2018 Board Review Pre-Test:
Device Therapy in Heart Failure

Device Therapy in Heart Failure - Joshua M. Cooper, MD

Please complete this brief Pre-Test to give a baseline for learning.

Question Title

* 1. 71-year-old woman, s/p pacemaker 3y ago for sinus bradycardia and fatigue
89% AP, 94% VP
EF dropped from 55% to 35%
Dyspnea on exertion, improved on Furosemide (lasix)
Referred by her cardiologist for upgrade to bi-v ICD

How would you manage this patient who reports she is now doing well on meds?

A. Assess underlying AV conduction

B. Upgrade to bi-v ICD

C. Upgrade to bi-v pacemaker

D. Continue current management

Question Title

* 2. 62yo man with ischemic CMP, class 3-4 CHF
EF 20-25%, LBBB
BiV pacemaker implanted in Puerto Rico
Moved to USA
Has not been taking medications
Admission with CHF exacerbation

What is the appropriate next step along with resuming medications?

A. Echo now, if EF <35%, upgrade to CRT-D

B. Check echo in 3 months

C. Assess RV, LV lead function

D. Increase programmed lower pacing rate

Question Title

* 3. 59 yo man with severe ischemic heart disease, EF 10%, ICD in place
LVAD implanted as bridge to transplant
Dramatic clinical improvement
Presents to ER with a single ICD shock, without preceding symptoms

What is the appropriate management?

A. Replace the RV lead

B. Amiodarone

C. Catheter ablation

D. Reassurance, continue current management

Question Title

* 4. 50 yo woman with hypertrophic CMP, h/o VF arrest, with ICD in place
Presents with fevers, MSSA bacteremia
Echo shows vegetation on ICD lead

What is the appropriate next step in management?

A. 6 weeks of IV antibiotics

B. IV abxuntil cultures clear, then 6 weeks PO

C. ICD Lead extraction, abx

D. ICD Lead extraction, abx, wearable defib

Question Title

* 5. Please provide your first and last name.
Pre-test questions will not be scored, your name is required solely to confirm completion.

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