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cardiology exam iii > Cardio 25: PCI > Flashcards

Cardio 25: PCI Flashcards

1
Q

Indications for Diagnostic Catheterization

A 
Acute coronary syndromes
Stable Angina
Abnormal stress test
Nonspecific chest pain/shortness of breath
Evaluation of congestive heart failure
Evaluation of valvular heart disease
Evaluation of congenital heart disease
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2
Q

Where are common sites of catheter access

A

Femoral (most common)
Radial
Brachial

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3
Q

Technique

A

Single puncture technique w/ 18-21guage needle
Place sheath w/ hemostatic check valve (artery and vein?)
Perform right heart catherization
Catheter exchanges over 0.35” guide wire
Engage arteries w/ appropriate cath
Angiograms in multiple views

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4
Q

Which vessel will the catheter enter the heart from ?

A

Superior Vena Cava –> Right atrium and into the pulmonary artery

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5
Q

Uses of catheterization

A

Measure left ventricular pressure & perform ventriculogram
Perform intervention as necessary
Remove sheath and gain hemostasis

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6
Q

Types of PCI

A 
Plain old balloon angioplasty (POBA)
Balloon expandable stents
     Bare metal (BM)
     Drug eluting stents (DES)
Rotational Atherectomy
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7
Q

POBA has a high risk of what occuring after procedure ?

A

Re-stenosis

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8
Q

Bare Metal Stents decrease elastic recoil after ballon angioplasty. What is the px for antiplatelets after placement ?

A

ASA for life

Clopidogrel 1 mos minimum

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9
Q

Drug eluting stents do just what they say. They have drugs imbedded that help reduce the risk of restenosis.What is the anti-platelet regimen for these devices post implantation ?

A

ASA for life
Clopidogrel 12 mos minimum
Prasugrel reasonable choice

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10
Q

List some common druge eluting stents

A

Cypher™ (Sirolimus)
Taxus™ (Paclitaxel)
Xience™/Promus™ (Everalomous)
Endeavour™ (Zotarolimus)

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11
Q

Rotational atherectomy

A

Like a drill tip

Used to modify the plaque

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12
Q

Post procedural care

A

Vitals
Groin care
Bedrest
1-8°

Dont want to rest too long, clotting risk

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13
Q

List other PCI that occur

A 
Treatment of symptomatic mitral stenosis
Treatment of severe aortic stenosis
Closure of atrial septal defects
Closure of symptomatic patent foramen ovale
Closure of left atrial appendage
Closure of muscular VSD’s
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14
Q

Complications associated with PCI

A 
Local hematoma
Retroperitoneal hematoma
Pseudoaneurysm (PSA)
Acute renal failure (0.37%)
Embolization
Arrhythmia 0.33%
Myocardial infarction 0.03%
Stroke 0.06%
Death 0.08%\

Overall these are low risk for patients

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15
Q

Risk for hematoma rises with use of …

A

anti-coagulation

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16
Q

How do you treat a hematoma ?

A

Obtain local hemostasis w/ manual compression
IV fluid and T+C for blood
Pain control
Rarely requires OR

17
Q

Describe the symptoms of a retroperitoneal hematoma

A

Usually sudden onset of hypotension associated w/ back pain, may have bradycardia

18
Q

Treatments for retroperitoneal hematoma

A 
IV fluids and blood transfusion
Manual compression of puncture site
Stop anticoagulants (not oral antiplatelets)
Can obtain CT scan to confirm
Rarely needs OR
19
Q

How would you diagnose a pseudo-aneurysm following PCI ?

A

Hear bruit on exam and may feel thrill

Diagnosis w/ ultrasound

20
Q

How would you treat pseudo-aneurysm following PCI ?

A

Thrombin injection
Manual compression
Surgical repair

21
Q

Prevention of Acute Renal Failure following PCI includes

A 
Hydration, hydration, hydration
Limit contrast amount
Limit repeat exposure
Hold metformin for 48° after contrast injection for diabetics
Sodium Bicarbonate infusion
Mucomyst
22
Q

What syndrome is associated with Embolization post PCI ?

A

Blue toe syndrome.

23
Q

What are the most common arrhyhtmias associated with PCI ?

A

V. tach
V. fib
A. fib
Bradycardia

Usually self limiting

24
Q

What kinds of strokes are more common with PCI: Embolic or Hemorrhagic ?

A

Embolic

All strokes are very rare.

25
Q

Conscious sedation is more common in …

A

Elderly
Critical illness
Obesity

26
Q

Describe long term post procedural anti platelet therapy for patients undergoing PCI

A 
ASA
   For life 81-325mg
Clopidogrel
   BMS 4 weeks
   DES 12 mos minimum

Prasugrel and Ticagrelor can also be given…

cardiology exam iii (12 decks)

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