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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

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
AP caudal imaging good for
Underside of arch, branch PAs
26
LAO imaging good for
Arch, proximal LPA, L pulmonary veins
27
RAO imaging good for
LVOT (subAS, AV annulus), anterior muscular/outlet VSDs, R pulmonary veins
28
RAO and long axial oblique imaging good for
Like a parasternal long echo image LVOT, AV annulus, membranous and anterior VSDs
29
Hepatoclavicular imaging good for
Like a 4 chamber view Crux of the art, AV valves, AVSD, inlet/posterior VSDs
30
Indication for balloon pulmonary valvuloplasty
Peak > 40 Or peak < 40 with symptoms or RV dysfunction or cyanosis (critical PS) Balloon:annulus 1.2-1.4
31
Indication for balloon aortic valvuloplasty
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
Indication for balloon mitral valvuloplasty
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
PA balloon vs. stent pros and cons
- 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
Coarc balloon vs stent pros and cons
- 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
Indications for intervention on RV-PA conduit
- 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
Indications for ASD cath lab closure
- Qp:Qs > 1.5 - RV volume load or dysfunction or elevated pressures - 5 mm rims
37
What issues can happen with aortic root injection
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
Definition of adequate result for aortic valuloplasty
Decrease in peak gradient to 20-35 mmHg
39
Risk for sub-optimal result for aortic valuloplasty
Age < 3 months or > 40 years Higher pre-dilation valve gradient Smaller annular Z score Vale calcification Prior procedure Undersized balloon
40
Tachypnea and lower saturations with edema post PA angioplasty
Re-perfusion injury
41
Indication for intervention on PA
- 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
Goal stent size for pulmonary vein to limit risk for re-stenosis
6-10 mm
43
Is re-intervention rate higher for coarc stents or balloons
Stents -- but most are planned re-interventions
44
Risk of endocarditis in implantable valves
2% per year
45
Risks with ASD cath lab closure
- 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
Formula to calculate PVR in differential Qp
- 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
Protamine reaction
Flushing, vasodilation, hypotension, cardiovascular collapse Higher risk in patients taking NPH insulin
48
Incidence of device erosion with Amplatzer ASD device
0.1%

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