03a: PCI and EKG

Question 1

Cardiac cath may be beneficial in Angina Class I/II patients under which circumstances?

Answer 1

1. Intolerant to anti-angina meds

2. Occupation high risk (ex: pilot)

Question 2

List the general categories of diseases in which diagnostic cardiac catheterization is indicated.

Answer 2

1. Coronary a disease
2. Valvular disease
3. Cardiomyopathy
4. Congenital disease

Question 3

List the complications/risks of cardiac cath related to contrast agents.

Answer 3

1. Anaphylaxis

2. Nephrotoxicity

Question 4

T/F: Death, MI, stroke are all risks of cardiac cath procedure.

Answer 4

True

Question 5

The limitation of balloon angioplasty is:

Answer 5

high rate of restenosis

Question 6

Exposed (bare-metal) stent struts are a nidus for (X) until (Y) of the stent occurs. For this reason, patients are treated (Z) therapy for about a month after procedure.

Answer 6

X = clot formation
Y = endothelialization
Z = antiplatelet

Question 7

The main late complication of bare-metal stents is:

Answer 7

In-stent stenosis (due to SM hyperplasia)

Question 8

Drug-eluding stents are embedded with paclitaxel. What does this drug do?

Answer 8

Chemotherapy agent that interferes with MT function (reduces SM hyperplasia)

Question 9

Drug-eluding stents are embedded with sirolimus. What does this drug do?

Answer 9

Immunosuppressant (reduces SM hyperplasia)

Question 10

Main limitation of drug-eluding stents:

Answer 10

Time to endothelialization is prolonged (1 year instead of 1 month); extends the time during which the stent is prone
to thrombosis

Question 11

In which patients has CABG been proven more efficacious than PCI?

Answer 11

1. Left main stenosis over 50%
2. 3-vessel disease (RCA, LAD, LCX)
3. 2-vessel disease (LAD and another) with reduced EF
4. Diabetes with multi-vessel disease

Question 12

What are the risk factors associated with acute renal failure during cardiac cath procedure?

Answer 12

1. Dehydration
2. Hypotension
3. Renal insufficiency
4. High contrast dose
5. Diabetes Mellitus

Question 13

T/F: Balloon angioplasty has higher rates of repeat revascularization than CABG.

Answer 13

True

Question 14

What are the criteria for a Q wave to be pathological?

Answer 14

1. Width greater than 1 small box
2. Height greater than 25% of QRS
3. Seen in 2 contiguous leads

Question 15

Which are the Limb Leads?

Answer 15

I, II, III

Question 16

Which are the Augmented Leads?

Answer 16

aVF, aVR, aVL

Question 17

Which are the precordial Leads?

Answer 17

V1-V6

Question 18

The “High Lateral” Leads are (X) and these regions supplied by (Y) artery.

Answer 18

X = I, aVL
Y = Circumflex

Question 19

The “Inferior” Leads are (X) and these regions supplied by (Y) artery.

Answer 19

X = II, III, aVF
Y = RCA

Question 20

The “Septal” Leads are (X) and these regions supplied by (Y) artery.

Answer 20

X = V1, V2
Y = LAD

Question 21

The “Anterior” Leads are (X) and these regions supplied by (Y) artery.

Answer 21

X = V3, V4
Y = LAD

Question 22

The “Lateral” precordial Leads are (X) and these regions supplied by (Y) artery.

Answer 22

X = V5, V6
Y = Distal LAD, RCA or Lateral Circumflex

Question 23

Normal PR interval

Answer 23

3-5 small boxes (120-200 ms)

Question 24

Normal QRS interval

Answer 24

Under 2.5 small boxes (90 ms)

Question 25

Normal QT interval

Answer 25

Under 11.5 small boxes (460 ms) MEASURE TO END OF T-WAVE

Question 26

Criteria for LBBB

Answer 26

1. Wide QRS 2. V1: absent R, prominent S 3. V6: broad, notched R

Question 27

RBBB criteria

Answer 27

1. Wide QRS 2. V1: rabbit ears 3. V6: wide, slurred S wave

Question 28

LVH Voltage criteria

Answer 28

1. aVL: R over 11 mm 2. Lead I: R over 15 mm 3. S in V1 + R in V5/6 equal 35 mm

Question 29

LVH Cornell criteria

Answer 29

S in V3 + R in aVL over 24 mm (men) or 20 mm (women)

Question 30

Sick Sinus Syndrome (SSS) is also known as (X). List three examples of manifestations of this disorder.

Answer 30

X = SND (Sinus Node Dysfunction) 1. Inappropriate rest bradycardia 2. Chronotropic incompetence 3. Tachy-Brady syndrome (ex: a-fib overrides SA Node)

Question 31

SA node is diseased and exhibits chronotropic incompetence. What does that mean?

Answer 31

Node fails to increase impulse frequency when stimulated by X or SNS

Question 32

Patient with A-fib experiences periods of syncope when tachyarrhythmia suddenly stops due to prolonged period of (X). What is the culprit of this phenomenon?

Answer 32

X = asystole Diseases SA Node results in prolonged recovery period after A-fib stops

Question 33

List the most common intrinsic etiologies that cause SA Node dysfunction

Answer 33

1. Fibrosis (age-related) 2. Ischemia (CAD) 3. Surgical trauma 4. Infiltration (sarcoidosis, amyloidosis)

Question 34

List the most common extrinsic etiologies that cause SA Node dysfunction

Answer 34

1. Drugs that suppress pacemaker (b-blockers, CCB) | 2. Metabolic

Question 35

2o Mobitz Type I: block occurs in (X) part of conduction system. Treat with (Y).

Answer 35

``` X = AV Node Y = exercise or Atropine ```

Question 36

2o Mobitz Type II: block occurs in (X) part of conduction system. Treat with (Y).

Answer 36

``` X = His-Purkinje Y = permanent pacemaker ```

Question 37

Junctions escape rhythm presents as (narrow/wide) QRS. And ventricular escape rhythm?

Answer 37

Narrow; | Wide