CVT Cardiac Catheterization Procedures 3 — Questions and Answers
Question 1: Which pressure waveform abnormality on right heart catheterization indicates severe tricuspid regurgitation?
- Prominent A-wave in right atrium
- Giant V-waves in right atrial pressure trace (Correct answer)
- Blunted X-descent
- Cannon A-waves
Correct answer: Giant V-waves in right atrial pressure trace
Severe tricuspid regurgitation causes large V-waves in the right atrial pressure trace due to systolic backflow into the atrium.
Question 2: During coronary angiography, the LAD is found to supply both the anterior wall and the inferior wall of the left ventricle. This pattern is called a:
- Right dominant system
- Left dominant system
- Codominant system
- Wrap-around LAD (Correct answer)
Correct answer: Wrap-around LAD
A wrap-around LAD extends past the cardiac apex to supply the inferior wall, which is normally supplied by the RCA.
Question 3: What is the significance of a fractional flow reserve (FFR) value of 0.75 in a coronary stenosis?
- The lesion is hemodynamically significant and warrants revascularization (Correct answer)
- The lesion is borderline and medical management is preferred
- The lesion is non-significant and stenting is not indicated
- The measurement is invalid and must be repeated
Correct answer: The lesion is hemodynamically significant and warrants revascularization
An FFR ≤0.80 (commonly cutoff 0.75-0.80) indicates a hemodynamically significant lesion that benefits from revascularization.
Question 4: A patient undergoing cardiac catheterization develops a sudden onset of hives, bronchospasm, and hypotension after contrast injection. What is the first-line treatment?
- IV diphenhydramine 50 mg
- IV methylprednisolone 125 mg
- Epinephrine 0.3 mg IM or IV (Correct answer)
- IV normal saline bolus 1 liter
Correct answer: Epinephrine 0.3 mg IM or IV
Epinephrine is the first-line treatment for anaphylaxis because it reverses bronchospasm, vasodilation, and urticaria simultaneously.
Question 5: During ventriculography, the technologist observes an hourglass appearance of the left ventricle. This finding is associated with which condition?
- Dilated cardiomyopathy
- Hypertrophic obstructive cardiomyopathy (HOCM) (Correct answer)
- Constrictive pericarditis
- Cardiac tamponade
Correct answer: Hypertrophic obstructive cardiomyopathy (HOCM)
HOCM causes dynamic mid-cavity obstruction that produces an hourglass or figure-8 appearance during systole on ventriculography.
Question 6: To assess the severity of aortic regurgitation during catheterization, the technologist performs an aortogram. Which injection site is used?
- Left ventricle apex
- Aortic root just above the aortic valve (Correct answer)
- Pulmonary artery
- Left main coronary ostium
Correct answer: Aortic root just above the aortic valve
Contrast injected in the aortic root just above the valve regurgitates into the left ventricle, allowing grading of aortic regurgitation severity.
Question 7: Which catheter is specifically designed for selective engagement of the right coronary artery via the femoral approach?
- Judkins Left 4 catheter
- Amplatz Right catheter (Correct answer)
- Pigtail catheter
- Swan-Ganz catheter
Correct answer: Amplatz Right catheter
The Amplatz Right catheter (or Judkins Right) is designed to selectively engage the right coronary ostium from the femoral approach.
CVT Cardiac Catheterization Procedures 3
Which pressure waveform abnormality on right heart catheterization indicates severe tricuspid regurgitation?