Management of Intraproceduraland Postprocedural Complication

Question 1

What is the significance of performing a right heart catheterization?

Answer 1

It may provide important insights, especially regarding impending pulmonary edema with contrast administration or patient positioning.

Question 2

What PCWP and systolic blood pressure values may indicate deferring a diagnostic catheterization?

Answer 2

PCWP >25 mm Hg and systolic blood pressure <100 mm Hg.

Question 3

What interventions should be considered if catheterization is deemed imperative?

Answer 3

IV diuretics, supplemental oxygen, and arterial vasodilators like NTG.

Question 4

What cardiac index value may prompt the use of hemodynamic support before an intervention?

Answer 4

Cardiac index <2.2.

Question 5

What does IVUS show in relation to the LAD?

Answer 5

A spiral dissection starting in the proximal LAD and extending to the distal portion.

Question 6

What premedication is recommended for patients with prior severe reactions to contrast?

Answer 6

Prednisone 50 mg orally 13, 7, and 1 hour prior, diphenhydramine 50 mg 1 hour before, and famotidine 40 mg before the procedure.

Question 7

What is the function of the Impella device?

Answer 7

It pumps blood from the LV into the ascending aorta at a specified flow rate.

Question 8

What are the flow rates for the Impella CP and Impella 5.0 devices?

Answer 8

• Impella CP: 3.5 to 4 L/min
• Impella 5.0: 5.0 L/min.

Question 9

What was the purpose of the PROTECT II trial?

Answer 9

To compare the Impella system with an IABP in high-risk PCI patients.

Question 10

What were the primary and secondary endpoints of the PROTECT II trial?

Answer 10

• Primary: Composite rate of major adverse events
• Secondary: Maximum CPO decrease and in-hospital major events.

Question 11

What does ventricularization of the pressure tracing indicate?

Answer 11

It is consistent with the ventricular position of the cannula (too far in).

Question 12

What is the only validated measure shown to reduce the risk of contrast-induced nephropathy?

Answer 12

IV saline hydration.

Question 13

What recent trial showed a mitigation of bivalirudin’s bleeding advantage with radial access?

Answer 13

The MATRIX trial.

Question 14

What should an interventionalist be familiar with regarding strokes during cardiac interventions?

Answer 14

Potential etiologies, preventive strategies, and treatments.

Question 15

What are common characteristics of patients who suffer procedural strokes?

Answer 15

• Older age
• Lower LVEF
• More diabetes
• Higher rate of intraprocedural complications.

Question 16

Can left heart catheterization be safely performed on patients with endocarditis?

Answer 16

Yes, it can be done safely.

Question 17

What is the cause of hypotension in a patient with occult bleeding at the arterial entry site?

Answer 17

Occult bleeding at the arterial entry site.

Question 18

What is the urgency of treating acute femoral artery thrombosis?

Answer 18

It requires immediate surgery or peripheral vascular intervention.

Question 19

What nerve complications can occur following cardiac catheterization through the femoral route?

Answer 19

• Femoral nerve
• Lateral cutaneous nerve.

Question 20

What is the most common cause of RP hematoma?

Answer 20

Arterial back wall puncture.

Question 21

What does an angiogram showing external iliac artery perforation indicate?

Answer 21

Dye extravasation.

Question 22

What is essential to stop bleeding from a lacerated iliac artery?

Answer 22

Immediate contralateral access and balloon inflation.

Question 23

What should be done if an aneurysm persists after treatment for 2 months?

Answer 23

It should be operated on.

Question 24

What is indicated by the angiographic appearance of coronary perforations?

Answer 24

Classification into type I, II, and III based on extravasation.

Question 25

What is the current dose of protamine for heparin reversal?

Answer 25

1 mg for each 100 units of heparin.

Question 26

What is the recommended intravenous dose of epinephrine for profound hypotension?

Answer 26

0.5 to 1.0 mL of 1:10,000, repeated every 5 to 10 minutes.

Question 27

What should be done if a filter device is full of debris?

Answer 27

Wire with another wire and capture and remove the emboli filter device.

Question 28

What agents are common for treating no-reflow during graft intervention?

Answer 28

• Adenosine
• Nitroprusside
• Verapamil
• GP IIb/IIIa receptor antagonists.

Question 29

What prognostic outcomes are associated with moderate to severe paravalvular leak post TAVR?

Answer 29

• Mortality
• Heart failure
• Anemia
• Endocarditis
• Poor valve hemodynamics.

Question 30

What adverse effects can occur with abciximab administration?

Answer 30

• Hypoxemia
• Alveolar infiltrates on chest x-ray
• Hemoptysis
• Unexplained drop in hemoglobin.