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RCES self assessment > Wes Todd Questions > Flashcards

Wes Todd Questions Flashcards

1
Q

Define: Disinfect

A

Destroy most pathogens on instruments. Un-safe for living tissues

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2
Q

Define: Bacteriostatic

A

Inhibits or stops the growth of bacteria (-static = hold steady)

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3
Q

Define: Antiseptic

A

Destroy most pathogens on living tissue, safe to use on skin

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4
Q

Define: Sterilize

A

Destroys all microorganisms

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5
Q

Define: Aseptic

A

Destroys all pathogens (-sepsis = infection)

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6
Q

A patient with AF is scheduled for PVI; he is NPH-insulin dependent. what specific precautions should be taken?

A

Avoid reversing heparin with protamine

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7
Q

What is the normal electrolyte lab value for K?

A

3.5 - 5.5

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8
Q

What is the normal electrolyte lab value for Platelets?

A

> 80 000

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9
Q

What is the normal electrolyte lab value for INR?

A

< 1.5

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10
Q

What is the normal electrolyte lab value for WBC?

A

< 12 000

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11
Q

What is the normal electrolyte lab value for Na?

A

135 - 145

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12
Q

What is the normal electrolyte lab value for Cl?

A

95 - 105

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13
Q

What is the normal electrolyte lab value for Ca?

A

0.8 - 1.0

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14
Q

What is the normal electrolyte lab value for Mg?

A

1.5 -2.1

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15
Q

Grossman and Peterson state, what is the most important factor in reducing complication rates invasive procedures?

A

Meticulous attention to details of technique

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16
Q

What is the only absolute contraindication to a PVI ablation procedure for AF?

A

Atrial thrombus on TEE

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17
Q

A major complication of pericardial centesis is the needle puncturing the heart, and its vessels. What part of the heart is least likely and least dangerous complication due to needle puncture?

A

LV (due to thick cardiac muscle)

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18
Q

In an electrical injury, what is the pathway of current most likely to be fatal?

A

hand to hand

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19
Q

What is the term for when the heart is insensitive to stimuli and cannot be depolarized by stimulation (such as pacing)?

A

Refractory

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20
Q

The sympathetic nervous system stimulation of the heart primarily affects the heart rate by altering what phase of the SA node action potential?

A

Phase 4

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21
Q

What ion concerning the transfer across the myocardial cell membrane happens throughout systole?

A

potassium leaks out and calcium seeps in

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22
Q

What part of the ventricular action potential is the “resting” membrane potential?

A

phase 4

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23
Q

What is the trans-membrane potential when a purkinje cell is in the resting state?

A

Polarized and negatively charged

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24
Q

Compared to a myocardial cell - SA node cells are prone to a faster _________ because of their steeper phase ___________.

A

Automaticity, phase 4

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25
Q

The SA and AV node depol come through what channels?

A

Slow Ca ++ channel

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26
Q

What cardiac tissue has the fastest electrical conduction velocity?

A

Purkinje Fibers

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27
Q

Sympathetic nervous stimulation of the heart primarily affects the rate by altering what phase of the SA node action potential?

A

Phase 4

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28
Q

Concerning ion transfer, what crosses the myocardial cell membranes throughout systole?

A

potassium leaks out

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29
Q

What is the trans-membrane potential when a Purkinje cell is in the resting state?

A

It is Polarized and negatively charged inside

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30
Q

The plateau phase of the ventricular action potential occurs on the surface ECG during ________ and during mechanical ___________.

A

QT interval and systole

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31
Q

Which two cardiac tissues have a slow phase 0 action potential and thus a slow conduction velocity?

A

SA nose and AV node

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32
Q

What is the response of cardiac tissues paced during the relative refractory period?

A

Requires higher mA but create a weaker contraction

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33
Q

What causes fractionated electrograms?

A

Nonuniform anisotropy (zigzag conduction)

Anistropy is the property where conduction is nonuniform, as opposed to to isotropy, which is normal concentric conduction in all directions.

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34
Q

What is the term for the pause after rapid atrial pacing is ceased?

A

Over drive suppression

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35
Q

Most arrhythmias in the EP lab are cause by what mechanism?

A

Re-entry

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36
Q

The “triggered” mechanism may cause an arrhythmia. Triggered arrhythmias are often associated with digitalis toxicity or elevated interventricular Ca++ levels. What mechanism causes triggered arrhythmias?

A

after-depolarization

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37
Q

How is the interval for the intra-atrial conduction time measured?

A

“P” wave to the “A” wave

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38
Q

If there is a prolonged HV where would we suspect the block?

A

infra-hisian block

more severe than a supra-hisian block

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39
Q

What 3 segments make up the PR interval?

A

PA, AH and HV

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40
Q

A HIS bundle electrogram has the following measurements: AH = 160 ms, HV = 40 ms and QRS = 180 ms. What is the diagnosis?

A

Supra-hisian, 1st degree AVB

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41
Q

In measuring EGMs, the earliest recorded atrial activation is almost always taken from the ____ while the earliest recorded ventricular activation is almost always taken from the _____.

A

Surface P wave, surface QRS complex

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42
Q

What is the term for when a V wave appears on the RA electrode?

A

Far field sensing

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43
Q

What information does the “stim” channel contain?

A

pacing output

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44
Q

Define: Incremental pacing (decremental)

A

pacing at a constant cycle length slightly shorter than the patient’s spontaneous rhythm then decreasing the cycle length ( or increasing pacing rate) by small steps

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45
Q

Define: Burst pacing

A

pacing at a fixed cycle length

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46
Q

Define: Pace mapping

A

a mapping technique designed to help locate the tachycardia focus by paving at different endocardial sites an comparing the characteristics/morphology of the paced beat to the reference beat. The reference beat is an ECG recorded during the clinical tachycardia.

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47
Q

Define: Entrainment mapping

A

Pacing at a cycle length slightly shorter than the tachycardia. If post pacing interval is short then the catheter is in the reentry circuit.

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48
Q

Define: Extrastimulus Testing

A

Drive train of typically 8 beats followed by 1, 2 or 3 premature beats. (S1, S1, S1……. S2, S3)

49
Q

Define: ATP

A

Anti Tachycardic Pacing - pacing the heart faster than its intrinsic heart rate. Used for VT

50
Q

What is the most common type of reentrant tachycardia?

A

AVNRT

51
Q

Define: Macro reetrant

A

A circuit including the atrium, AV node, His/Purkinje system, ventricle and accessory pathway

52
Q

Define: Antedromic pathway

A

down accessory pathway (AP), up the node (AV node)

53
Q

Define: Orthodromic pathway

A

down node (AV), up accessory pathway (AP)

54
Q

What is the most common SVT?

A

Atrial fibrillation

55
Q

What is the most common type of A. flutter?

A

right atrium with counterclockwise propagation

56
Q

What kind of reentry tachycardia is A. Flutter?

A

Macro reentry

57
Q

What two conditions are associated with A. Fib?

A

hypertension and mitral regurgitation

58
Q

What are the types of A. Fib?

A

Spontaneous or persistent

59
Q

After being used in a patient, what type of catheters are considered “single use devices” and may be re-sterilized by 3rd party reproccesor companies and then reused on other patients?

A

Diagnostic EP catheters

because they have no lumen

60
Q

What French size is a catheter with an outer diameter of 2.66mm?

A

8F

61
Q

When using a 5F selective catheter through a 90 cm 5F sheath in cardiovascular procedures; it will be almost impossible to ______.

A

Flush the sheath because it is too tight

62
Q

What mapping catheter uses 64 electrodes on eight self expanding splines as shown on x-ray?

A

basket catheter

63
Q

What are the steerable catheters with handles and large platinum tips designed for?

A

radiofrequency ablations

64
Q

What is the Hansen Robotic system?

A

Remotely steers guider catheters

65
Q

What does the Ensite Velocity contact mapping system utilize?

A

Electrical impedance mapping

66
Q

What does the Ensite non-contact mapping balloon catheter do with each heart beat?

A

Acquires all EGMs in one heart beat

67
Q

What do closely spaced bipolar cardiac electrodes record locally?

A

Depolarization only (phase 0)

68
Q

What should the ECG be filtered at?

A

0.1 - 100 Hz

69
Q

What is the normal EGM filter settings for bipolar EP catheters?

A

30 - 300 Hz

70
Q

If large T waves in an electrogram interfere with A or V wave recognition, what should you do?

A

Raise the high-pass filter

71
Q

When filtering an EGM, a low pass filter setting of 500 would mean what?

A

Frequencies above 500 Hz will be eliminated

72
Q

When a mapping catheter is guided to the site of origin of a focal tachycardia its distal bipolar EGM records the earliest intrinsic presystolic deflection. To confirm the focus, switch your mapping catheter to ____ and look for a ____.

A

Unipolar (filter settings 30 - 300 Hz), positive QR of R deflection

73
Q

In general what is the longest amount of time a standard diagnostic guide wire should be used in the body before it is removed and carefully wiped with a heparinized gauze?

A

3 min

74
Q

What are the standard equipment sizes of micropuncture introducer sets?

A

21-gauge needle, .018 inch wire

75
Q

Compared to bipolar pacemakers the unipolar electrode configuration is more prone to what?

A

Pectoralis muscle stimulation and oversensing of EMI and muscle artifacts

76
Q

Compared to the PPM, what does a TVP have considering voltage?

A

constant voltage and generates up to 20 volts

77
Q

When connecting a bipolar pacing lead to the PSA or pulse generator the distal electrode should be connected to the __________ terminal.

A

black active negative

78
Q

The 1st extrastimuli after a pulse train is labeled what?

A

S2

79
Q

What are the two types of programmable paced beats?

A

Extrastimuli and incremental

80
Q

A pulse train of 8 paced beats with a fixed cycle length is termed as what?

A

incremental pacing

81
Q

When using the auto-decrement feature on a stimulator, what does a pause of 2000 indicate?

A

2 sec delay between drivetrains

82
Q

The new RF transseptal needle that may be used to puncture a fibrotic or aneurysmal atrial septum has what feature?

A

side holes for pressure and contrast

83
Q

In cardiovascular Doppler, what is the usual target off of which the ultrasound waves are reflected back?

A

RBC

84
Q

What type of ultrasound test is the best way to rule out atrial thrombi prior to PVI?

A

TEE

85
Q

What is a major advantage to using intracardiac echocardiography over a TEE?

A

General anesthesia is not needed

86
Q

What does intracardiac echocardiography use as an injectable agent to view shunts or distinguish the right heart from the left heart chambers?

A

agitated saline (bubble study)

87
Q

What type of ablation method is best suited for AVNRT slow path ablation?

A

RF

88
Q

What type of ablation method is best suited for PVI for AF?

A

Cryoballoon

89
Q

What type of ablation method is best suited for AFL cavo-tricuspid isthmus ablation?

A

Irrigated RF

90
Q

What type of ablation method is best suited for AP near the AV node or in CS?

A

Cryocatheter

91
Q

During RF ablation, what mode of heating is responsible for increasing the temperature of the ablation electrode and the closest 1-2mm of tissue?

A

Resistive heating

92
Q

During RF ablation, what type of heating increases the temperature of the deeper tissue 2-5 mm beneath the electrode?

A

conductive heating

93
Q

Using irrigated RF ablation catheter, how much power will be lost to passing blood if only half of the eletcrodes is in contact with the tissue?

A

more than half the power will be lost

94
Q

What is the main mechanism of RF ablation?

A

tissue heating (burning)

95
Q

With standard saline closed irrigated tip ablation catheters, what should be done to avoid endocardial burning and char formation when more than 30 watts are being delivered?

A

increase the flow to 15 - 30 ml/min

96
Q

What type of pump is usually used with cooled or open irrigated ablation catheters?

A

Peristaltic (roller)

97
Q

What is the cryoablation balloon for PVI inflated with?

A

N2O (Nitrous Oxide), the same a cryoablation

98
Q

The cryoballoon (artic front) has 2 balloons one inside and one out. What is the reasoning for this?

A

Inflated with N2O and the other is to detect any leaks in the other balloon

99
Q

How should you prep the cryo balloon prior to use?

A

Never pull the balloon sheath off the catheter

100
Q

What size sheath does the artic frost catheter require?

A

12F

101
Q

At what temperature and for how long is cryomapping performed?

A

-30 C for <60 sec

102
Q

In cryoablation, when is the formation of an ice ball at the catheter tip and adherence to the myocardium is indicated?

A

Distal electrodes show electrical noise

103
Q

Which valves are open during ventricular systole?

A

Semilunar valves

104
Q

Where is the fibrous skeleton of the heart or annuli fibrosis located?

A

Around the heart valves

105
Q

Where is the CS os located?

A

Posterior to the tricuspid valve

106
Q

Where is the fossa ovale located?

A

Superior - posterior to the CS os

107
Q

Where is the crista terminalis located?

A

Anterior to the IVC

108
Q

What is the valve over the CS ostium that may interfere with the placement of the CS catheter?

A

Thebesian valve

109
Q

To record the earliest depolarization from the SA node, where should you position the EP electrode?

A

Near the RA high lateral wall near the junction of the SVC

110
Q

What does Bachman’s bundle connect?

A

RA - LA

111
Q

The SA node lies at the junction of the SVC and the _______.

A

Superior end of crista terminalis

112
Q

The SA node is innervated with which fibers of the autonomic nervous system?

A

Sympathetic and parasympathetic

113
Q

The sides of the triangles of Koch are formed by the tricuspid annulus, the AV node, and what other boundary?

A

Tendon of todaro

114
Q

The superior border of the triangle of koch is the tendon of todaro and it normally contains which pathway?

A

AV node fast pathway

115
Q

Where are the pectinate muscles in the left atrium?

A

LA appendage

116
Q

The vena cavae have a smooth inner endothelial lining, but the RA is heavily pectinated. What RA structure separates smooth muscle from pectinated muscle?

A

Crista terminalis

117
Q

Most high-frequency depolarizations found in AF patients originate from where?

A

Muscular sleeve of the PVs

118
Q

What is the diaphragmatic surfrace of the LV called?

A

Inferior wall

RCES self assessment (11 decks)

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