Invasive Diagnosis

Question 1

What are the uses of a right heart catheter?

Answer 1

1. To differentiate the different forms of shock.

2. ASDs/VSDs

Question 2

Differentiate the forms of shock

Answer 2

Cardiogenic: Low CO, high wedge
Septic: High CO, low SVR
Hypovolemia: Low CO, High SVR

Question 3

What is the red flag for mitral stenosis?

Answer 3

Pressure gradient between wedge and LV end diastolic pressure

Question 4

What is the red flag for pulmonic stenosis?

Answer 4

Pressure gradient between RV systolic pressure and Pulmonary artery pressure

Question 5

What is the red flag for tamponade?

Answer 5

Equalization of right atrial, pulmonary artery and wedge pressures.

Question 6

How can wedge pressure differentiate a cardiac problem from a pulmonary one?

Answer 6

If pulmonary hypertension with high wedge = CHF or left sided valvular disease
If pulmonary hypertension with low wedge = pulmonary etiology

Question 7

What are left heart catheters used for?

Answer 7

1. Assess ejection fraction.

2. Pressure gradients

Question 8

Discuss Coronary Angiography

Answer 8

Gold standard for evaluation of coronary anatomy.

Question 9

What is the use of Intravascular ultrasound?

Answer 9

Used to delineate borderline lesions seen on coronary angiography.