Cardiology Interface and Invasive Diagnostics
This domain tests collaboration with cardiology and interpretation of invasive diagnostics. The exam expects you to know when catheterization adds information and when it delays surgery.
Core rules
- Coronary angiography defines anatomy before CABG and in acute coronary syndromes; FFR assesses intermediate lesions but is not used in acute unstable settings.
- Echocardiography and stress testing evaluate ischemia and valve severity; symptoms may be atypical in diabetes and women.
- Right-heart catheterization helps assess pulmonary hypertension and shunt physiology; interpret in context, not in isolation.
- Biomarkers support diagnosis of myocardial infarction but cannot replace ECG and clinical assessment.
Worked example
A patient with stable angina, moderate aortic stenosis and two-vessel disease has a borderline lesion in the circumflex. The correct reasoning is that FFR can assess the intermediate lesion if stable, while severe symptomatic AS independently affects operative planning. The heart team integrates both, rather than treating the angiogram alone.
Traps
Do not use FFR in acute STEMI; do not diagnose severe AS from gradient alone without flow and symptoms; do not ignore right-heart data when assessing operability; do not delay urgent surgery for elective catheterization in an unstable patient.