Interventional Cardio Flashcards
What is the primary clinical means of estimating inotropy in echocardiography?
Calculation of ejection fraction (EF)
EF is a surrogate for inotropy and can be influenced by preload, afterload, and autonomic tone.
What is considered a normal ejection fraction (EF)?
55% or greater
Fill in the blank: Severe aortic stenosis is characterized by a valve area of < ______ cm2.
1
What are the classifications of systolic dysfunction based on EF?
- Mild: EF 45-54%
- Moderate: EF 30-44%
- Severe: EF <30%
What is a common indication for performing an echocardiogram?
New onset atrial fibrillation
True or False: A normal echocardiogram can exclude the diagnosis of infective endocarditis.
False
A TTE can identify vegetations, but a normal study cannot exclude the diagnosis.
What is the purpose of a stress echocardiogram?
To identify reversible ischemic myocardial dysfunction
What is the gold standard for 3-D analysis of cardiothoracic anatomy?
Cardiac MRI
What is the primary indication for cardiac catheterization?
Evaluation of coronary artery disease (CAD)
What are the two types of cardiac catheterization?
- Left heart catheterization (LHC)
- Right heart catheterization (RHC)
Fill in the blank: Cardiac catheterization allows for direct measurement of _______ in each cardiac chamber.
pressures
What are the common access sites for left heart catheterization?
- Femoral artery
- Radial artery
- Brachial artery
What is the utility of right heart catheterization?
Evaluation of pulmonary vascular disease
What condition is associated with right atrial and right ventricular collapse during diastole?
Tamponade
True or False: A cardiac CT has a high positive predictive value for coronary artery disease.
False
Cardiac CT has a limited positive predictive value but a high negative predictive value.
What can a myocardial perfusion scintigraphy indicate?
Coronary artery disease (CAD) via differences in tracer uptake
What is a paradoxical thromboembolus?
When a thrombus crosses from the right heart to the left heart via a septal defect
What are the common indications for transesophageal echocardiography (TEE)?
- Suspected aortic dissection
- Evaluation of prosthetic valve failure
- Suspected endocarditis
What imaging study is often used for congenital heart disease evaluation?
Echocardiography
What is the main advantage of TEE over TTE?
Higher sensitivity and specificity
What does cardiac catheterization allow for in terms of hemodynamic values?
Direct measurements
What is the significance of a normal echocardiogram in the context of pulmonary embolism?
It cannot exclude the diagnosis of PE.
What is an important consideration before performing a TEE?
Presence of esophageal disease
Fill in the blank: The presence of differences in uptake between rest and exercise indicates _______.
inducible hypoperfusion
What does elevated pulmonary artery pressure indicate?
Possible left ventricular failure, valvular disease, or pulmonary embolism
What is the test of choice for evaluating infective endocarditis?
Echocardiogram
What is the utility of echocardiography in assessing left ventricular hypertrophy?
Measurement of LV mass
What is a common risk factor for infective endocarditis?
Injection drug use
What does cardiac catheterization help determine in patients with coronary artery disease?
Need for revascularization procedures
What is the primary purpose of cardiac catheterization?
To detect pressure directly and assess LV function, valve lesions, etc.
What can be directly measured during cardiac catheterization?
Intracardiac pressures
What is thermodilution in the context of cardiac catheterization?
A known quantity of cool saline is injected into the heart, and temperature is measured downstream to determine cardiac output.
How is oximetry used in cardiac catheterization?
Changes in oxygen concentration downstream are used to measure flow.
What does quantitative angiography measure?
Left ventricular volume using radiographic contrast media.
What can be evaluated from end diastolic and end systolic volumes?
Ejection fraction
How are intracardiac shunts quantified during cardiac catheterization?
Through measurement of oxygen concentration.
What is the oxygen saturation in the right heart (pre-lung)?
About 75%
What is the oxygen saturation in the left heart (post-lung)?
About 99%
What does the determination of vascular resistance help assess?
Right heart function
How is vascular resistance calculated?
Using Ohm’s law: resistance = pressure/flow.
What data can be used to generate pressure-volume loops?
Data from LV function assessment
What is the single most essential application of cardiac catheterization?
Assessment of coronary artery anatomy and function via angiography/arteriography.
What can angiography/arteriography measure in affected vessels?
Pressure and flow
What does it mean if a patient is left coronary dominant?
The posterior descending artery (PDA) arises off of the left heart circulation.
What percentage of the population is right coronary dominant?
80-90%
What is considered significant stenosis in terms of artery diameter?
Around a 70% decrease in diameter
What symptoms may occur with 90% stenosis?
Symptoms may occur at rest – unstable angina.
What are some common complications of cardiac catheterization?
Bleeding, hematoma formation, pseudoaneurysms, renal failure, myocardial infarction, coronary artery perforation.
What characterizes cardiac tamponade?
Obstructive shock, elevated JVP, and muted heart sounds.
What is balloon angioplasty?
Physical dilation of vascular lesions using a small balloon inflated after catheter placement.
What is thrombectomy/embolectomy?
Removal of an acute clot by suction to restore flow.
What is atherectomy?
Removal of atherosclerotic plaque through cutting, drilling, or laser use.
What can balloon valvuloplasty treat?
Some stenotic valvular lesions.
What structural lesions can be repaired via catheterization?
Patent foramen ovale.
Artery w/ 75% stenosis
