vascular assessment

Question 1

• See extent & severity of cardiac dz in pt w/ symptoms (stable angina)
• Exclude severe pt in symptomatic pt w/ equivocal (ambiguous) findings on non-invasive studies
• See if medical, surgical, catheter interventions are needed
• Plan upcoming surgeries
• Intervene on known ischemic heart dz (STEMI or NSTEMI)

Answer 1

Indication for cardiac cath

Question 2

most common risk/complication of cardiac cath

Answer 2

access site bleeding

Question 3

these are risks of what procedure

• Arrhythmias
• acute renal failure
• vascular complications
• transient heart block
• contrast rxn

Answer 3

cardiac cath

Question 4

list some C/I to cardiac cath

Answer 4

• acute renal failure or severe chronic renal insufficiency
• decompensated CHF
• acute stroke
• acute GI bleeding
• severe uncorrected electrolyte issues
• hx of anaphylaxis to contrast
• hx of allergy/bronchospasm to aspirin in pt who need stent

Question 5

these are indications for what procedure

• Define coronary anatomy
• Determine extent of coronary artery & bypass graft dz
• Assess feasibility of therapy
• Investigation when non-invasive means are inadequate

Answer 5

coronary angiography

Question 6

this describes which procedure

inject contrast into R & L coronary ostia then radiographic images are recorded in real time

Answer 6

coronary angiography

Question 7

if pt getting cath has suspected CAD what must you do before hand

Answer 7

aspirin 325 mg

Question 8

if pt getting cath is likely to need PCI in the procedure, what must you do before hand

Answer 8

clopidogrel 600mg loading

Question 9

Goal INR pre cath

Answer 9

< 2; hold warfarin

Question 10

this describes what procedure

Catheter advanced under fluoroscopic guidance: femoral or jugular vein → RA→ RV→ pulmonary artery→ pulmonary wedge position (surrogate for LA pressure)

Answer 10

R heart catheterization

Question 11

what procedure

measure pressure, obtain blood samples for O2 saturation analysis, consider CO

Answer 11

R heart cath

Question 12

these are indications for what procedure

• Unexplained dyspnea
• Valvular heart dz, congenital heart dz
• Pericardial dz
• R/L Ventricular dysfunction
• Suspected intracardiac shunt

Answer 12

R heart cath

Question 13

Catheter advanced under fluoroscopic guidance: femoral, brachial or radial artery > Aorta > LV

Answer 13

L heart cath

Question 14

what procedure allows to measure pressures & evaluate function and structure of left side of heart

Answer 14

L heart cath

Question 15

diff between coronary angiogram and coronary CTA

Answer 15

coronary angiogram involves a catheter into the artery and area to be studied, a CT angiogram does not require catheter insertion

Question 16

• Contrast injected to visualize LV chamber
• Assess for wall motion abnormalities, aneurysm, pseudoaneurysm or diverticulum
• Can assess MVP & MR severity

Answer 16

ventriculography in L heart cath

Question 17

which procedure is better for

• Left MAIN dz
• 3 vessel dz in reduced LVEF or treated DM
• long lesions >35 mm/diffuse dz

Answer 17

CABG

Question 18

stent placement needs ____ or other anticlotting therapy

Answer 18

clopidogrel

Question 19

which type of stent has antiproliferative agent that prevents clotting on it

Answer 19

drug eluting stents (DES)

Question 20

in pt w/ mild or moderate stable sx (stable angina), ____ & ____ may be preferred initial strategy

Answer 20

aggressive lipid & antianginal therapy

Question 21

4 factors associated w/ restenosis after stents

Answer 21

• DM
• small luminar diameter
• more complex lesions
• lesion at coronary ostia or LAD

Question 22

what medication does everyone who gets a stent stay on for life? (2)

Answer 22

atorvastatin 80 mg or Rosuvastatin 20mg

high intensity statins

Question 23

minimum duration of dual platelet therapy for pt w/ BMS vs DES

Answer 23

• BMS– 1 month
• DES– 6-12 mo

Question 24

what meds are used in dual antiplatelet therapy after shunt placement?

Answer 24

clopidogrel + aspirin 325 mg

Question 25

if risk of bleeding is low after 12 mo of dual antiplatelet therapy from stent placement, how much longer do you keep them on it?

Answer 25

another 18-24 month (DAPT score)

Question 26

When combined w/ perfusion imaging, can provide assessment of the coronary arteries and the cardiac myocardium in one sitting

Answer 26

coronary CT

Question 27

useful when probability of severe CAD is low to r/o ACS/CAD in setting of chest pain
high sensitivity w/ limited specificity– many lesions that look obstructive on it are non-obstructive on coronary angiography

Answer 27

coronary CT

Question 28

Non ionizing radiation; high resolution dynamic images of myocardium & heart structures
can add gadolinium to help assess viability

Answer 28

cardiac MRI

Question 29

continuous ambulatory ECG monitoring for 24-48 hrs; used for daily sx of dizziness, syncope, near syncope, palpitations
also to detect silent preoperative ischemia

Answer 29

holter monitoring

Question 30

• Tests heart electrical conduction system to assess electrical activity and conduction pathway
• Used to investigate the cause, location of origin, and ideally tx various arrhythmias
• may ablate cells of origin in abnormal activity

Answer 30

electrophysiology study

Question 31

• evaluation/diagnosis of vasovagal syncope
• May include provoked vasodilation (w/ nitroglycerin)
• test ends when pt faints, develops other sx or specified time elapses

Answer 31

tilt table testing

Question 32

what is a positive table tilt test (2)

Answer 32

• having sx
• drop in BP or arrhythmia