CIR CIR Hemodynamic Monitoring & Cardiac Catheterization 2 — Questions and Answers
Question 1: During coronary angiography, the Judkins right catheter is most commonly used to cannulate which ostium?
- Left main coronary ostium
- Right coronary ostium (Correct answer)
- Left circumflex ostium
- Saphenous vein graft ostium
Correct answer: Right coronary ostium
The Judkins right (JR4) catheter is specifically shaped to engage the right coronary artery ostium from the right femoral or radial approach.
Question 2: What does an 'A' wave on a central venous pressure (CVP) tracing represent?
- Ventricular contraction
- Atrial contraction (Correct answer)
- Tricuspid valve closure
- Ventricular relaxation
Correct answer: Atrial contraction
The 'A' wave on CVP tracing corresponds to atrial contraction against a closed or closing tricuspid valve.
Question 3: Which finding on hemodynamic tracings is characteristic of cardiac tamponade?
- Wide pulse pressure
- Equalization of diastolic pressures across chambers (Correct answer)
- Elevated cardiac output
- Decreased right atrial pressure
Correct answer: Equalization of diastolic pressures across chambers
Tamponade physiology produces equalization of RA, RV diastolic, PA diastolic, and PCWP pressures due to pericardial compression.
Question 4: A thermodilution cardiac output measurement involves injection of cold saline into the:
- Left atrium
- Pulmonary artery
- Right atrium (Correct answer)
- Femoral artery
Correct answer: Right atrium
Cold saline is injected into the right atrium through the proximal port of a Swan-Ganz catheter, and temperature change is detected distally in the pulmonary artery.
Question 5: Elevated left ventricular end-diastolic pressure (LVEDP) above 18 mmHg most likely indicates:
- Hypovolemia
- Left ventricular dysfunction or failure (Correct answer)
- Normal cardiac function
- Pulmonary hypertension alone
Correct answer: Left ventricular dysfunction or failure
LVEDP > 18 mmHg reflects impaired LV compliance or systolic dysfunction, indicating elevated filling pressures consistent with heart failure.
Question 6: The pressure gradient across a stenotic aortic valve is most accurately measured by simultaneous recording from the:
- Pulmonary artery and right ventricle
- Left ventricle and ascending aorta (Correct answer)
- Left atrium and left ventricle
- Right atrium and right ventricle
Correct answer: Left ventricle and ascending aorta
Aortic valve stenosis severity is determined by the peak-to-peak or mean gradient between LV pressure and ascending aortic pressure.
CIR CIR Hemodynamic Monitoring & Cardiac Catheterization 2
During coronary angiography, the Judkins right catheter is most commonly used to cannulate which ostium?