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MSRS 6310 > Right And Left Heart Catheterization > Flashcards

Right And Left Heart Catheterization Flashcards

1
Q

Who developed the right heart catheterization technique in the 1970s?
a) Dr. Jonas Salk and Dr. Paul Muller
b) Dr. Harold Swan and Dr. William Ganz
c) Dr. Robert Jarvik and Dr. Michael DeBakey
d) Dr. Charles Drew and Dr. Denton Cooley

A

b) Dr. Harold Swan and Dr. William Ganz

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2
Q

What is the primary function of the balloon at the distal tip of the PA catheter? a) To inject medications
b) To measure cardiac output
c) To temporarily occlude the pulmonary artery
d) To measure blood pressure directly

A

c) To temporarily occlude the pulmonary artery

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3
Q

What does the thermistor on a PA catheter measure? a) Blood pressure
b) Heart rate
c) Temperature change of injected fluid
d) Pulmonary artery diameter

A

c) Temperature change of injected fluid

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4
Q

Which of the following is not used in the preprocedural evaluation for right heart catheterization? a) History and physical examination
b) Transthoracic echocardiogram
c) Chest X-ray
d) Routine laboratory data

A

c) Chest X-ray

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5
Q

What is the “wedge” pressure measured by?
a) Proximal port
b) Distal port
c) Thermistor
d) ECG leads

A

b) Distal port

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6
Q

Which organizations have published guidelines on the indications for right heart catheterization?
a) American College of Surgeons and the World Health Organization
b) American College of Cardiology and the American Heart Association
c) Society of Interventional Radiology and the CDC
d) American Diabetes Association and the American Cancer Society

A

b) American College of Cardiology and the American Heart Association

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7
Q

What is one debated use of PA catheters in clinical settings?
a) Routine use to guide clinical management in critically ill patients
b) Diagnosis of cancer
c) Routine monitoring of blood glucose levels
d) Use in outpatient physical therapy

A

a) Routine use to guide clinical management in critically ill patients

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8
Q

What have randomized trials investigating PA catheter-based management in patients with heart failure and ARDS shown?
a) Improved survival rates
b) Increased risk of complications with no improvement in survival
c) Lower costs of treatment
d) Better quality of life for patients

A

b) Increased risk of complications with no improvement in survival

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9
Q

What are some criticisms of the studies on PA catheter-based management?
a) Insufficient funding and lack of randomized data
b) Study design flaws, improper patient selection, and inexperienced physicians
c) Excessive use of advanced imaging technologies
d) Lack of follow-up and placebo groups

A

b) Study design flaws, improper patient selection, and inexperienced physicians

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10
Q

Is there a clear consensus on whether PA catheters are beneficial for guiding clinical management?
a) Yes, they are universally accepted as beneficial
b) No, there is no clear consensus
c) Yes, they are universally considered harmful
d) No, they are no longer used in clinical settings

A

b) No, there is no clear consensus

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11
Q

What is the first absolute contraindication to right heart catheterization? a) Severe thrombocytopenia
b) Lack of informed consent
c) Active infection
d) Left bundle branch block

A

b) Lack of informed consent

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12
Q

Why should patients with mechanical prosthetic tricuspid or pulmonic valves avoid right heart catheterization?
a) Risk of bleeding
b) Risk of catheter entrapment
c) Risk of heart failure
d) Risk of infection

A

b) Risk of catheter entrapment

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13
Q

Which of the following is a contraindication for right heart catheterization in patients with right-sided heart conditions?
a) Pulmonary embolism
b) Thrombus, endocarditis, or intracardiac tumor
c) Left atrial enlargement
d) Atrial septal defect

A

b) Thrombus, endocarditis, or intracardiac tumor

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14
Q

Which of the following is considered a relative contraindication to right heart catheterization? a) Complete heart block
b) Pulmonary hypertension
c) Active infection
d) Prosthetic heart valves

A

c) Active infection

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15
Q

Why is underlying left bundle branch block a relative contraindication for right heart catheterization?
a) It increases the risk of thrombosis
b) It increases the risk of complete heart block if a right bundle branch block occurs
c) It increases the risk of bleeding
d) It causes pulmonary artery occlusion

A

b) It increases the risk of complete heart block if a right bundle branch block occurs

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16
Q

Which veins can be used for central venous access during right heart catheterization?
a) Brachial vein, radial artery, femoral artery
b) Femoral vein, internal jugular vein, brachial vein, subclavian vein
c) Radial vein, brachial artery, internal carotid artery
d) Ulnar vein, saphenous vein, subclavian artery

A

b) Femoral vein, internal jugular vein, brachial vein, subclavian vein

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17
Q

What is used to guide the placement of the venous sheath during right heart catheterization?
a) X-ray only
b) Echocardiography
c) The modified Seldinger technique with ultrasound guidance
d) Direct palpation of the vein

A

c) The modified Seldinger technique with ultrasound guidance

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18
Q

What is the pulmonary capillary wedge pressure (PCWP) a reflection of?
a) Right atrium (RA) pressure
b) Left atrium (LA) pressure and left ventricular (LV) diastolic pressure
c) Pulmonary artery (PA) systolic pressure
d) Systemic vascular resistance

A

b) Left atrium (LA) pressure and left ventricular (LV) diastolic pressure

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19
Q

Which of the following is NOT directly measured during right heart catheterization?
a) Ventricular preload
b) Ventricular afterload
c) Cardiac output
d) Coronary artery pressure

A

d) Coronary artery pressure

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20
Q

What type of disorders can be evaluated using data from right heart catheterization?
a) Intracardiac shunts, cardiomyopathy, valvular disease
b) Stroke, aneurysm, arterial stenosis
c) Coronary artery disease only
d) Atrial fibrillation exclusively

A

a) Intracardiac shunts, cardiomyopathy, valvular disease

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21
Q

What should be assessed by vascular ultrasound before starting the right heart catheterization procedure?
a) The patient’s blood pressure
b) The patency of the access vein
c) The size of the heart chambers
d) The patient’s lung function

A

b) The patency of the access vein

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22
Q

Which technique is used to insert the venous sheath during right heart catheterization?
a) Direct surgical incision
b) Fluoroscopic imaging
c) Modified Seldinger technique
d) Contrast angiography

A

c) Modified Seldinger technique

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23
Q

How is the PA catheter advanced through the heart chambers?
a) By manually guiding it with surgical instruments
b) By direct fluoroscopic visualization or pressure monitoring
c) By using magnetic navigation
d) By inflating a stent to create a passage

A

b) By direct fluoroscopic visualization or pressure monitoring

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24
Q

What does the pulmonary capillary wedge pressure (PCWP) indicate when measured?
a) Right ventricular pressure
b) Pulmonary artery systolic pressure
c) Left atrial and left ventricular diastolic pressure
d) Systemic arterial pressure

A

c) Left atrial and left ventricular diastolic pressure

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25
Q

After recording the PCWP, what is the next step with the PA catheter?
a) Advance it further into the pulmonary vein
b) Deflate the balloon and withdraw it into the proximal pulmonary artery
c) Leave the balloon inflated to continue measuring pressure
d) Inflate the balloon more to increase blood flow

A

b) Deflate the balloon and withdraw it into the proximal pulmonary artery

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26
Q

What measurement is used to assess RV preload during right heart catheterization?
a) Pulmonary artery pressure
b) Right atrial (RA) pressure
c) Left ventricular pressure
d) Cardiac output

A

b) Right atrial (RA) pressure

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27
Q

Which disorder can be evaluated using the hemodynamic data collected from right heart catheterization?
a) Kidney failure
b) Stroke
c) Cardiomyopathy
d) Peripheral artery disease

A

c) Cardiomyopathy

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28
Q

What does the term “ventricular afterload” refer to in right heart catheterization measurements?
a) The pressure needed to fill the ventricles during diastole
b) The resistance the ventricles must overcome to pump blood
c) The pressure in the pulmonary veins
d) The amount of blood returning to the heart

A

b) The resistance the ventricles must overcome to pump blood

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29
Q

What pressures can be directly measured with the PA catheter?
a) Left atrium and aortic pressure
b) Vena cavae, right atrium (RA), right ventricle (RV), pulmonary artery (PA), and pulmonary capillary wedge pressure (PCWP)
c) Pulmonary veins and left ventricular pressure
d) Systemic arterial pressure and central venous pressure (CVP)

A

b) Vena cavae, right atrium (RA), right ventricle (RV), pulmonary artery (PA), and pulmonary capillary wedge pressure (PCWP)

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30
Q

Which method is used to calculate cardiac output (CO) by injecting a cooler substance through the PA catheter?
a) Fick method
b) Thermodilution method
c) Pulse oximetry
d) Doppler ultrasound

A

b) Thermodilution method

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31
Q

What principle, first described by Adolph Fick, is used to determine pulmonary blood flow?
a) Poiseuille’s law
b) Bernoulli’s principle
c) Fick principle
d) Boyle’s law

A

c) Fick principle

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32
Q

How is cardiac index (CI) calculated?
a) CI = CO × BSA
b) CI = CO/BSA
c) CI = (MAP − CVP)/CO
d) CI = SVR × BSA

A

b) CI = CO/BSA

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33
Q

Which tool can be used to directly measure oxygen consumption when calculating CO with the Fick method?
a) Arterial blood gas analyzer
b) Water’s hood or a metabolic cart
c) Pulse oximeter
d) CT angiography

A

b) Water’s hood or a metabolic cart

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34
Q

What is the formula for systemic vascular resistance (SVR)?
a) SVR = (MAP − CVP)/(CO × 80)
b) SVR = (PCWP − PA pressure)/CO
c) SVR = (CO × CVP)/BSA
d) SVR = MAP/CO

A

a) SVR = (MAP − CVP)/(CO × 80)

35
Q

What value is substituted for (MAP − CVP) in the pulmonary vascular resistance (PVR) equation?
a) (PCWP − right atrial pressure)
b) (Mean PA pressure − PCWP)
c) (RV pressure − mean PA pressure)
d) (RA pressure − RV pressure)

A

b) (Mean PA pressure − PCWP)

36
Q

What is the purpose of the correction factor of 80 in the calculation of SVR and PVR?
a) To adjust for body mass index (BMI)
b) To convert units to dynes/s/cm^5
c) To adjust for temperature variations
d) To normalize oxygen consumption

A

b) To convert units to dynes/s/cm^5

37
Q

Which of the following is NOT a category of potential complications from right heart catheterization?
a) Complications associated with central venous access
b) Complications related to misinterpretation of acquired data
c) Complications from allergic reactions to saline
d) PA catheter–associated complications

A

c) Complications from allergic reactions to saline

38
Q

What is the most common type of rhythm disturbance caused by advancing the PA catheter through the right heart chambers?
a) Atrial fibrillation
b) Atrial and ventricular arrhythmias or complete heart block
c) Ventricular fibrillation
d) Supraventricular tachycardia

A

b) Atrial and ventricular arrhythmias or complete heart block

39
Q

What specific condition can develop in patients with preexisting left bundle branch block during PA catheterization?
a) Pulmonary embolism
b) Right bundle branch block leading to complete heart block
c) Aortic dissection
d) Systemic hypertension

A

b) Right bundle branch block leading to complete heart block

40
Q

What should be readily available when performing a PA catheterization on a patient with a left bundle branch block?
a) Defibrillator
b) Temporary pacing capabilities
c) Extra saline for thermodilution
d) Additional PA catheters

A

b) Temporary pacing capabilities

41
Q

Which complication is associated with the highest mortality rate during PA catheterization?
a) Pulmonary embolism
b) PA rupture due to balloon overinflation or trauma
c) Catheter-associated infection
d) Endocarditis

A

b) PA rupture due to balloon overinflation or trauma

42
Q

In which patient population is PA rupture most commonly seen?
a) Patients with systemic hypertension
b) Patients with pulmonary artery hypertension
c) Patients with chronic kidney disease
d) Patients with coronary artery disease

A

b) Patients with pulmonary artery hypertension

43
Q

What factor increases the risk of pulmonary infarction during PA catheterization?
a) Prolonged balloon inflation in a PA branch
b) Use of a larger catheter than recommended
c) Delayed recording of the pressure waveform
d) Rapid advancement of the catheter

A

a) Prolonged balloon inflation in a PA branch

44
Q

Which of the following is NOT a factor increasing the risk of PA rupture?
a) Female sex
b) Frequent wedging of the balloon
c) Advanced age
d) Use of the Fick method to measure cardiac output

A

d) Use of the Fick method to measure cardiac output

45
Q

What procedure is left heart catheterization often performed in conjunction with?
a) Coronary angiography
b) Echocardiography
c) MRI
d) Endoscopy

A

a) Coronary angiography

46
Q

Which of the following is NOT a common indication for left heart catheterization?
a) Evaluation of LV systolic function
b) Detection of aortic stenosis or mitral regurgitation
c) Diagnosis of systemic hypertension
d) Investigation of intracardiac shunts like ventricular septal defects

A

c) Diagnosis of systemic hypertension

47
Q

Which of the following is an absolute contraindication for left heart catheterization?
a) Severe peripheral vascular disease
b) Pregnancy
c) Known or suspected left ventricular thrombus
d) Active infection

A

c) Known or suspected left ventricular thrombus

48
Q

Which type of patient refusal is an absolute contraindication to left heart catheterization?
a) Refusal to follow preoperative instructions
b) Refusal to cooperate during the procedure
c) Refusal to consent to the procedure
d) Refusal to stay in bed post-procedure

A

c) Refusal to consent to the procedure

49
Q

Which of the following is a relative contraindication for left heart catheterization?
a) Mechanical prosthetic aortic valves
b) Severe thrombocytopenia
c) LV systolic dysfunction
d) Ventricular septal defects

A

b) Severe thrombocytopenia

50
Q

Left heart catheterization is often performed to assess which of the following conditions?
a) Pulmonary artery hypertension
b) Cardiomyopathy
c) Tricuspid regurgitation
d) Systemic venous pressure

A

b) Cardiomyopathy

51
Q

Which valvular disease might be evaluated through left heart catheterization?
a) Mitral regurgitation
b) Tricuspid stenosis
c) Pulmonary stenosis
d) Atrial septal defect

A

a) Mitral regurgitation

52
Q

What condition is a contraindication to left heart catheterization due to the risk of embolism?
a) Severe coagulopathy
b) Severe thrombocytopenia
c) Known left ventricular thrombus
d) Peripheral vascular disease

A

c) Known left ventricular thrombus

53
Q

Where is left heart catheterization typically performed?
a) Operating room
b) Intensive care unit
c) Cardiac catheterization laboratory
d) Emergency department

A

c) Cardiac catheterization laboratory

54
Q

Which artery is NOT mentioned as a possible access site for arterial access during left heart catheterization?
a) Common femoral artery
b) Brachial artery
c) Radial artery
d) Subclavian artery

A

d) Subclavian artery

55
Q

What is the standard size of the guidewire used for left heart catheterization?
a) 0.025-inch
b) 0.035-inch
c) 0.040-inch
d) 0.050-inch

A

b) 0.035-inch

56
Q

Which catheter is commonly used for left heart catheterization and requires a technique to cross the aortic valve?
a) Pigtail catheter
b) Swan-Ganz catheter
c) Right heart catheter
d) Umbrella catheter

A

a) Pigtail catheter

57
Q

How should a pigtail catheter be positioned before crossing the aortic valve?
a) Straightened
b) Rotated to resemble a “6”
c) Curved in a U-shape
d) Angled downward

A

b) Rotated to resemble a “6”

58
Q

What is the recommended projection for the radiographic view when crossing the aortic valve?
a) Left lateral view
b) Anterior-posterior (AP) view
c) Right anterior oblique (RAO) projection
d) Lateral view

A

c) Right anterior oblique (RAO) projection

59
Q

After crossing the aortic valve, where should the distal end of the catheter be positioned?
a) Near the aortic arch
b) In the ascending aorta
c) In the mid-cavity of the left ventricle (LV)
d) At the entrance of the coronary arteries

A

c) In the mid-cavity of the left ventricle (LV)

60
Q

What specific pressures are typically noted after the catheter is connected to the pressure transducer?
a) Aortic systolic pressure and mean arterial pressure
b) LV peak systolic pressure and LV end-diastolic pressure
c) Pulmonary artery pressure and right atrial pressure
d) Central venous pressure and systemic vascular resistance

A

b) LV peak systolic pressure and LV end-diastolic pressure

61
Q

What is one of the main uses of left heart catheterization regarding the left ventricle (LV)?
a) To assess cardiac valve morphology
b) To determine the presence and etiology of an LV outflow tract pressure gradient
c) To evaluate coronary artery disease
d) To measure systemic vascular resistance

A

b) To determine the presence and etiology of an LV outflow tract pressure gradient

62
Q

What can cause a pressure difference between the LV apex and the aorta?
a) Ventricular dilation
b) Fixed obstruction at the subvalvular, valvular, or supravalvular level
c) Decreased contractility of the left ventricle
d) Increased left atrial pressure

A

b) Fixed obstruction at the subvalvular, valvular, or supravalvular level

63
Q

Which of the following conditions can lead to dynamic obstruction of the LV outflow tract?
a) Aortic regurgitation
b) Hypertrophic obstructive cardiomyopathy
c) Mitral valve prolapse
d) Dilated cardiomyopathy

A

b) Hypertrophic obstructive cardiomyopathy

64
Q

How can a pressure gradient between the LV and the aorta be measured?
a) Only through echocardiography
b) By using a “pullback” method across the aortic valve
c) By magnetic resonance imaging (MRI)
d) By using an electrocardiogram (ECG)

A

b) By using a “pullback” method across the aortic valve

65
Q

In which method is femoral arterial pressure used as a surrogate for aortic pressure?
a) Dual-lumen catheter measurement
b) Simultaneous LV and femoral arterial pressure recording
c) Pullback method
d) Doppler ultrasound measurement

A

b) Simultaneous LV and femoral arterial pressure recording

66
Q

What does a decrease in pressure indicate when retracting an end-hole catheter from the LV apex?
a) Improved cardiac output
b) Location of the obstruction
c) Increased heart rate
d) Decreased preload

A

b) Location of the obstruction

67
Q

Which maneuver can provoke dynamic LV outflow tract obstruction?
a) Deep breathing exercises
b) Valsalva maneuver
c) Standing up quickly
d) Holding one’s breath

A

b) Valsalva maneuver

68
Q

What type of medication might be administered to increase contractility and provoke dynamic LV outflow tract obstruction?
a) Beta-blockers
b) Isoproterenol infusion
c) Anticoagulants
d) Diuretics

A

b) Isoproterenol infusion

69
Q

What is the primary purpose of left ventriculography?
a) To measure systemic vascular resistance
b) To estimate the LV ejection fraction and assess mitral regurgitation
c) To evaluate right ventricular function
d) To assess coronary artery blockages

A

b) To estimate the LV ejection fraction and assess mitral regurgitation

70
Q

Which imaging technique is used for left ventriculography?
a) Ultrasound
b) Computed tomography (CT)
c) Cineradiography
d) Magnetic resonance imaging (MRI)

A

c) Cineradiography

71
Q

Which imaging technique is used for left ventriculography?
a) Ultrasound
b) Computed tomography (CT)
c) Cineradiography
d) Magnetic resonance imaging (MRI)

A

c) Cineradiography

72
Q

What are the typical angiographic views for left ventriculography?
a) Anterior-posterior (AP) and lateral views
b) Right anterior oblique (RAO) and left anterior oblique (LAO) projections
c) Transverse and sagittal views
d) Coronal and axial views

A

b) Right anterior oblique (RAO) and left anterior oblique (LAO) projections

73
Q

Which projection provides the best visualization of the septal, lateral, and posterior walls of the LV?
a) Right anterior oblique (RAO) projection
b) Left anterior oblique (LAO) projection
c) Anterior-posterior (AP) projection
d) Lateral projection

A

b) Left anterior oblique (LAO) projection

74
Q

How is mitral regurgitation quantified during left ventriculography?
a) By measuring the size of the left ventricle
b) By observing the degree of opacification of the left atrium relative to the LV
c) By assessing heart rate variability
d) By examining wall motion abnormalities

A

b) By observing the degree of opacification of the left atrium relative to the LV

75
Q

What grade of mitral regurgitation indicates that the left atrium (LA) is faintly opacified and is not cleared by a single heartbeat?
a) 1+
b) 2+
c) 3+
d) 4+

A

b) 2+

76
Q

4+ mitral regurgitation, what additional observation can be made regarding the contrast?
a) Contrast does not fill the left atrium
b) Contrast can be seen filling the pulmonary veins
c) Contrast clears from the left atrium after several beats
d) Contrast is only visible in the left ventricle

A

b) Contrast can be seen filling the pulmonary veins

77
Q

What is indicated by a 3+ grade of mitral regurgitation?
a) The LA is completely opacified, and the opacification equals that of the LV
b) The LA is faintly opacified but clears with every heartbeat
c) The LA is not opacified at all
d) The LA is completely opacified in a single heartbeat

A

a) The LA is completely opacified, and the opacification equals that of the LV

78
Q

PCWP

A

pulmonary capillary wedge pressure

79
Q

EF

A

Ejection Fraction

80
Q

LVEDP

A

Left-ventricular end diastolic pressure

81
Q

MR

A

Mitral regurgitation

82
Q

PVC

A

Premature ventricular contraction

83
Q

SVR

A

Systemic Vascular resistance

MSRS 6310 (11 decks)

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