Specialty Exams - Cardiac Catheterization

Question	Answer
Gold standard utilization for coronary arteries	Cardiac Cath
Where is the incision site for a cardiac cath?	Most commonly femoral junction; can utilize upper extremity arteries
Cardiac cath technique	Femoral incision made; guide wire inserted to the level of the aorta; catheter is inserted over guide wire; dye injected into coronary arteries; simultaneously X-rays are taken (fluoroscopy) to look for filling defects
True/False cardiac cath lab can be utilized to determine pressure curves and gradients of valves	True
Cardiac Cath Lab Technique for Left side with valve disease	Insertion same as coronary cath (into femoral artery) Catheter is placed into LV and pulled back into aorta to record pressure differences (AoV) Catheter is placed into LA and pulled back into LV to record MV pressure gradients
Cardiac Cath Lab techniques for Right side with Valve disease	Femoral Vein used to obtain pressure gradients in right side of heart Pulmonic valve: catheter is placed into PA and pulled back into RV for pressure gradients Tricuspid valve: catheter is placed into RV and pulled back into RA for gradients
What are the normal pressures for the heart?	With all valves open= all valves should be equal. If stenotic the pressures are checked prox and distal. ( the difference equals the gradients)
What type of gradients do cath labs use?	Peak to peak gradient
What do we use in the echo lab for pressure gradients?	Peak instantaneous or mean gradient
With a peak instantaneous gradient, what do you use to convert the max Doppler velocity?	Bernoulli's Equation
True/False Peak to peak pressure gradient usually exceeds peak instantaneous gradient.	False - peak instantaneous exceeds peak to peak
In the echo lab which gradient is the average of pressure gradients during the entire flow period?	Mean gradient
Mean Doppler and ________________ correlate the best!	Mean catheterization gradients
How does echo calculate mean?	By tracing V2
How does cath calculate mean gradient?	It averages maximum instantaneous pressure and peak to peak gradient
From the Cath lab ____________ is used to determine AoV area using mean pressure gradient and cardiac output	Gorlin Formula
Besides Gorlin's equation, what else will give us AoV area?	Echo, continuity equation
How close should the Gorlin equation and echo, continuity equation be in calculations of AoV area?	VERY CLOSE
With Cath assessment of mitral stenosis, pressure waveforms show what?	Elevated atrial pressures above ventricular pressure during DIASTOLIC filling
With mitral stenosis, MVA is determined by ______.	Gorlin's formula
How does cath assessment determine mitral stenosis?	By determining transvalvular diastolic gradient across MV (Hallmark finding)
How does cath lab determine mitral regurgitation?	By left ventriculography
With a cath lab assessment for mitral regurgitation, what do the pressure waveforms show?	Elevation in SYSTOLIC pressures into LA
What is left ventriculography?	Radiopaque dye (contrast) is injected into LV and amount of reflux into LA is graded (1+ to 4+)
What gradients are used in a cath lab assessment for Aortic stenosis?	Peak to Peak pressure gradient Mean transvalvular pressure gradient
AVA is determined by what formula?	Gorlin formula
In a cath lab assessment for aortic stenosis, pressure waveforms show what?	Systolic gradients between LV and aorta between 10-100mmHg
In a cath lab assessment for aortic regurgitation, how is the regurgitant volume determined?	By supravalvular aortography
What is supravalvular aortography?	Contrast injected above the AoV to evaluate for reversal of flow into the LV during diastole
In a cath lab assessment for aortic regurgitation, the pressure waveforms show what?	Elevation in end diastolic pressures and decreased end diatolic pressures of the AV
True/False: TVA is determined by the Gorlin formula	True
What do the pressure waveforms show with tricuspid stenosis?	Elevated atrial pressures above ventricular pressures during Diastolic filling
With tricuspid stenosis we will see an increased mean diastolic pressure gradient between which two chambers?	RA and RV (increases with inspiration)
How is tricuspid regurgitation determined?	By right ventriculography
With tricuspid regurgitation, pressure waveforms will show elevation where?	In systolic pressure in the LA or RA
Tricuspid regurgitation will show ____________ RA pressure and RV diastolic pressure	An increased
What do the pressure waveform show with pulmonary stenosis?	Systolic gradients between the RV and pulmonary artery between 10 and 100mmHg
With a pulmonary insufficiency, regurgitant volume is determined by ___________________	pulmonary angiography
With pulmonary insufficiency, demonstrated diastolic reflux in the RV during systole or diastole?	Diastole
What do the pressure waveforms show with pulmonary insufficiency?	Elevation in end diastolic RV pressures and decreased end diastolic pressures of the PV
When doing a cath assessment LV function, what functions are you looking at?	Global and Systolic
How do you assess LV function?	By left ventriculography
What are the 4 methods of determining cardiac output?	Thermodilution Indicator dilution Fick method Angiography
Which CO method measures the difference between end-diastolic and end-systolic volumes and multiplying it by heart rate	Angiography
Which CO method is an injection of chilled saline into RA. The difference in temperature measured in the PA is used to calculate CO	Thermodilution
Which CO method involves comparing the difference in O2 consumption/difference in O2 content between arterial and pulmonary system	Fick method
This rarely used method of determining CO is an injection of idocyanine green dye into the right side	Indicator dilution

Next up

Specialty Exams - Cardiac Catheterization

Description

Resource summary

Similar

	Created by ecmarchese about 10 years ago