Mixed Deck — All RCIS Topics Flashcards

Which medication is commonly used to terminate supraventricular tachycardia (SVT) during an electrophysiology study?

Answer: Adenosine

Adenosine is a medication commonly used to terminate supraventricular tachycardia (SVT) during an electrophysiology study. Adenosine works by temporarily blocking the atrioventricular (AV) node, which often interrupts the re-entrant electrical pathway responsible for SVT. Its rapid onset and short duration of action make it effective for acute termination.

Abciximab (ReoPro) is classified as which type of cardiovascular medication?

Answer: Glycoprotein IIb/IIIa inhibitor

Abciximab is a monoclonal antibody fragment that binds to the glycoprotein IIb/IIIa receptor on the surface of platelets. This action blocks the final common pathway of platelet aggregation, preventing fibrinogen from linking platelets together.

When treating a stenotic lesion in the common iliac artery, which of the following is a critical consideration to avoid compromising blood flow to the contralateral leg?

Answer: Avoiding 'jailing' the contralateral common iliac artery ostium

The common iliac arteries bifurcate into the internal and external iliac arteries. When stenting a lesion in one common iliac artery that extends to the aortic bifurcation, care must be taken not to 'jail' or cover the ostium of the contralateral common iliac artery. This could compromise blood flow to the other leg, a complication that may require complex 'kissing stent' techniques to resolve.

In which patient population is combined coronary angiography with right heart catheterization most commonly performed as a single procedure?

Answer: Cardiac transplant patients for rejection surveillance and heart failure patients for hemodynamic assessment

Combined coronary angiography and right heart catheterization is routinely performed in heart transplant patients for allograft vasculopathy surveillance and in heart failure patients for hemodynamic assessment.

Radial artery spasm during transradial catheterization is best managed initially with:

Answer: Intra-arterial nitroglycerin or verapamil through the sheath

Intra-arterial vasodilators such as nitroglycerin or verapamil administered through the sheath are first-line treatment for radial artery spasm.

What is the primary purpose of using an embolic protection device (EPD) during a carotid artery stenting procedure?

Answer: To capture embolic debris and prevent stroke

The primary goal of an EPD, such as a filter or a balloon occlusion system, is to prevent procedural emboli from traveling to the brain. During angioplasty and stenting of the carotid artery, atherosclerotic debris can be dislodged. The EPD is deployed distal to the lesion to capture this debris, thereby reducing the risk of periprocedural stroke.

The primary purpose of heparin administered during cardiac catheterization is to:

Answer: Prevent thrombotic complications from catheter and sheath introduction

Systemic heparin anticoagulation prevents thrombus formation on catheters, guidewires, and sheaths placed within the arterial system during catheterization.

Which of the following congenital defects results in a direct connection between the aorta and the pulmonary artery, often leading to a continuous 'machinery-like' murmur?

Answer: Patent Ductus Arteriosus (PDA)

A Patent Ductus Arteriosus (PDA) is the failure of the fetal ductus arteriosus to close after birth. This vessel connects the descending aorta to the pulmonary artery, causing a continuous left-to-right shunt and a characteristic machinery-like murmur heard on auscultation.

The 'left main equivalent' lesion in coronary artery disease refers to:

Answer: Proximal LAD and proximal LCx stenoses jeopardizing equivalent myocardial territory as left main disease

Left main equivalent refers to proximal LAD plus proximal LCx stenoses, which together jeopardize the same large myocardial territory as unprotected left main disease.

Stoke Volume is ________?

Answer: Related to preload

Stroke volume, the amount of blood pumped by the ventricle per beat, is directly related to preload. Preload refers to the volume of blood filling the ventricles at the end of diastole, which stretches the cardiac muscle fibers. According to the Frank-Starling mechanism, increased preload leads to a stronger contraction and thus a greater stroke volume.

When opening a sterile package, which flap should be opened first?

Answer: The flap furthest away from you

To maintain sterility, the flap furthest away should be opened first. This prevents the non-sterile arm and body from reaching over the sterile field that is being created. Subsequent flaps are opened to the sides and then the final flap is pulled towards yourself.

The primary mechanism by which IV hydration prevents contrast nephropathy is:

Answer: Increasing urine output to flush contrast through the kidneys, reducing tubular exposure time

IV hydration increases renal blood flow and urine output, which dilutes contrast and accelerates its excretion, reducing tubular exposure time and osmotic injury.

During a right heart catheterization, a significant 'step-up' in oxygen saturation is noted between the superior vena cava (SVC) and the right atrium (RA). This finding is most indicative of which congenital heart defect?

Answer: Atrial Septal Defect (ASD)

A 'step-up' in oxygen saturation from the SVC to the RA signifies the shunting of oxygenated blood from the left atrium to the right atrium. This is the classic hemodynamic finding for an atrial septal defect (ASD). The mixing of oxygenated blood increases the overall oxygen saturation in the right atrium compared to the systemic venous return.

Which of the following factors directly affects cardiac output (CO)?

Answer: Heart rate (HR) and stroke volume (SV)

Cardiac output (CO) is directly affected by heart rate (HR) and stroke volume (SV). The formula for cardiac output is CO = HR x SV. Heart rate is the number of beats per minute, and stroke volume is the amount of blood pumped out of the ventricle with each beat, making them the two direct determinants of the total blood pumped per minute.

Fractional flow reserve (FFR) measurement requires which pharmacologic agent to induce maximal coronary hyperemia?

Answer: Adenosine

Adenosine induces maximal coronary hyperemia by causing maximal vasodilation, which is required for accurate FFR assessment of lesion physiologic significance.

During left ventriculography, the RAO 30° view is used primarily to assess:

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.

Which part of a sterile surgical gown is considered non-sterile?

Answer: The neckline and back of the gown

The sterile area of a gown includes the front from the chest to the level of the sterile field, and the sleeves from 2 inches above the elbow to the cuff. The neckline, shoulders, underarms, and back are considered non-sterile as they cannot be continuously monitored for contamination.

IABP deflation should occur:

Answer: Just before systole (end diastole)

Deflation just before systole reduces afterload by creating a pressure void, decreasing left ventricular work during the ejection phase.

When performing an antegrade access for a superficial femoral artery (SFA) intervention, the common femoral artery (CFA) is punctured in which direction?

Answer: In an antegrade direction, towards the foot

Antegrade access means puncturing the artery in the direction of blood flow. For an SFA intervention, the CFA is punctured from above, directing the needle, wire, and sheath downwards into the SFA. This is in contrast to retrograde access, where the puncture is against the direction of blood flow.

Which trigger mode for IABP is preferred when a patient has an irregular cardiac rhythm?

Answer: Arterial pressure trigger

The arterial pressure trigger is preferred in irregular rhythms because it responds directly to the arterial pressure waveform, which is more reliable than the ECG in arrhythmias.