Cardiac catheterisation

Question 1

What are complications of coronary angiography

Answer 1

local vascular complications (3%) 
Contrast nephropathy (0.5%) 
Emergency surgery for pericardial tamponade, coronary artery dissection, retained fragment of wire or ongoing coronary ischemia (0.1%)
MI (0.05%)
mortality (<0.05%)
CVA (0.05%)

Question 2

What is intracoronary pressure wire monitoring

Answer 2

Using a fine wire pressure transducer, the intracoronary pressure can be measured, allowing a comparison of the pressure distal to the lesion with pressure proximal to the lesion.

The fractional flow reserve (FFR) to be calculated to determine the hemodynamic significance of the lesion. The normal FFR should be approximately 1.0 whereas the FFR < 0.8 is significant flow limiting lesion

Flow limitation can also be assessed by measuring the pressure gradient after administering a vasodilator (adenosine)

Question 3

What is coronary artery intravascular ultrasound

Answer 3

IVUS is a transcatheter ultrasound probe that is introduced into the coronary artery over an angioplasty wire
allows direct imaging of the luminal diameter and vessel wall giving a visual assessment of atheroma and calcification
useful in patients with equivocal stenosis and vessels with marked ednoluminal calcification

Question 4

What is TIMI flow

Answer 4

TIMI (thrombolysis in myocardial infarction) derives its name from a trial of similar name and describes the different grades of coronar flow

a) Grade 0: No contrast flow
b) Grade 1: reduced flow and incomplete opacification of the distal vessel
c) Grade 2: slow distal flow but complete opacification of the distal vessel
d) Grade 3: prompt antegrade contrast flow with rapid clearning

Question 5

How is mitral regurgitation classified by angiography

Answer 5

Sellers classification

a) I: incomplete opacification of the left atrium that clears with each beat
b) II: complete opacification of the left atrium that does not clear with each beat
c) III: complete opacification of the left atrium with a similar density to the left ventricle
d) IV: complete opacification of the left atrium in one beat, that becomes progressively more dense with each beat, with contrast refluxing into the pulmonary veins

Question 6

How is aortic regurgitation classified by angiography

Answer 6

According to Sellers classification

a) 1+ small regurgitant jet across the aortic valve but without opacification of the left ventricle
b) 2+ regurgitant jet across the aortic valve with faint opacification of the left ventricle
c) 3+ dense opacification of the left ventricle with no distinct jet across the aortic valve
d) 4+ opacification of the left ventricle that is greater then the ascending aorta

Question 7

What are rates of coronary artery dissection with PCI

Answer 7

.

Question 8

What is management of Coronary artery dissection

Answer 8

.

Question 9

What are the standard views of the left coronary system

Answer 9

RAO 20 degrees caudal 20 degrees
AP 0 caudal 30 degrees
AP
LAO
LAO
On RAO views the spine is on the left side of the image.
On LAO views the spine is on the right side of the image
The circumflex is closest to the thoracic spine