CVT Cardiac Catheterization Procedures 2 — Questions and Answers
Question 1: During a left heart catheterization, which valve must the catheter cross to enter the left ventricle when using the retrograde approach?
- Mitral valve
- Tricuspid valve
- Aortic valve (Correct answer)
- Pulmonic valve
Correct answer: Aortic valve
The retrograde approach enters the femoral artery, travels up the aorta, and crosses the aortic valve to reach the left ventricle.
Question 2: A patient develops a sudden drop in blood pressure and loss of cardiac output during catheterization. The monitor shows electrical alternans. What is the most likely complication?
- Ventricular fibrillation
- Cardiac tamponade (Correct answer)
- Air embolism
- Vasovagal reaction
Correct answer: Cardiac tamponade
Cardiac tamponade causes electrical alternans, hemodynamic compromise, and requires immediate pericardiocentesis.
Question 3: Which hemodynamic finding is characteristic of severe mitral stenosis on cardiac catheterization?
- Elevated left ventricular end-diastolic pressure
- Large V-waves in the pulmonary capillary wedge trace
- Elevated mean pulmonary capillary wedge pressure with a diastolic gradient (Correct answer)
- Equalization of diastolic pressures in all chambers
Correct answer: Elevated mean pulmonary capillary wedge pressure with a diastolic gradient
Severe mitral stenosis produces an elevated mean PCWP with a pressure gradient between PCWP and left ventricular diastolic pressure.
Question 4: The Gorlin formula is used during cardiac catheterization to calculate which measurement?
- Cardiac output by thermodilution
- Valve orifice area (Correct answer)
- Systemic vascular resistance
- Coronary flow reserve
Correct answer: Valve orifice area
The Gorlin formula uses flow and pressure gradient across a valve to calculate valve orifice area.
Question 5: During right heart catheterization, the catheter is positioned in the pulmonary artery 'wedge' position. What does this measurement approximate?
- Right ventricular end-diastolic pressure
- Pulmonary artery systolic pressure
- Left atrial pressure (Correct answer)
- Aortic root pressure
Correct answer: Left atrial pressure
The PCWP reflects back-pressure from the left atrium when the catheter occludes forward flow in a branch pulmonary artery.
Question 6: A patient undergoing percutaneous coronary intervention develops acute stent thrombosis 2 hours post-procedure. Which anticoagulation regimen failure is most likely implicated?
- Inadequate heparin dosing during the procedure
- Failure to load with dual antiplatelet therapy before PCI (Correct answer)
- Excess protamine reversal of heparin
- Low-dose aspirin instead of high-dose aspirin
Correct answer: Failure to load with dual antiplatelet therapy before PCI
Inadequate pre-procedural dual antiplatelet therapy (aspirin + P2Y12 inhibitor) is the most common cause of early stent thrombosis.
Question 7: Which access site complication is most unique to the radial approach compared to the femoral approach in cardiac catheterization?
- Retroperitoneal hematoma
- Radial artery occlusion (Correct answer)
- Arteriovenous fistula
- Pseudoaneurysm formation
Correct answer: Radial artery occlusion
Radial artery occlusion occurs in approximately 1-5% of transradial procedures and is rare with the femoral approach.
CVT Cardiac Catheterization Procedures 2
During a left heart catheterization, which valve must the catheter cross to enter the left ventricle when using the retrograde approach?