Management of Intraproceduraland Postprocedural Complication Flashcards
What is the significance of performing a right heart catheterization?
It may provide important insights, especially regarding impending pulmonary edema with contrast administration or patient positioning.
What PCWP and systolic blood pressure values may indicate deferring a diagnostic catheterization?
PCWP >25 mm Hg and systolic blood pressure <100 mm Hg.
What interventions should be considered if catheterization is deemed imperative?
IV diuretics, supplemental oxygen, and arterial vasodilators like NTG.
What cardiac index value may prompt the use of hemodynamic support before an intervention?
Cardiac index <2.2.
What does IVUS show in relation to the LAD?
A spiral dissection starting in the proximal LAD and extending to the distal portion.
What premedication is recommended for patients with prior severe reactions to contrast?
Prednisone 50 mg orally 13, 7, and 1 hour prior, diphenhydramine 50 mg 1 hour before, and famotidine 40 mg before the procedure.
What is the function of the Impella device?
It pumps blood from the LV into the ascending aorta at a specified flow rate.
What are the flow rates for the Impella CP and Impella 5.0 devices?
- Impella CP: 3.5 to 4 L/min
- Impella 5.0: 5.0 L/min.
What was the purpose of the PROTECT II trial?
To compare the Impella system with an IABP in high-risk PCI patients.
What were the primary and secondary endpoints of the PROTECT II trial?
- Primary: Composite rate of major adverse events
- Secondary: Maximum CPO decrease and in-hospital major events.
What does ventricularization of the pressure tracing indicate?
It is consistent with the ventricular position of the cannula (too far in).
What is the only validated measure shown to reduce the risk of contrast-induced nephropathy?
IV saline hydration.
What recent trial showed a mitigation of bivalirudin’s bleeding advantage with radial access?
The MATRIX trial.
What should an interventionalist be familiar with regarding strokes during cardiac interventions?
Potential etiologies, preventive strategies, and treatments.
What are common characteristics of patients who suffer procedural strokes?
- Older age
- Lower LVEF
- More diabetes
- Higher rate of intraprocedural complications.
Can left heart catheterization be safely performed on patients with endocarditis?
Yes, it can be done safely.
What is the cause of hypotension in a patient with occult bleeding at the arterial entry site?
Occult bleeding at the arterial entry site.
What is the urgency of treating acute femoral artery thrombosis?
It requires immediate surgery or peripheral vascular intervention.
What nerve complications can occur following cardiac catheterization through the femoral route?
- Femoral nerve
- Lateral cutaneous nerve.
What is the most common cause of RP hematoma?
Arterial back wall puncture.
What does an angiogram showing external iliac artery perforation indicate?
Dye extravasation.
What is essential to stop bleeding from a lacerated iliac artery?
Immediate contralateral access and balloon inflation.
What should be done if an aneurysm persists after treatment for 2 months?
It should be operated on.
What is indicated by the angiographic appearance of coronary perforations?
Classification into type I, II, and III based on extravasation.
What is the current dose of protamine for heparin reversal?
1 mg for each 100 units of heparin.
What is the recommended intravenous dose of epinephrine for profound hypotension?
0.5 to 1.0 mL of 1:10,000, repeated every 5 to 10 minutes.
What should be done if a filter device is full of debris?
Wire with another wire and capture and remove the emboli filter device.
What agents are common for treating no-reflow during graft intervention?
- Adenosine
- Nitroprusside
- Verapamil
- GP IIb/IIIa receptor antagonists.
What prognostic outcomes are associated with moderate to severe paravalvular leak post TAVR?
- Mortality
- Heart failure
- Anemia
- Endocarditis
- Poor valve hemodynamics.
What adverse effects can occur with abciximab administration?
- Hypoxemia
- Alveolar infiltrates on chest x-ray
- Hemoptysis
- Unexplained drop in hemoglobin.