Cath Lab

Question 0

What is avg volume of contrast used for diagnostic cath?

Answer 0

130 mL

Question 1

What is the recommended maximum volume of contrast to prevent contrast-induced nephropathy?

Answer 1

3 mL/kg (or 5 mL/kg divided by Serum Creatinine)

Question 3

What is avg volume of contrast used for angioplasty procedure?

Answer 3

191 mL

Question 4

What is the most common catheter to cannulate the LEFT coronary artery? RIGHT coronary?

Answer 4

JL4 (Judkins - 4cm curve); JR4 (engagement requires a slow 180 degree rotation when the tip reaches the aortic root)

Question 5

What % of saphenous vein grafts occlude within the first month? What is the mechanism for SVGs to occlude between 1 month to 1 year?

Answer 5

3 - 12%; Neointimal hyperplasia

Question 6

After 1 year, what is the most common mechanism of saphenous vein graft occlusion? What % SVGs will be occluded by 7 years?

Answer 6

Diffuse graft atherosclerosis; 50%

Question 7

List 6 side effects of older high-osmolar contrast agents that are less likely with newer low-osmolar agents.

Answer 7

1. Transient (10-20 second) hemodynamic depression marked by arterial hypotension and elevated LVEDP
2. EKG changes: T-wave inversion or peaking in the inferior leads, sinus slowing or arrest, prolonged intervals (PR, QRS or QT)
3. Significant arrhythmia (VTach, VFib, asystole)
4. Myocardial ischemia (decrease oxygen delivery or coronary steal from vasodilation)
5. Allergic reaction
6. Cumulative renal toxicity

Question 8

Why is the LEFT ventriculogram usually done AFTER study of the coronaries?

Answer 8

Reaction to high contrast load may prevent successful cannulation of the coronaries

Question 9

What is the best course of action if angina/ischemia develops during coronary angiography? What if it is associated with tachycardia?

Answer 9

1. Withdraw the catheter from the coronary osmium and suspend injections until angina resolves. If this takes longer than 30 seconds, give a 200mg nitroglycerin bolus (repeated q30 seconds to a total of 1000mg prn). Other vasodilators may be used for marked arterial hypertension, if fails to resolve with nitro.
2. If associated with tachycardia, use metoprolol 5mg q5min (up to 15mg) or esmolol

Question 10

What is the average volume and rate required to opacify the LEFT coronary during angiography? RIGHT?

Answer 10

LEFT - 7mL at rate of 2.1mL/second
RIGHT - 4.8mL at a rate of 1.7mL/second
Less with diseased vessels
**Too rapid rate may cause dissection and excessive myocardial blushing
**Too prolonged may cause more myocardial depression or bradycardia

Question 11

Best view and orthogonal view for LAD

Answer 11

Left main: ostium Left main: distal LAD: proximal LAD: mid
LAD: distal Septal perforators Diagonals Circumflex Obtuse marginals Right
“Best view”
Straight AP to LAO 0-5 RAO 0-20
RAO 30, caudal 20
RAO 30, cranial 30
RAO 30, cranial 0-15 RAO 15-30, cranial 30-45 RAO 30, cranial 30
RAO 30, caudal 30-40 RAO 30, caudal 30-40 LAO 45, cranial 20-30
Orthogonal view
LAO 60, caudal 30 LAO 60, caudal 30 LAO 60, cranial 30 LAO 60, cranial 20 LAO 60, cranial 0-10 Difficult—variable LAO 60, cranial 20-30 LAO 60, caudal 30-40 Difficult—variable RAO 30, cranial 20-30