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Evaluation of the Cardiac System > Diagnostic Coronary Angiography > Flashcards

Diagnostic Coronary Angiography Flashcards

1
Q

What is a Coronary Angiography?

A

Examination of the coronary arteries that is performed by the injection of contrast media directly into the Ostium of the coronary arteries

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2
Q

What is the absolute contraindication of Coronary Angiography?

A

Lack of patient consent

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3
Q

Where does the RCA (Right coronary artery) arise from?

A

Right Coronary Sinus

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4
Q

What does the conus artery supply?

A

Right ventricular outflow tract

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5
Q

Where does the sinoatrial nodal and AV nodal branches arise from?

A

Right Coronary Artery

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6
Q

What arises from the mid Right coronary artery?

A

Marginal branches

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7
Q

What does the Marginal branches supply

A

Right ventricular wall

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8
Q

What does the distal Right Coronary Arteries give rise to?

A

Right Posterolateral branches and the Posterior descending artery (PDA)

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9
Q

What percentage of cases is right dominant? PDA arises from the distal RCA

A

85%

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10
Q

What percentage of cases is left dominance? PDA arises from LCX

A

8%

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11
Q

What percentage of cases is the PDA co dominant? PDA arises from both the RCA and LCX

A

7%

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12
Q

What groove does the PDA run in and what does it supply?

A

1: Posterior Interventricular grove
2: Posterior Interventricular septum

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13
Q

Where does the left main coronary artery arise from?

A

Left Coronary Sinus

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14
Q

What does the Left Coronary Artery do?

A

Birfurcates into the Left anterior descending and Left Circumflex Artery

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15
Q

In a minority of cases, what does the left main coronary artery do?

A

Trifurcates into the LAD, Ramus intermedius artery, and LCX.

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16
Q

What does the Left Anterior Descending artery supply?

A

Anterior wall of the left Ventricle

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17
Q

Where does the LCX artery run through?

A

Left AV groove

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18
Q

What does the LCX artery supply?

A

Obtuse marginal branches that supply the posterolateral wall of the left ventricle.

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19
Q

What percentage of coronary artery anomalies are found

A

1 to 1.5 %

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20
Q

What is the most common coronary artery anomaly?

A

Presence of separate origins of the LAD and LCX

21
Q

What do you need for the Preprocedural evaluation?

A

-History
-Physical Examination
-Routine lab data
-12 lead ECG
-Transthoracic ECHO

22
Q

What are the indications of Diagnostic Coronary Angiography

A

-Acute coronary syndrome
-ST elevation myocardial infarction (STEMI)
-Unstable Angina
-High Risk Features (Electrical instability or Cardiogenic Shock)

23
Q

When should a patient undergo diagnostic coronary angiography with acute coronary syndrome?

A

Emergent or urgent

24
Q

When should a patient undergo diagnostic coronary angiography with STEMI?

A

Emergent with goal to establish reperfusion within 90 minutes

25
Q

When should a patient undergo diagnostic coronary angiography with unstable angina?

A

24 to 72 hours

26
Q

When should a patient undergo diagnostic coronary angiography with high risk features (rafractory angina, hemodynamic, electrical instability, cardiogenic shock)?

A

within a few hours of clinical presentation

27
Q

What are relative contrindications for diagnostic coronary angiography?

A

Co-morbidities
Renal failure
Electrolyte abnormalities
Active bleeding
Decompensated Heart Failure
Severe Aortic Stenosis
Uncontrolled hypertension
Pulmonary Edema
Respiratory Failure
Active Infection
Allergic Reaction to contrast
Pregnancy
Peripheral vascular disease

28
Q

What is PCI?

A

Percuteanous Coronary Intervention

29
Q

What artery is becoming popular in patients with obesity, decompensated heart failure and severe peripheral artery disease

A

Radial artery

30
Q

What is the anatomic landmark for vessel puncture in the femoral artery?

A

Upper one third of the femoral head.

31
Q

What is used to prevent vasospasm in the radial approach?

A

Vasodilator such as verapamil in the sidearm of the sheath after obtaining radial access

32
Q

What guidewire is introduced in the sheath for coronary artery cannulation?

A

0.035 in J tipped guidewire

33
Q

What should be done with patients with a history of CABG

A

All bypass conduits should be investigated.

34
Q

Most common views for RCA Angiography

A

RAO projection
LAO projection
AP projection with cranial angulation

35
Q

Most common views for Left Coronary Angiography

A

RAO projection with cranial and caudal angulation
LAO projection with cranial and caudal angulation
AP Projection with cranial and caudal angulation

36
Q

What is the Thrombolysis in Myocardial Infarction (TIMI) flow grading scale?

A

TIMI 3: normal flow with complete filling of distal vessel
TIMI 2: Delayed or sluggish flow with complete filling of the distal vessel
TIMI 1: Faint flow beyond the stenosis with incomplete filling of the distal vessel
TIMI 0: Completely occluded artery with no distal flow beyond the lesion

37
Q

What is CAD?

A

Coronary Artery Disease

38
Q

What are the major complications of coronary angiography

A

Death
Myocardial Infarction
Stroke

39
Q

What is the percentage risk of major complications in coronary angiography?

A

0.3%

40
Q

What are the minor complications of coronary angiography?

A

Coronary artery dissection
Bleeding
Vascular complications
Arrhythmias
Contrast reactions

41
Q

Risk percentage of minor complications during coronary angiography?

A

<2%

42
Q

What is PCI?

A

Percutaneous Coronary Intervention

43
Q

What is the limitations of Coronary Angiography in evaluation of CAD:

A

Severity of CAD can be underestimated
Unable to provide accurate information about the vessel wall
Cannot exclude underlying disease in the coronary endothelium
Improper interpretation of stenosis severity

44
Q

What is the critical reference point used to assess the severity of coronary artery narrowing

A

An adjacent normal appearing segment

45
Q

What are the potential complications of the arterial puncture above the ingunial ligament

A

Retroperitanal Bleeding
Hematoma

46
Q

What is the purpose of FFR (Fractional Flow Reserve)

A

To measure intracoronary pressure and assess lesion hemodynamic significance

47
Q

Which factors may contribute to the underestimation of coronary artery disease (CAD) severity during coronary angiography?

A

Two-dimensional imaging of three-dimensional coronary anatomy.

Difficulty in identifying an appropriate reference segment.

48
Q

What can be assessed using both IVUS and OCT in coronary artery evaluation?

A

The size of the artery, vascular wall, and plaque composition.

Evaluation of the Cardiac System (10 decks)

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