RCIS Cardiac Catheterization Techniques and Contrast Media 2 — Questions and Answers
Question 1: The Judkins left 4 (JL4) catheter is designed to engage the left coronary ostium without active manipulation from which access site?
- Radial
- Brachial
- Femoral (Correct answer)
- Subclavian
Correct answer: Femoral
The Judkins left 4 catheter is shaped to passively engage the left coronary ostium from the femoral approach without requiring active catheter manipulation.
Question 2: During coronary angiography, the LAO cranial (Spider) view is best used to visualize which coronary segment?
- Left main and proximal LAD origin
- Left circumflex and obtuse marginal branches
- Mid and distal LAD with septal perforators and diagonal branches (Correct answer)
- Right coronary artery ostium and proximal segment
Correct answer: Mid and distal LAD with septal perforators and diagonal branches
The LAO cranial (Spider) view elongates the mid and distal LAD, separating septal perforators and diagonal branches for optimal visualization.
Question 3: What is the purpose of test injections before full contrast injection in selective coronary angiography?
- To measure TIMI flow grade before intervention
- To verify catheter position, exclude deep intubation or pressure damping, and confirm coaxial engagement (Correct answer)
- To check for coronary artery spasm
- To prime the catheter and manifold with contrast
Correct answer: To verify catheter position, exclude deep intubation or pressure damping, and confirm coaxial engagement
Small test injections confirm coaxial catheter seating, detect pressure damping from ostial disease, and ensure the catheter is not deeply intubated before a full injection.
Question 4: Pressure damping during coronary catheter engagement is most commonly caused by:
- Guidewire artifact inside the catheter
- Ostial coronary stenosis or catheter tip occlusion of the vessel lumen (Correct answer)
- Air bubble in the manifold tubing
- Vasospasm of the aortic root
Correct answer: Ostial coronary stenosis or catheter tip occlusion of the vessel lumen
Pressure damping indicates catheter tip occlusion of the coronary lumen, often due to ostial stenosis or a catheter that is too large for the vessel.
Question 5: Fractional flow reserve (FFR) measurement requires which pharmacologic agent to induce maximal coronary hyperemia?
- Nitroglycerin
- Adenosine (Correct answer)
- Dobutamine
- Atropine
Correct answer: Adenosine
Adenosine induces maximal coronary hyperemia by causing maximal vasodilation, which is required for accurate FFR assessment of lesion physiologic significance.
Question 6: During left ventriculography, the RAO 30° view is used primarily to assess:
- Mitral regurgitation severity and LV inferior wall motion only
- LV anterior and inferior wall motion, chamber volume, and ejection fraction (Correct answer)
- Aortic valve anatomy and regurgitation
- Right ventricular systolic function
Correct answer: LV anterior and inferior wall motion, chamber volume, and ejection fraction
The RAO 30° view during left ventriculography is the standard projection for assessing LV anterior and inferior wall motion, calculating chamber volumes, and ejection fraction.
RCIS Cardiac Catheterization Techniques and Contrast Media 2
The Judkins left 4 (JL4) catheter is designed to engage the left coronary ostium without active manipulation from which access site?