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Exertional syncope — EECC MCQ

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HardMedical Conditions in SportExertional syncopeEECC

A patient with CTEPH has distal segmental disease considered technically inoperable by an expert pulmonary-endarterectomy team. Symptoms and pulmonary vascular resistance remain substantial despite anticoagulation. Which disease-modifying options should be discussed?

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Correct answer: A — CTEPH-team assessment for angioplasty and riociguat

The best answer is “CTEPH-team assessment for angioplasty and riociguat”. Inoperable CTEPH can be treated by staged balloon pulmonary angioplasty and the soluble-guanylate-cyclase stimulator riociguat, selected and sequenced by an expert team. “Stop anticoagulation because surgery is unavailable” is less appropriate because lifelong anticoagulation remains foundational “Use calcium-channel blockade after routine vasoreactivity testing” is less appropriate because CTEPH is not treated according to idiopathic-PAH vasoreactivity pathways “Implant a left-ventricular assist device” is less appropriate because an LVAD does not remove chronic pulmonary arterial obstruction “Treat with oxygen alone and no specialist follow-up” is less appropriate because supportive oxygen cannot replace mechanical or targeted vascular treatment

Reference: 2022 ESC/ERS Guidelines for pulmonary hypertension. https://academic.oup.com/eurheartj/article/43/38/3618/6673929