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MSRS 6310 > Diagnostic Coronary Angiography > Flashcards

Diagnostic Coronary Angiography Flashcards

1
Q

Which patients should undergo emergent coronary angiography according to ACC/AHA guidelines? (Select two)

Patients with stable angina at rest
Patients with ST-elevation myocardial infarction (STEMI)
Patients with mild chest pain without known risk factors
Patients with non-STEMI at intermediate or high risk

A
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2
Q

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

A) The patient’s blood flow velocity
B) An adjacent normal-appearing segment
C) The patient’s cholesterol levels
D) The width of the entire artery

A

B) An adjacent normal-appearing segment

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3
Q

Which branches of the right coronary artery (RCA) supply critical structures in the heart? (Select two)

Left anterior descending artery supplying the AV node
Conus artery supplying the mitral valve
Sinoatrial nodal branch supplying the sinus node
AV nodal branch supplying the AV node

A
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4
Q

What regions of the heart are supplied by the LAD artery and its branches? (Select two)

The posterior wall of the right ventricle
The mitral valve
The interventricular septum
The anterior wall of the left ventricle

A

The interventricular septum
The anterior wall of the left ventricle

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5
Q

Which artery is responsible for supplying the obtuse marginal branches?

Left circumflex artery (LCX)
Left anterior descending artery (LAD)
Posterior descending artery (PDA)
Right coronary artery (RCA)

A
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6
Q

What is generally considered the optimal entry site for the femoral artery during the femoral approach?

A) The lower one-third of the femoral head
B) The middle of the femoral shaft
C) The upper one-half or upper one-third of the femoral head
D) The top of the iliac crest

A

C) The upper one-half or upper one-third of the femoral head

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7
Q

What are potential complications of arterial puncture above the inguinal ligament? (Select two)

Arteriovenous fistula
Hematoma
Pseudoaneurysm
Retroperitoneal bleeding

A
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8
Q

Why is the guidewire always advanced before the coronary catheter?

A) To increase catheter flexibility
B) To improve contrast flow
C) To avoid vascular damage from the catheter’s proximal edges
D) To measure arterial blood gases

A

C) To avoid vascular damage from the catheter’s proximal edges

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9
Q

What is the optimal access site for the radial approach?

A) 2 cm proximal to the radial styloid process
B) 5 cm proximal to the radial styloid process
C) At the wrist crease
D) Directly over the ulnar artery

A

A) 2 cm proximal to the radial styloid process

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10
Q

Which vasodilator is routinely administered to prevent vasospasm during the radial approach?

A) Lidocaine
B) Norepinephrine
C) Epinephrine
D) Verapamil

A

D) Verapamil

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11
Q

What is the first step after positioning the proximal end of the catheter in the aortic root?

A) The catheter is connected to the transducer
B) The catheter is flushed with saline
C) The catheter is loaded with contrast
D) The guidewire is removed from the catheter

A

D) The guidewire is removed from the catheter

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12
Q

Which of the following is a key sign that the catheter is properly positioned during coronary artery cannulation?

A) A pressure tracing showing normal aortic pressure
B) High blood pressure in the artery
C) A steady heart rate
D) Continuous ECG monitoring

A

A) A pressure tracing showing normal aortic pressure

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13
Q

Which of the following aspects are considered in the selection of catheters for coronary angiography? (Select two)

A) The coronary artery being investigated
B) The amount of contrast used
C) The diameter of the aortic root
D) The patient’s blood pressure

A

A) The coronary artery being investigated

C) The diameter of the aortic root

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14
Q

What solution is used to flush the catheter after positioning it in the aortic root?

A) Contrast solution
B) Dextrose solution
C) Heparinized saline
D) Normal saline

A

C) Heparinized saline

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15
Q

What is the purpose of Fractional Flow Reserve (FFR) in coronary angiography?

A) To calculate coronary blood flow velocity.
B) To measure plaque burden using ultrasound technology.
C) To measure intracoronary pressure and assess lesion hemodynamic significance.
D) To provide high-resolution cross-sectional images of the artery.

A

C) To measure intracoronary pressure and assess lesion hemodynamic significance.

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16
Q

Which of the following are essential to obtain a comprehensive evaluation of the coronary arteries during angiography? (Select two)

A) Imaging in multiple views
B) Using a single, static image view
C) Ensuring no vessel foreshortening or overlap occurs
D) Minimizing the use of contrast during the procedure

A

A & C

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17
Q

Which TIMI flow grade is characterized by delayed or sluggish flow with complete filling of the distal vessel?

A) TIMI 2
B) TIMI 1
C) TIMI 0
D) TIMI 3

A

A) TIMI 2

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18
Q

Why might coronary angiography fail to provide complete information about coronary artery disease (CAD)? (Select two)

A) It provides an accurate comparison of the diseased and reference segments.
B) It cannot accurately assess the vessel wall.
C) It only provides a two-dimensional representation of coronary anatomy.
D) It offers detailed visualization of the coronary endothelium.

A

B & C

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19
Q

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

A) Visualization of the coronary endothelium.
B) Two-dimensional imaging of three-dimensional coronary anatomy.
C) Difficulty in identifying an appropriate reference segment.
D) Accurate depiction of the vessel lumen.

A

B & C

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20
Q

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

A) The aortic pressure during maximal coronary hyperemia.
B) The blood flow velocity through the coronary arteries.
C) The hemodynamic significance of a coronary lesion.
D) The size of the artery, vascular wall, and plaque composition.

A

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

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21
Q

Where does the right coronary artery (RCA) arise from?
A) Left coronary sinus
B) Right coronary sinus
C) Aorta
D) Pulmonary trunk

A

B) Right coronary sinus

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22
Q

What is the first branch that typically arises from the RCA?
A) Posterior descending artery (PDA)
B) Marginal branches
C) Conus artery
D) Left circumflex artery (LCX)

A

C) Conus artery

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23
Q

Which part of the heart does the sinoatrial nodal branch supply?
A) Right ventricle
B) Atrioventricular node
C) Sinoatrial node
D) Left atrium

A

C) Sinoatrial node

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24
Q

What percentage of cases does the posterior descending artery (PDA) arise from the RCA?
A) 100%
B) 85%
C) 8%
D) 7%

A

B) 85%

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25
Q

In what percentage of cases does the PDA arise from the left circumflex artery (LCX)?
A) 85%
B) 8%
C) 7%
D) 100%

A

B) 8%

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26
Q

What is defined as right dominance in coronary circulation?
A) PDA arises from the RCA
B) PDA arises from the LCX
C) PDA arises from both RCA and LCX
D) PDA does not exist

A

A) PDA arises from the RCA

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27
Q

Which branches supply the right ventricular wall?
A) Posterolateral branches
B) Marginal branches
C) AV nodal branches
D) Conus artery

A

B) Marginal branches

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28
Q

What is the anatomical location of the PDA?
A) Anterior interventricular groove
B) Right atrioventricular groove
C) Posterior interventricular groove
D) Left circumflex groove

A

C) Posterior interventricular groove

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29
Q

In cases of co-dominance, from where does the PDA arise?
A) Only from the RCA
B) Only from the LCX
C) From both the RCA and LCX
D) It does not exist in co-dominance

A

C) From both the RCA and LCX

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30
Q

What is the primary function of the conus artery?
A) Supply blood to the left atrium
B) Supply blood to the right ventricular outflow tract
C) Supply blood to the interventricular septum
D) Supply blood to the sinoatrial node

A

B) Supply blood to the right ventricular outflow tract

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31
Q

From where does the left main coronary artery arise?
A) Right coronary sinus
B) Aorta
C) Left coronary sinus
D) Pulmonary trunk

A

C) Left coronary sinus

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32
Q

What are the two primary branches of the left main coronary artery?
A) Right coronary artery and PDA
B) Left anterior descending (LAD) and left circumflex (LCX) arteries
C) Marginal branches and septal branches
D) Conus artery and AV nodal artery

A

B) Left anterior descending (LAD) and left circumflex (LCX) arteries

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33
Q

In a minority of cases, what additional artery may arise from the left main coronary artery?
A) PDA
B) Ramus intermedius artery
C) Right marginal artery
D) Conus artery

A

B) Ramus intermedius artery

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34
Q

What does the LAD artery primarily supply?
A) Right atrium
B) Anterior wall of the left ventricle
C) Posterior wall of the left ventricle
D) Right ventricle

A

B) Anterior wall of the left ventricle

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35
Q

What is the function of the septal perforator branches of the LAD artery?
A) Supply the left atrium
B) Supply the right ventricle
C) Supply the interventricular septum
D) Supply the anterior wall of the right ventricle

A

C) Supply the interventricular septum

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36
Q

What does the LCX artery primarily supply?
A) Anterior wall of the left ventricle
B) Posterolateral wall of the left ventricle
C) Right ventricle
D) Interventricular septum

A

B) Posterolateral wall of the left ventricle

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37
Q

What type of branches does the LCX artery provide?
A) Septal branches
B) Diagonal branches
C) Obtuse marginal branches
D) Conus branches

A

C) Obtuse marginal branches

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38
Q

In what percentage of cases does the PDA arise from the LCX artery?
A) 85%
B) 8%
C) 7%
D) 100%

A

C) 7%

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39
Q

Which classification systems are widely accepted for describing coronary anatomy?
A) CASS, SYNTAX, and BARI
B) LVEF, NYHA, and CASS
C) CASS, ACE, and BARI
D) SYNTAX, BARI, and CAPR

A

A) CASS, SYNTAX, and BARI

40
Q

What does the LAD artery run along?
A) Posterior interventricular groove
B) Left AV groove
C) Anterior interventricular groove
D) Right atrioventricular groove

A

C) Anterior interventricular groove

41
Q

What is the prevalence of coronary artery anomalies in the general population?
A) 0.1%
B) 0.5%
C) 1% to 1.5%
D) 2% to 3%

A

C) 1% to 1.5%

42
Q

What is the most common coronary artery anomaly?
A) A single coronary artery
B) Separate origins of the LAD and LCX arteries
C) A coronary artery originating from the pulmonary artery
D) A coronary artery coursing between the aorta and pulmonary artery

A

B) Separate origins of the LAD and LCX arteries

43
Q

In what percentage of cases does the separate origin of the LAD and LCX arteries occur?
A) 0.1% to 0.3%
B) 0.4% to 1%
C) 2% to 5%
D) 10% to 15%

A

B) 0.4% to 1%

44
Q

Which of the following anomalies is associated with a bicuspid aortic valve?
A) A single coronary artery
B) Separate origins of the LAD and LCX arteries
C) A coronary artery coursing between the aorta and pulmonary artery
D) A coronary artery originating from the pulmonary artery

A

B) Separate origins of the LAD and LCX arteries

45
Q

Which of the following is a clinically significant coronary artery anomaly?
A) Coronary artery originating from the opposite coronary sinus
B) A separate origin of LAD and LCX arteries
C) Normal coronary artery anatomy
D) Bicuspid aortic valve

A

A) Coronary artery originating from the opposite coronary sinus

46
Q

What type of anomaly involves a single coronary ostium leading to a single coronary artery?
A) Coronary artery–ventricular fistula
B) Single coronary artery anomaly
C) A coronary artery coursing between the great vessels
D) Anomalous left coronary artery

A

B) Single coronary artery anomaly

47
Q

Which anomaly involves a coronary artery coursing between the aorta and pulmonary artery?
A) Single coronary artery
B) Coronary artery–ventricular fistula
C) Coronary artery originating from the opposite coronary sinus
D) Coronary artery coursing between the great vessels

A

D) Coronary artery coursing between the great vessels

48
Q

What is a potential consequence of a coronary artery originating from the pulmonary artery?
A) Increased myocardial oxygenation
B) Decreased oxygenation of the myocardium
C) No clinical significance
D) Normal coronary function

A

B) Decreased oxygenation of the myocardium

49
Q

Coronary artery anomalies are typically a result of what type of development?
A) Abnormal genetic development
B) Abnormal embryological development
C) Acquired heart disease
D) Post-surgical complications

A

B) Abnormal embryological development

50
Q

Which coronary artery anomaly is characterized by a connection between a coronary artery and a ventricle?
A) A coronary artery originating from the opposite coronary sinus
B) A single coronary artery
C) Coronary artery–ventricular fistula
D) A coronary artery coursing between the great vessels

A

C) Coronary artery–ventricular fistula

51
Q

What is the purpose of obtaining an accurate medical history before PCI?
A) To determine the patient’s physical fitness
B) To assess the need for anesthesia
C) To determine patient candidacy for PCI and dual antiplatelet therapy
D) To evaluate the patient’s psychological state

A

C) To determine patient candidacy for PCI and dual antiplatelet therapy

52
Q

Which of the following tests provides valuable information for procedural planning before PCI?
A) Chest X-ray
B) Routine laboratory data
C) MRI of the heart
D) All of the above

A

B) Routine laboratory data

53
Q

What is typically included in routine laboratory data for assessing a patient before PCI?
A) Serum electrolyte levels
B) Complete blood count
C) Coagulation studies
D) All of the above

A

D) All of the above

54
Q

What is the role of a 12-lead ECG in the pre-procedural assessment for PCI?
A) To assess liver function
B) To evaluate lung capacity
C) To detect arrhythmias and other cardiac abnormalities
D) To determine cholesterol levels

A

C) To detect arrhythmias and other cardiac abnormalities

55
Q

What information does a transthoracic echocardiogram provide before PCI?
A) Size of coronary arteries
B) Assessment of heart function and structure
C) Blood pressure readings
D) Heart rate variability

A

B) Assessment of heart function and structure

56
Q

Why is the examination of peripheral pulses important before PCI?
A) To assess for fever
B) To help plan the site of vascular access
C) To evaluate nutritional status
D) To check for allergies

A

B) To help plan the site of vascular access

57
Q

What is the purpose of stress testing prior to coronary angiography?
A) To increase physical endurance
B) To risk stratify patients and localize areas of myocardial ischemia
C) To monitor cholesterol levels
D) To evaluate lung function

A

B) To risk stratify patients and localize areas of myocardial ischemia

58
Q

Which of the following could indicate a need for dual antiplatelet therapy?
A) Normal ECG results
B) Obstructive coronary artery disease (CAD) demonstrated in angiography
C) Low blood pressure
D) High cholesterol levels

A

B) Obstructive coronary artery disease (CAD) demonstrated in angiography

59
Q

What does PCI stand for?
A) Percutaneous coronary intervention
B) Pulmonary cardiomyopathy intervention
C) Peripheral cardiac intervention
D) Preoperative cardiac infusion

A

A) Percutaneous coronary intervention

60
Q

In which scenario is the pre-procedural assessment most critical?
A) For patients with a history of anxiety
B) For patients with stable angina only
C) For all patients undergoing PCI
D) Only for patients undergoing elective surgeries

A

C) For all patients undergoing PCI

61
Q

What is the recommended time frame for performing coronary angiography in patients with STEMI?
A) Within 60 minutes of presentation
B) Within 90 minutes of clinical presentation
C) Within 12 hours of symptom onset
D) Within 24 hours of admission

A

B) Within 90 minutes of clinical presentation

62
Q

Which of the following patients should undergo coronary angiography within 24 to 72 hours?
A) Patients with stable angina
B) Patients with STEMI
C) Patients with non-STEMI or unstable angina who are at intermediate or high risk
D) Patients with low-risk angina

A

C) Patients with non-STEMI or unstable angina who are at intermediate or high risk

63
Q

What is a critical indication for performing coronary angiography immediately in patients with non-ST elevation acute coronary syndromes?
A) Presence of hypertension
B) Refractory angina or hemodynamic instability
C) History of smoking
D) Age above 60

A

B) Refractory angina or hemodynamic instability

64
Q

Which of the following is NOT an indication for diagnostic coronary angiography in patients with stable ischemic heart disease?
A) Clinical characteristics indicating high likelihood of severe ischemic heart disease
B) Successful resuscitation from sudden cardiac death
C) Mild angina on exertion
D) Nonsustained polymorphic ventricular tachycardia

A

C) Mild angina on exertion

65
Q

Patients with which of the following conditions may be referred for coronary angiography without previous stress testing?
A) Patients with atypical chest pain
B) Patients with symptoms highly typical of angina
C) Patients with new-onset diabetes
D) Patients with a family history of heart disease

A

B) Patients with symptoms highly typical of angina

66
Q

What should patients with STEMI and symptom onset within 12 to 24 hours and evidence of ongoing ischemia undergo?
A) Observation
B) Coronary angiography
C) Medical management only
D) Stress testing

A

B) Coronary angiography

67
Q

Which evaluation is NOT a guideline-recommended indication for coronary angiography?
A) Evaluation of left ventricular systolic dysfunction
B) Evaluation of patients before elective cosmetic surgery
C) Evaluation prior to transcatheter aortic valve replacement
D) Evaluation of infective endocarditis with evidence of coronary embolization

A

B) Evaluation of patients before elective cosmetic surgery

68
Q

What condition warrants coronary angiography prior to cardiac surgery?
A) Presence of mild chest discomfort
B) Evaluation before aortic surgery
C) Uncontrolled hypertension
D) Recent viral infection

A

B) Evaluation before aortic surgery

69
Q

When should a patient with unstable angina and decreased quality of life due to angina be referred for coronary angiography?
A) Immediately, regardless of other factors
B) Only if symptoms worsen
C) Within 24 to 72 hours if at intermediate or high risk
D) After 6 months of medical therapy

A

C) Within 24 to 72 hours if at intermediate or high risk

70
Q

Which of the following clinical features could prompt a direct referral for coronary angiography without prior stress testing?
A) Age above 70
B) Previous myocardial infarction
C) Family history of heart disease
D) Regular exercise

A

B) Previous myocardial infarction

71
Q

What is the only absolute contraindication to diagnostic coronary angiography?
A) Severe aortic stenosis
B) Active infection
C) Patient refusal to consent
D) Acute renal failure

A

C) Patient refusal to consent

72
Q

Which of the following conditions is considered a relative contraindication to diagnostic coronary angiography?
A) Chronic kidney disease
B) Patient refusal to consent
C) Aortic valve endocarditis
D) Acute renal failure

A

All but B

73
Q

Why is acute renal failure a relative contraindication for diagnostic coronary angiography?
A) It prevents the use of contrast agents.
B) It increases the risk of contrast-induced nephropathy.
C) It makes the procedure longer.
D) It requires additional monitoring.

A

B) It increases the risk of contrast-induced nephropathy.

74
Q

Which of the following may increase the risk of arrhythmias during contrast injection?
A) Severe coagulopathy
B) Electrolyte abnormalities
C) Decompensated heart failure
D) Severe peripheral vascular disease

A

B) Electrolyte abnormalities

75
Q

What can significantly increase the risk of vascular complications during a coronary angiography procedure?
A) A history of smoking
B) Severe thrombocytopenia
C) Previous myocardial infarction
D) Low physical activity

A

B) Severe thrombocytopenia

76
Q

In which situation is a patient likely to be at increased risk of acute flash pulmonary edema during diagnostic coronary angiography?
A) If they have diabetes mellitus
B) If they have uncontrolled hypertension
C) If they have a family history of heart disease
D) If they have stable angina

A

B) If they have uncontrolled hypertension

77
Q

Active bleeding is considered a relative contraindication because it increases the risk of:
A) Hypotension
B) Respiratory failure
C) Vascular complications and bleeding risk
D) Contrast-induced nephropathy

A

C) Vascular complications and bleeding risk

78
Q

Which of the following conditions is NOT listed as a relative contraindication for diagnostic coronary angiography?
A) Severe coagulopathy
B) Acute stroke
C) Patient cooperation issues
D) Previous coronary artery bypass surgery

A

D) Previous coronary artery bypass surgery

79
Q

What is a relative contraindication for diagnostic coronary angiography in pregnant patients?
A) Increased risk of renal failure
B) Risk of radiation exposure
C) Increased risk of thrombosis
D) Decreased ability to cooperate

A

B) Risk of radiation exposure

80
Q

Which of the following conditions would require careful assessment before proceeding with diagnostic coronary angiography?
A) Mild hypertension
B) Allergic reactions to iodinated contrast agents
C) History of exercise
D) Previous myocardial infarction without complications

A

B) Allergic reactions to iodinated contrast agents

81
Q

What is the primary purpose of obtaining written informed consent before a diagnostic coronary angiography?
A) To ensure the procedure is performed within a specific time frame
B) To inform the patient of the indication, benefits, risks, and alternatives of the procedure
C) To verify the patient’s identity
D) To prepare the patient for sedation

A

B - To inform the patient of the indication, benefits, risks, and alternatives of the procedure

82
Q

Which of the following arteries is NOT typically used for arterial access during coronary angiography?
A) Common femoral artery (CFA)
B) Brachial artery
C) Radial artery
D) Carotid artery

A

D) Carotid artery

83
Q

What is the significance of the time-out procedure performed before the angiography?
A) To confirm the patient’s vital signs
B) To verify the patient, procedure, indication, access site, and any allergies
C) To discuss the procedure with the patient’s family
D) To administer pre-procedure medication

A

B - To verify the patient, procedure, indication, access site, and any allergies

84
Q

What anatomical landmark is typically used to identify the optimal entry site for the femoral artery?
A) The lower one-third of the femoral head
B) The upper one-half or upper one-third of the femoral head
C) The inguinal ligament
D) The patellar tendon

A

B) The upper one-half or upper one-third of the femoral head

85
Q

What complication may arise from arterial puncture above the inguinal ligament?
A) Vasospasm
B) Hematoma or retroperitoneal bleeding
C) Pseudoaneurysm
D) Arteriovenous fistula

A

B) Hematoma or retroperitoneal bleeding

86
Q

What does the Allen test assess?
A) The presence of arrhythmias
B) The patency of the palmar arch circulation
C) The size of the radial artery
D) The effectiveness of sedation

A

B) The patency of the palmar arch circulation

87
Q

Which vasodilator is routinely administered to prevent vasospasm during the radial approach?
A) Nitroglycerin
B) Amlodipine
C) Verapamil
D) Clopidogrel

A

C) Verapamil

88
Q

Why has the Allen test become less widely used in assessing radial artery access?
A) It is too complicated to perform.
B) It has not been shown to correlate with outcomes.
C) It takes too much time.
D) Patients find it uncomfortable.

A

B) It has not been shown to correlate with outcomes.

89
Q

What type of guidewire is typically used in coronary angiography?
A) 0.025-inch guidewire
B) 0.035-inch, J-tipped guidewire
C) 0.045-inch guidewire
D) 0.055-inch guidewire

A

B

90
Q

Why is the guidewire advanced before the catheter during the procedure?
A) To facilitate catheter loading with contrast
B) To prevent vascular damage from the catheter’s proximal edges
C) To reduce the need for fluoroscopy
D) To monitor arterial pressure

A

B

91
Q

Why is the guidewire advanced before the catheter during the procedure?
A) To facilitate catheter loading with contrast
B) To prevent vascular damage from the catheter’s proximal edges
C) To reduce the need for fluoroscopy
D) To monitor arterial pressure

A

B

92
Q

What is the purpose of flushing the catheter with heparinized saline?
A) To prevent thrombosis in the catheter
B) To enhance contrast visibility
C) To clean the catheter after use
D) To adjust the catheter’s position

A

A

93
Q

What imaging technique is used during coronary angiography to visualize the coronary arteries?
A) Ultrasound
B) Cineradiography
C) MRI
D) CT Scan

A

B

94
Q

In patients with a history of coronary artery bypass grafting (CABG), which bypass conduits should be investigated during angiography?
A) Only the native coronary arteries
B) Only the left coronary artery
C) All bypass conduits
D) Only the right coronary artery

A

C

95
Q

Where are saphenous vein grafts typically anastomosed in CABG patients?
A) Above the left ventricle
B) Above the right atrium
C) To the anterior wall of the ascending aorta
D) To the descending aorta

A

C

96
Q

What anatomical structure does the left internal mammary artery (LIMA) arise from?
A) Right subclavian artery
B) Ascending aorta
C) Left subclavian artery
D) Brachiocephalic trunk

A

C

97
Q

How is the catheter maneuvered to cannulate the LIMA?
A) It is advanced straight into the artery.
B) It is withdrawn with gentle counterclockwise rotation while facing anteriorly.
C) It is pushed into the artery rapidly.
D) It is twisted in a clockwise direction.

A

B

MSRS 6310 (11 decks)

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