CCI Invasive Catheterization Procedures 4 — Questions and Answers
Question 1: What is the 'pullback' technique used for during hemodynamic assessment of aortic stenosis?
- Measuring LVEDP while withdrawing from LV to aorta
- Withdrawing the catheter from the pulmonary artery to the right ventricle to measure pulmonic gradient
- Measuring the pressure gradient across the aortic valve as the catheter is pulled from the LV to the ascending aorta (Correct answer)
- Assessing mitral valve gradient during withdrawal from PCWP to PA
Correct answer: Measuring the pressure gradient across the aortic valve as the catheter is pulled from the LV to the ascending aorta
The pullback technique records the pressure gradient across the aortic valve by continuously recording pressure as the catheter is withdrawn from the LV into the ascending aorta.
Question 2: Which of the following correctly identifies the 'v wave' on the pulmonary capillary wedge pressure tracing?
- Atrial contraction during late diastole
- Passive ventricular filling of the left atrium during ventricular systole with mitral valve closed (Correct answer)
- Opening of the mitral valve at end-systole
- Right ventricular end-diastolic pressure
Correct answer: Passive ventricular filling of the left atrium during ventricular systole with mitral valve closed
The v wave represents passive filling of the left atrium during ventricular systole while the mitral valve is closed; a large v wave suggests mitral regurgitation.
Question 3: What is the recommended anticoagulation regimen during a diagnostic-only left heart catheterization via the femoral approach?
- No heparin is required for diagnostic catheterization alone (Correct answer)
- Heparin 5,000 units IV bolus mandatory for all cases
- Bivalirudin 0.75 mg/kg IV bolus
- Enoxaparin 1 mg/kg subcutaneous injection
Correct answer: No heparin is required for diagnostic catheterization alone
Routine anticoagulation is generally not required for diagnostic-only coronary angiography; heparin is added if the procedure converts to an interventional case.
Question 4: A patient has a measured Qp:Qs ratio of 2.5:1. How should this be interpreted?
- No significant shunt is present
- A right-to-left shunt with pulmonary blood flow reduced by 2.5 times
- A left-to-right shunt with pulmonary blood flow 2.5 times systemic flow (Correct answer)
- Pulmonary hypertension with elevated PVR
Correct answer: A left-to-right shunt with pulmonary blood flow 2.5 times systemic flow
A Qp:Qs ratio of 2.5:1 indicates a significant left-to-right shunt where pulmonary blood flow is 2.5 times systemic blood flow, typically warranting intervention.
Question 5: What is the primary advantage of using isosmolar contrast media (e.g., iodixanol) over low-osmolar contrast media during cardiac catheterization?
- Superior image quality due to higher iodine concentration
- Reduced nephrotoxicity in high-risk patients with chronic kidney disease (Correct answer)
- Faster injection rates possible due to lower viscosity
- Lower cost making it preferred for routine cases
Correct answer: Reduced nephrotoxicity in high-risk patients with chronic kidney disease
Isosmolar contrast agents like iodixanol have the lowest nephrotoxic potential, making them preferred in patients with pre-existing chronic kidney disease or high contrast-induced nephropathy risk.
Question 6: During coronary angiography, the left anterior descending artery is best visualized in which projection to assess the mid-vessel without foreshortening?
- RAO caudal (spider view)
- LAO cranial (spider view)
- RAO cranial projection (Correct answer)
- AP cranial projection
Correct answer: RAO cranial projection
The RAO cranial projection optimally profiles the mid-LAD by elongating the vessel and separating it from overlapping diagonal branches.
Question 7: What hemodynamic pattern is characteristic of cardiac tamponade?
- Elevated and equalized diastolic pressures in all four cardiac chambers (Correct answer)
- Elevated LVEDP with normal RAP
- Low PAP with elevated PCWP
- Decreased RAP with elevated systolic PAP
Correct answer: Elevated and equalized diastolic pressures in all four cardiac chambers
Cardiac tamponade causes equalization of diastolic pressures (RAP = RV diastolic = PAD = PCWP) due to extrinsic pericardial compression restricting all chambers equally.
CCI Invasive Catheterization Procedures 4
What is the 'pullback' technique used for during hemodynamic assessment of aortic stenosis?