Right And Left Heart Pt 2

Question 1

Right heart cath or left heart cath?

•Management of cardiogenic shock following acute MI

Answer 1

Right heart cath

Question 2

Mitral stenosis

Answer 2

Increased LA pressure (PCWP) with a gradient between the LA (PCWP) and the LV (LVEDP) that persists throughout diastole.

Question 3

Mitral regurgitation

Answer 3

Acute MR: elevated PCWP, elevated PA pressure, prominent v wave, hyperdynamic LV function; hemodynamics can mimic constrictive pericarditis.

Question 4

Restrictive cardiomyopathy

Answer 4

PA systolic pressure may be >50 mm Hg, RV/LV systolic pressure concordant, RVEDP/LVEDP separation >5 mm Hg, pronounced y descent.

Question 5

Constrictive pericarditis

Answer 5

Elevated RA pressure, elevated PCWP, PA systolic pressure usually <50 mm Hg, RV/LV systolic pressure discordant, RVEDP/LVEDP separation <5 mm Hg.

Question 6

Cardiac tamponade

Answer 6

Elevated diastolic pressures and equalization of end-diastolic pressures, x descent preserved or prominent and y descent small or absent on RA pressure.

Question 7

Dilated cardiomyopathy

Answer 7

Right and left heart filling pressures typically elevated, decreased CO and index, decreased mixed venous oxygen saturation, pulsus alternans.

Question 8

Hypertrophic obstructive cardiomyopathy

Answer 8

Spike and dome arterial pulse, systolic intraventricular pressure gradient, elevated LVEDP, Brockenbrough sign.

Question 9

Aortic stenosis

Answer 9

Pressure gradient between the LV and aorta, elevated LVEDP, elevated PCWP, elevated PA pressures as resultant heart failure progresses.

Question 10

Aortic insufficiency

Answer 10

Wide pulse pressure, low aortic diastolic pressure, elevated LVEDP; in severe aortic insufficiency, the LV and aortic pressures will be equal.

Question 11

Which technique is used to insert the venous sheath during right heart catheterization?

Answer 11

Modified Seldinger technique

Question 12

How is the PA catheter advanced through the heart chambers?

Answer 12

By direct fluoroscopic visualization or pressure monitoring

Question 13

What does the pulmonary capillary wedge pressure (PCWP) indicate when measured?

Answer 13

Left atrial and left ventricular diastolic pressure

Question 14

After recording the PCWP, what is the next step with the PA catheter?

Answer 14

Deflate the balloon and withdraw it into the proximal pulmonary artery

Question 15

What measurement is used to assess RV preload during right heart catheterization?

Answer 15

Right atrial (RA) pressure

Question 16

Which disorder can be evaluated using the hemodynamic data collected from right heart catheterization?

Answer 16

Cardiomyopathy

Question 17

What does the term ‘ventricular afterload’ refer to in right heart catheterization measurements?

Answer 17

The resistance the ventricles must overcome to pump blood

Question 18

Clinical Situation: Vasodilatory Shock, leads to what catheterization findings?

Answer 18

Elevated CO, decreased SVR, decreased PCWP

Question 19

Clinical Situation: Cardiogenic Shock, leads to what catheterization findings?

Answer 19

Decreased CO, increased SVR, increased PCWP

Question 20

Right heart or Left heart cath?

Diagnosis of RV ischemia during MI

Answer 20

Right heart

Question 21

Right or left?

Answer 21

Diagnosis of