Cardiac catheterization

Question 1

Relative contraindications to cardiac catheterization

Answer 1

Fever
Anemia
Hypokalemia and other electrolyte imbalances
Systemic illness –> acute GI bleed, uncontrolled bleeding diathesis, recent CVA (<1 mo)
Renal failure
Uncontrolled CHF, HTN, or arrhythmia

Question 2

Route for L heart catheterization

Answer 2

Ascending aorta
Across aortic valve
Into LV

Question 3

Purpose of L heart catheterization

Answer 3

Measures pressures in the L heart as a determinant of LV performance

Question 4

Route for R heart catheterization

Answer 4

IVC or SVC
R atrium
R ventricle
Pulmonary A –> pulmonary wedge position

Question 5

Pressure immediately after L atrial contraction

Answer 5

LVEDP

Question 6

Wave that corresponds to L atrial contraction

Answer 6

a wave

Question 7

Normal LVEDP

Answer 7

4-12 mmHg

Question 8

General causes of increased LVEDP

Answer 8

Excessive diastolic volume overload
Impairment of myocardial contractility

Question 9

Possible causes of impaired myocardial contractility

Answer 9

HTN
Valvular stenosis
Restrictive cardiomyopathy
MI

Question 10

Reflects RA contraction at the end of diastole on intracardiac pressure tracing

Answer 10

a wave

Question 11

Reflects from bulging of tricuspid valve during early systole on intracardiac pressure tracing

Answer 11

c wave

Question 12

Reflects passive filling of the RA from the systemic veins during systole, when the tricuspid valve is closed, on intracardiac pressure tracing

Answer 12

v wave

Question 13

Downward deflection on intracardiac pressure tracing that follows the c wave

Answer 13

x descent

Question 14

Downward deflection on intracardiac pressure tracing that follows y wave

Answer 14

y descent

Question 15

Normal mean RA pressure

Answer 15

1-8 mmHg

Question 16

Causes of increased a wave

Answer 16

Tricuspid stenosis
RV hypertrophy
Atrioventricular dissociation

Question 17

Cause of increased v wave

Answer 17

Tricuspid regurgitation

Question 18

Normal RV diastolic pressure

Answer 18

1-8 mmHg

Question 19

Peak RV systolic pressure

Answer 19

15-30 mmHg

Question 20

Causes of increased systolic RV pressure

Answer 20

Pulmonic stenosis
Pulmonary HTN

Question 21

Causes of increased diastolic RV pressure

Answer 21

RV failure
Cardiac tamponade
RV hypertrophy

Question 22

Causes of increased RA pressure

Answer 22

RV failure
Cardiac tamponade

Question 23

Normal systolic pulmonary A pressure

Answer 23

15-30 mmHg

Question 24

Normal diastolic pulmonary A pressure and PCWP

Answer 24

4-12 mmHg

Question 25

3 characteristics that indicate entry into pulmonary A from RV

Answer 25

High diastolic pressure Dicrotic descending systolic portion Down-sloping of diastolic portion

Question 26

Causes of increased diastolic and systolic pulmonary A pressure

Answer 26

Pulmonary HTN LHF Chronic lung disease Pulmonary vascular disease

Question 27

Causes of increased systolic pulmonary A pressure only

Answer 27

Increased flow --> due to L to R shunt

Question 28

Causes of increased pulmonary capillary wedge pressure

Answer 28

LHF Mitral stenosis of regurgitation Cardiac tamponade

Question 29

Parts of hemodynamic assessment of cardiac catheterization

Answer 29

Determine CO Measure pressures in cardiac chambers and vessels

Question 30

Uses of cardiac catheterization

Answer 30

Hemodynamic assessment Calculating resistance Assessment of valve area Intracardiac shunts

Question 31

At what value of SaO2 in the L heart will cyanosis be present

Answer 31

<80%