CCI Invasive Catheterization Procedures 5

Question 1

A patient with hypertrophic obstructive cardiomyopathy (HOCM) undergoes catheterization. Which maneuver will increase the outflow tract gradient?

Accepted Answer

Valsalva maneuver or standing (decreased preload)

Answer

The Valsalva maneuver decreases LV preload (venous return), which reduces LV cavity size and worsens dynamic LVOT obstruction in HOCM.

Question 2

What does the 'Brockenbrough-Braunwald-Morrow sign' demonstrate during catheterization?

Accepted Answer

Increased post-extrasystolic LV systolic pressure with decreased aortic pulse pressure — pathognomonic of HOCM

Answer

The Brockenbrough sign shows that after a premature ventricular beat, LV systolic pressure increases while aortic pulse pressure paradoxically decreases, pathognomonic for dynamic LVOT obstruction in HOCM.

Question 3

During transseptal puncture, which anatomical landmark is used to confirm correct needle position before puncture?

Accepted Answer

The 'tenting' of the fossa ovalis observed on fluoroscopy and confirmed by pressure monitoring

Answer

Tenting of the fossa ovalis seen fluoroscopically and confirmed by a right atrial pressure waveform at the needle tip confirms correct positioning before transseptal puncture.

Question 4

Which finding on coronary angiography is described as TIMI 2 flow?

Accepted Answer

Partial perfusion with contrast filling the distal vessel slowly, not clearing by the end of 3 cardiac cycles

Answer

TIMI 2 flow describes partial perfusion where contrast fills the distal coronary bed beyond the lesion but clears more slowly than normal (not within 3 cardiac cycles).

Question 5

What is the primary role of the Allen test prior to transradial cardiac catheterization?

Accepted Answer

Confirming adequate ulnar collateral circulation to the hand before radial artery cannulation

Answer

The Allen test assesses ulnar artery collateral flow to ensure the hand will remain perfused if the radial artery becomes occluded during or after the procedure.

CCI - Cardiovascular Credentialing International Practice Test

CCI - Cardiovascular Credentialing International Practice Test

CCI Invasive Catheterization Procedures 5