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Peds Cards Boards > Cath > Flashcards

Cath Flashcards

1
Q

Oxygen capacity formula

A

Amount of oxygen that can be carried by Hgb if 100% saturated
- 13.6 x Hgb

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2
Q

Oxygen content

A

Oxygen in blood (bound to Hgb and dissolved)
- 13.6 x Hgb x O2 sat + 0.03 x PaO2

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3
Q

What causes falsely elevated O2 sat

A

High bili
Carboxyhemoglobin (smokers)

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4
Q

Qp:Qs quick calc

A

SA - SV / PV - PA

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5
Q

Fick equation

A

VO2 / 13.6 x Hgb x (difference in sat / 100)
Need to add paO2 if not on room air

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6
Q

Q effective calculation

A

VO2 / 13.6 x Hgb x (PV - SVC / 100)
Volume of blue blood that goes to lungs and volume of red blood that goes to body

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7
Q

Left to right shunt calculation

A

Qp - Qeff

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8
Q

Right to left shunt calculation

A

Qs - Qeff

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9
Q

PVR/SVR calculations

A

Change in pressure / flow over that bed

If indexed Q then its WU * m2
If not indexed need to MULTIPLY PVR times BSA to get indexed (not divide)

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10
Q

What is a wave in RA pressure and what causes elevation

A

Atrial systole - immediately after p wave
Corresponds with RVEDp if no TV abnormalities
TV closes at end of atrial contraction
Increased a wave in stiff RV (PS, RVH, tamponade), TS, arrhythmia (cannon A waves)

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11
Q

What is x descent in RA pressure

A

Fall of RA pressure after TV closes

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12
Q

What is v wave in RA pressure and what causes elevation

A
  • Rise in atrial pressure during atrial filling and ventricular contraction
  • At peak of v wave, RV pressure falls below RA pressure and TV opens
  • Increased in TR, ASD, LV to RA shunt
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13
Q

What is y descent in RA pressure

A
  • Rapid fall in RA pressure during ventricular filling
  • Prominent in restrictive physiology
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14
Q

Normal A and V wave in LA pressure

A

A is lower than V in LA (opposite of RA)
- Mean LA pressure about 2 higher than RA pressure

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15
Q

Increased v wave in LA pressure

A
  • MR, tri atresia with ASD
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16
Q

Increased a wave in LA pressure

A
  • MS, poorly compliant LV, large ASD, TAPVR, arrhythmia
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17
Q

Different causes for high ventricular pressure with flat plateau vs early systolic rise that falls

A
  • Broad flat = VSD, severe PH, systemic hypertension
  • Early systolic rise = pulmonary valve stenosis/aortic valve stenosis
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18
Q

Cath features of DCM

A
  • Increased LA pressure and LVEDp
  • Normal RA pressure
  • Normal/low CO
  • Decreased PVR
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19
Q

Cath features of RCM

A
  • Increased LA pressure
  • Normal RA pressure
  • Prominent y descent
  • Square root sign on ventricular tracing (due to rapid filling)
  • Increased PVR
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20
Q

Cath features of HCM

A
  • Sub aortic gradient (spike and dome look)
  • Decreased pulse pressure after PVC
21
Q

What happens with contrast and metformin

A

Risk for lactic acidosis with renal insufficiency
- Hold 24 hours pre and post

22
Q

Max contrast dose

A

6 cc/kg

23
Q

Acute risk (most common side effect) with radiation

A

Dermal injury (erythema) which is often transient

24
Q

AP cranial imaging good for

A

PV annulus, RVOT, supravalvar PS, RV-PA conduit

25
Q

AP caudal imaging good for

A

Underside of arch, branch PAs

26
Q

LAO imaging good for

A

Arch, proximal LPA, L pulmonary veins

27
Q

RAO imaging good for

A

LVOT (subAS, AV annulus), anterior muscular/outlet VSDs, R pulmonary veins

28
Q

RAO and long axial oblique imaging good for

A

Like a parasternal long echo image
LVOT, AV annulus, membranous and anterior VSDs

29
Q

Hepatoclavicular imaging good for

A

Like a 4 chamber view
Crux of the art, AV valves, AVSD, inlet/posterior VSDs

30
Q

Indication for balloon pulmonary valvuloplasty

A

Peak > 40
Or peak < 40 with symptoms or RV dysfunction or cyanosis (critical PS)
Balloon:annulus 1.2-1.4

31
Q

Indication for balloon aortic valvuloplasty

A

Peak > 60 (echo) if asymptomatic, peak > 50 (echo) if wanting to play competitive sports or get pregnant
Or peak < 50 with LV dysfunction or PGE dependence
Balloon:annulus 0.8-1

32
Q

Indication for balloon mitral valvuloplasty

A

Rheumatic heart disease is only class 1 indication
No if supravalvar mitral ring or in HLHS patients
Indications in RHD are peak > 20 or mean > 15

33
Q

PA balloon vs. stent pros and cons

A
  • Balloon if proximal PA stenosis or too small or stent, genetic conditions have poor response
  • Balloon size 2.5-3.5x diameter of lesion but < 2x surrounding vessel – use high pressure, low compliance balloons
  • Stent if can get big enough stent in, better in fold/kink or longer segment, risk for reperfusion injury
34
Q

Coarc balloon vs stent pros and cons

A
  • Indication is re-coarc gradient > 20 or < 20 with ventricular dysfunction or single ventricle
  • Need to get to adult size for stent
  • No balloon if arch hypoplasia
  • Balloon 2-3x diameter of stenosis but < 1 mm larger than surrounding vessel
  • Increased risk recurrence and aneurysm with ballooning vs stent
  • Stent size smaller than surrounding vessel - risk for embolization and femoral injury
35
Q

Indications for intervention on RV-PA conduit

A
  • RVOT gradient > 35 or moderate PI or 2/3 systemic RV pressures
  • Stent if going to prolong life of conduit
  • Valve if big enough
  • Risk for conduit disruption as well as coronary injury
36
Q

Indications for ASD cath lab closure

A
  • Qp:Qs > 1.5
  • RV volume load or dysfunction or elevated pressures
  • 5 mm rims
37
Q

What issues can happen with aortic root injection

A

Acute arrest in graft rejection, coronary disease, aortopathy or cardiomyopathy
- Issue likely not related to the contrast but potentially due to injection time limiting myocardial oxygen delivery

38
Q

Definition of adequate result for aortic valuloplasty

A

Decrease in peak gradient to 20-35 mmHg

39
Q

Risk for sub-optimal result for aortic valuloplasty

A

Age < 3 months or > 40 years
Higher pre-dilation valve gradient
Smaller annular Z score
Vale calcification
Prior procedure
Undersized balloon

40
Q

Tachypnea and lower saturations with edema post PA angioplasty

A

Re-perfusion injury

41
Q

Indication for intervention on PA

A
  • Peak gradient > 20-30 across the stenosis
  • RV pressure or MPA pressure > 1/2 to 2/3 systemic
  • Flow discrepency between two lungs of > 35/65%
  • Angiographic appearance of significant narrowing
42
Q

Goal stent size for pulmonary vein to limit risk for re-stenosis

A

6-10 mm

43
Q

Is re-intervention rate higher for coarc stents or balloons

A

Stents – but most are planned re-interventions

44
Q

Risk of endocarditis in implantable valves

A

2% per year

45
Q

Risks with ASD cath lab closure

A
  • Minor arrhythmia
  • Thrombus formation
  • Device embolization
  • Serious arrhythmia
  • Cardiac erosion (0.1%) –> oversizing device, absent/deficient aortic rim
  • Mortality from erosion
  • Stroke
  • Allergic reaction –> Nickel allergy
46
Q

Formula to calculate PVR in differential Qp

A
  • Need lung perfusion scan
  • Calculate individual PVR for each lung based on pressures and flow (use proportion of flow to that lung)
  • Total resistance formula: 1/total = 1/right + 1/left
47
Q

Protamine reaction

A

Flushing, vasodilation, hypotension, cardiovascular collapse

Higher risk in patients taking NPH insulin

48
Q

Incidence of device erosion with Amplatzer ASD device

A

0.1%

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