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BCC > Card Cath > Flashcards

Card Cath Flashcards

1
Q

Indications for cardiac catheterization

A

Suspected CAD, MI, sudden cardiac death, valvular heart disease, congenital heart disease (before surgery), aortic dissection, pericardial constriction/tamponade, cardiomyopathy, heart transplant

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2
Q

What is the Right Anterior Oblique (RAO) view?

A

RAO is shooting from bottom left to the right shoulder; good for crossing the aortic valve (TAVR)

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3
Q

What is the Left Anterior Oblique (LAO) view?

A

LAO is shooting from the bottom right to the left shoulder; good view for entering the coronary artery ostia in the aortic root

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4
Q

What view can you see the left main in its entirety?

A

LAO caudal (spider view)

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5
Q

What is the caudal view best for? Cranial views?

A

Caudal: LCX
Cranial: LAD

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6
Q

What is the RAO cranial view best for? LAO cranial?

A

RAO Cranial: LAD with septal perforators going to the left
LAO Cranial: origins of diagonals along the LAD to the right

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7
Q

If you see the diaphragm, what view is it most likely?

A

Some cranial view (but not always)

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8
Q

What can you see in the LAO cranial view (left)?

A

LAD courses straight down + septal perforators to the left, diagonal to the right; can see PDA if left-dominant circulation

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9
Q

What can you see in the LAO caudal view (left)?

A
  1. The proximal and mid LCX
  2. Origins of obtuse marginal (OM) branches off LCX
  3. Left main with ostiums of the LAD and LCX
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10
Q

What can you see in the RAO caudal view (left)?

A
  1. LCX
  2. Obtuse marginals
  3. Proximal LAD
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11
Q

What can you see in the RAO cranial view (left)?

A
  1. LAD
  2. Septal perforators of LAD
  3. Diagonal branches of LAD
  4. Distal LCX and left-sided posterolateral branches
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12
Q

What can you see in the lateral view (left)?

A

Best view of mid and distal LAD + ramus intermedius branch is well visualized + best view to demonstrate insertions of LIMA to LAD

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13
Q

What views show you the RCA?

A

LAO cranial and RAO cranial

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14
Q

What can you see in LAO cranial view (right coronary)?

A
  1. Origins of RCA and entire length of RCA
  2. PDA bifurcation (but RAO is better)
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15
Q

What can you see in RAO cranial view (right coronary)?

A
  1. RCA (LAO is better for RCA course)
  2. Bifurcation of the PDA and posterolateral branches
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16
Q

What can you see in the PA cranial view (right)?

A

Best view for PDA and posterolateral branches (if right-dominant)

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17
Q

What can you see in the lateral view (right)?

A

Shows RCA origin and mid-RCA

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18
Q

What are the best views for the LIMA?

A

RAO cranial, LAO cranial, and lateral

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19
Q

How are coronary artery stenoses assessed?

A

Minimal/mild CAD <40%, Moderate 40-70%, Severe 70-95%, Total occlusion 100%

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20
Q

What are TIMI flow grades?

A

Qualitative assessments of flow by observing distal runoff; developed from the Thrombolysis In Myocardial Infarction Studies (1980s)

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21
Q

What is TIMI 0 flow?

A

TIMI 0 = No flow beyond total occlusion

22
Q

What is TIMI 1 flow?

A

TIMI 1 = Some contrast filling beyond culprit lesion but no significant antegrade flow

23
Q

What is TIMI 2 flow?

A

TIMI 2 = Distal flow in artery less than in non-infarcted arteries

24
Q

What is TIMI 3 flow?

A

TIMI 3 = Distal flow rate in artery is equal to non-infarcted arteries

25
Q

What is fractional flow reserve?

A

Used to determine ischemic potential of a questionable (40-70%) lesion; ratio of aortic pressure to post-stenotic pressure in coronary artery during hyperemia (adenosine IV infusion or intracoronary bolus)

26
Q

What is the formula for fractional flow reserve?

A

Mean pressure of distal artery / mean pressure of aorta

27
Q

What is a normal fractional flow reserve? What if it is 0.75?

A

Normal is close to 1; if FFR < 0.75, it is associated with inducible ischemia

28
Q

What are indications for percutaneous coronary intervention?

A

Angina pectoris despite optimal medical therapy, mild angina with evidence of ischemia and high-grade lesion, unstable angina or NSTEMI, STEMI, angina after CABG, restenosis after PCI, LV dysfunction, arrhythmia 2/2 ischemia

29
Q

What are contraindications for PCI or stent?

A

Inability to tolerate DAPT, need for surgery within 2 weeks, inability to dilate lesion, hypersensitivity to stent material, inability to tolerate anticoagulation during PCI (ACT goal > 250)

30
Q

What is the rate of restenosis after DES placement?

A

<10%

31
Q

Why and when does restenosis occur?

A

Intimal hyperplasia usually within the first 6 months

32
Q

What is the rate of in-stent thrombosis?

A

1-2%

33
Q

What is the most common case of in-stent thrombosis?

A

Most commonly due to cessation of antiplatelet therapy or if stent is suboptimally expanded

34
Q

What are the anticoagulation guidelines for a PCI?

A

Loading dose of ASA (162-325mg) > 2 hours prior to the procedure; then 325mg daily for one month followed by 81mg daily

35
Q

What are the anticoagulation guidelines for stents?

A

Loading dose of P2Y12 inhibitor; DAPT for 12 months (DES) or 4 weeks (bare metal stent)

36
Q

Normal right heart cath pressure and O2 sats

A

RA 0-4 (75%), RV 25/5 (75%), PA 25/10 (75%), PCWP 7-12

37
Q

When are right heart caths necessary?

A

Valvular heart disease + CHF + RV dysfunction + pericardial disease + cardiomyopathy + intracardiac shunts + congenital abnormalities

38
Q

How is the mean pressure gradient calculated for AS?

A

The area under the curve between the LV pressure and the aortic pressure through the systolic ejection period

39
Q

Difference in LV pressure rise for a fixed obstruction versus a dynamic obstruction

A

Fixed = steady upstroke of the aortic pressure while the AV is open; Dynamic = aortic pressure rises rapidly at the onset of AV opening and then develops a spike and dome as the obstruction occurs in late systole

40
Q

When should PCWP be measured?

A

End-diastole and end-expiration

41
Q

How can you calculate mitral valve area using pressure measurements?

A

Mean gradient between LA and LV in diastole (LV pressures + PCWP) which is then used to calculate the MVA

42
Q

Indications for left ventriculography

A

Determining LV function in CAD, myopathy, or valvular heart disease + VSD identification + MR severity + quantification of myocardial mass

43
Q

What is the gold standard to assess cardiac structure and function?

A

Cardiac MRI

44
Q

What are contraindications for cardiac MRI?

A

Cerebral aneurysm clips + PPM/ICD + PA catheter + cochlear implant + metallic foreign bodies + severe CKD

45
Q

What is the only valve that is NOT cardiac MRI safe?

A

Starr Edwards valve (1968)

46
Q

Difference between Spin Echo and Gradient Echo for cardiac MRI?

A

Spin echo = blood is black + good for assessing anatomy + good for cardiomyopathy/tumors/myocarditis; Gradient echo = blood is bright + good for assessing function/flow/angiography + detects edema/inflammation

47
Q

What kind of signal is seen with gadolinium injection?

A

T1-weighted images are bright (tissue takes up gad)

48
Q

What is late gadolinium enhancement?

A

5-20 minutes after gadolinium, it washed out of normal tissue and is retained in pathologic tissue only (i.e. in MI, myocarditis, cardiomyopathy, cardiac neoplasms, genetic diseases)

49
Q

Advantages of MRI perfusion studies

A

Higher spatial resolution + no radiation exposure + no attenuations + provides perfusion imaging based on changes in signal intensity during the first pass of IV contrast

50
Q

How does stress myocardial perfusion imaging work?

A

Stress is applied (dipyridamole or adenosine) and contrast is given; myocardium that is stenotic does not take up more contrast so it is darker (lower intensity)

51
Q

What is a myocardial perfusion reserve index?

A

The relative difference of perfusion before and after vasodilation

BCC (29 decks)

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