Q51 / 110
What theoretical advantage is emphasized for replacing both ventricles with two centrifugal pumps rather than a conventional total artificial heart?
Correct answer: B — Use of familiar continuous-flow LVAD technology configured for biventricular support
The concept extends familiar continuous-flow pump engineering to biventricular replacement. A is false because anticoagulation remains relevant. C misstates the flow design. D is an impossible absolute and is not claimed.
Board pearl: HeartMate 6 is an extension of continuous-flow technology.
The concept extends familiar continuous-flow pump engineering to biventricular replacement. A is false because anticoagulation remains relevant. C misstates the flow design. D is an impossible absolute and is not claimed.
Board pearl: HeartMate 6 is an extension of continuous-flow technology.
Q52 / 110
Why is balancing right- and left-sided pump speed especially important in continuous-flow BiVAD support?
Correct answer: B — Imbalance can shift the septum and impair filling
Balancing right- and left-sided pump speed is especially important in continuous-flow BiVAD support because imbalance can shift the septum and impair filling. See question 19: both devices in BiVAD insertions can result in recirculation due to pulmonic and aortic insufficiency, and the calibrated flows can be deceiving. The goal is balanced circulation rather than simply maximizing displayed pump flow.
Board pearl: The calibrated flows can be deceiving in continuous-flow BiVAD support, especially when valve insufficiency permits recirculation.
Balancing right- and left-sided pump speed is especially important in continuous-flow BiVAD support because imbalance can shift the septum and impair filling. See question 19: both devices in BiVAD insertions can result in recirculation due to pulmonic and aortic insufficiency, and the calibrated flows can be deceiving. The goal is balanced circulation rather than simply maximizing displayed pump flow.
Board pearl: The calibrated flows can be deceiving in continuous-flow BiVAD support, especially when valve insufficiency permits recirculation.
Q53 / 110
What is the principal clinical role of CardioMEMS?
Correct answer: B — Ambulatory pulmonary artery pressure monitoring to guide heart-failure therapy
The principal clinical role of CardioMEMS is ambulatory pulmonary artery pressure monitoring to guide heart-failure therapy. It measures pressure, not flow. For a review of CardioMEMS devices, see Tolu-Akinnawo et al. CardioMEMS Heart Failure System: An Up-to-Date Review. It does not provide continuous LVEF measurement, continuous mixed venous oxygen saturation, or direct continuous cardiac output measurement.
Board pearl: For a review of CardioMEMS devices, see Tolu-Akinnawo et al.
The principal clinical role of CardioMEMS is ambulatory pulmonary artery pressure monitoring to guide heart-failure therapy. It measures pressure, not flow. For a review of CardioMEMS devices, see Tolu-Akinnawo et al. CardioMEMS Heart Failure System: An Up-to-Date Review. It does not provide continuous LVEF measurement, continuous mixed venous oxygen saturation, or direct continuous cardiac output measurement.
Board pearl: For a review of CardioMEMS devices, see Tolu-Akinnawo et al.
Source(s): Tolu-Akinnawo et al. CardioMEMS Heart Failure System: An Up-to-Date Review. Cureus. 2025 Jan. DOI: 10.7759/cureus.77816.
Q54 / 110
A patient on VA-ECMO has corrected systemic oxygenation but severe RV dysfunction, pulmonary edema, minimal native LV ejection, and rising lactate. What additional intervention most directly addresses the major remaining problem?
Correct answer: B — Add active LV unloading
Pulmonary edema and minimal LV ejection identify persistent LV overload despite cardiopulmonary support. A can worsen afterload. C affects gas exchange, not LV pressure-volume work. D removes support still needed for severe shock.
Board pearl: After ECMO restores perfusion, reassess what is limiting myocardial recovery.
Pulmonary edema and minimal LV ejection identify persistent LV overload despite cardiopulmonary support. A can worsen afterload. C affects gas exchange, not LV pressure-volume work. D removes support still needed for severe shock.
Board pearl: After ECMO restores perfusion, reassess what is limiting myocardial recovery.
Q55 / 110
Which overarching principle best summarizes contemporary cardiogenic-shock management?
Correct answer: B — Match support to evolving physiology and escalate or de-escalate as conditions change
Device choice should respond to LV, RV, oxygenation, and perfusion needs over time. A ignores shock heterogeneity. C and D falsely frame complementary tools as universal replacements.
Board pearl: There is no universally best MCS device—only the best match for the current physiology.
Device choice should respond to LV, RV, oxygenation, and perfusion needs over time. A ignores shock heterogeneity. C and D falsely frame complementary tools as universal replacements.
Board pearl: There is no universally best MCS device—only the best match for the current physiology.