Cardiac Catheterization Procedures Flashcards

A 68-year-old patient on metformin is scheduled for coronary angiography with contrast. What is the standard recommendation regarding metformin use?

Answer: Hold metformin 48 hours post-procedure due to risk of lactic acidosis

Contrast-induced nephropathy can impair metformin excretion, causing dangerous lactic acid accumulation, so metformin is held 48 hours post-procedure.

During right heart catheterization using a balloon-tipped flotation catheter, the balloon ruptures in the right ventricle. What is the most appropriate next action?

Answer: Withdraw the catheter and replace it with a new one

A ruptured balloon cannot safely float into the pulmonary artery and risks air embolism; the catheter must be withdrawn and replaced.

What is the primary advantage of intravascular ultrasound (IVUS) over coronary angiography during a catheterization procedure?

Answer: It provides real-time cross-sectional imaging of plaque burden and vessel architecture

IVUS provides detailed cross-sectional imaging of plaque composition, vessel wall architecture, and stent apposition not visible on angiography.

A patient develops chest pain, ST elevation, and hemodynamic instability during PCI. Angiography shows abrupt vessel closure at the stent site. What is the most likely mechanism?

Answer: Coronary artery dissection with luminal compromise

Abrupt vessel closure during PCI is most commonly caused by coronary artery dissection that creates a flow-limiting intimal flap.

Which radiation protection measure is most effective at reducing scatter radiation exposure to the cardiac catheterization team?

Answer: Increasing the distance from the X-ray source

Radiation exposure follows the inverse square law — doubling distance from the source reduces exposure by 75%.

During a diagnostic catheterization, the operator notes that left ventricular end-diastolic pressure (LVEDP) is 28 mmHg. Which clinical condition does this most strongly suggest?

Answer: Left ventricular diastolic dysfunction or heart failure

An LVEDP above 18-20 mmHg indicates elevated filling pressure consistent with left ventricular diastolic dysfunction or heart failure.

A CVT is assisting with a diagnostic catheterization and notices the pressure waveform transitions from a ventricular pattern to a pulmonary artery waveform without fluoroscopy confirmation. What should the technologist do next?

Answer: Confirm catheter position with fluoroscopy before proceeding

Catheter position should always be confirmed fluoroscopically when waveform changes are ambiguous to prevent perforation or misplacement complications.