Presence of symptoms (SAD, presyncope)
- EF < 50% in an asymptomatic patient
- concomitant cardiac surgical procedure for another indication (such as
simultaneous CABG or ascending aortic surgery)
●● Late-peaking systolic murmur, a diminished or absent aortic
component of the S2, and a weak and delayed carotid upstroke
Answer: AORTIC STENOSIS
●● Management of acute aortic regurgitation
Answer: EMERGENT SURGERY
●● Patient with acute aortic regurgitation has surgery delayed, what do
you do?
Answer: Nitroprusside
Dobutamine
, NEVER ANSWER IABP!!!!!
●● Indications for SAVR in chronic aortic regurgitation
Answer: - symptoms
- EF < 50%
- undergoing other cardiac surgery
- End-systolic diameter > 50 mm + EF > 50%
●● Management of acute mitral regurgitation
Answer: EMERGENT SURGERY
●● Patient with acute mitral regurgitation has surgery delayed, what do
you do?
Answer: Vasodilator therapy (nitroprusside)
IABP
●● Indications for mitral valve repair
Answer: - Symptomatic + EF > 30%
- Asymptomatic + EF 30-60% or LVESD >/= 40 mm
- Undergoing another cardiac procedure
