Core Lecture Series

Question 1

Describe the image

Answer 1

RAO Caudal

• LAD (on top)
• CFx (coming towards front)

Question 2

Describe the image

Answer 2

LAO Cranial

Question 3

Describe the findings

Answer 3

Question 4

Describe the findings

Answer 4

LAO Straight

Question 5

Describe the findings

Answer 5

LAO Cranial

Question 6

Describe the findings

Answer 6

RAO Straight

Question 7

What are the branches of the SMA?

Answer 7

• inferior pancreaticoduodenal
• intestinal
• ileocolic
• right colic
• middle colic

Question 8

What are the branches of the celiac trunk?

Answer 8

• Left gastric
• Common hepatic
• Splenic

Question 9

Describe the views and imaging of the left coronary system

Answer 9

Question 10

Describe the image

Answer 10

Question 11

Describe the image

Answer 11

Question 12

Describe the image

Answer 12

Question 13

Describe the image

Answer 13

Question 14

Describe the image

Answer 14

Question 15

Describe the image

Answer 15

Question 16

Describe the image

Answer 16

Question 17

Describe the views and imaging of the right coronary system

Answer 17

Question 18

Describe the image

Answer 18

Question 19

Describe the image

Answer 19

Question 20

Describe the image

Answer 20

Question 21

Describe the findings of the LV gram

Answer 21

Question 22

What is the most common challenge in regards to radial access?

Answer 22

vasospasm

Question 23

What tests should be performed before attempting radial access?

Why?

Answer 23

• Barbeau or Allen’s Test
• To assess ulnar and radial flow in the superficial palmar arch

Question 24

What is the best treatment for radial artery vasospasm during cath?

Answer 24

• Intra-arterial vasodilators
  
  • verapamil, Nitrates
• Sedation
• Minimizing catheter manipulation and catheter exchanges

Question 25

What is a dreaded complication or transradial access?

Answer 25

compartment syndrome

Question 26

What is one way to treat suspected compartment syndrome related to cardiac catheterization?

Answer 26

early recognition and tamponade * often using a sphygmomanometer cuff to apply direct pressure to the forearm

Question 27

What percentage of patients following transradial access will develop arterial thrombosis?

Answer 27

**up to 10%**

Question 28

What is the optimal projection for visualizing: * LMCA

Answer 28

* Proximal and mid-LM * RAO caudal (shallow) * AP caudal * Distal LM * LAO Caudal

Question 29

What is the optimal projection for visualizing: * LAD

Answer 29

* Proximal * LAO caudal * LAO cranial (if foreshetening occurs with LAO caudal) * RAO cranial * eliminates foreshortening seen with LAO cranial/caudal views but overlap with CFx may occur in proximal LAD * Mid * AP cranial or * RAO cranial

Question 30

What is the optimal projection for visualizing: * CFx

Answer 30

* AP caudal * LAO caudal (shallow) * RAO caudal * Proximal * RAO caudal (shallow) * may be compromised by foreshortening * Ostium of RI * LAO caudal (steep)

Question 31

What is the optimal projection for visualizing: * RCA

Answer 31

* Proximal * LAO straight * Mid * left lateral projection * Distal RCA, PDA, PLB bifuraction * LAO cranial * Proximal and mid PDA * RAO

Question 32

What is the optimal projection for visualizing: * LIMA

Answer 32

**Lateral projection**

Question 33

What study demonstrated the noninferiority of Edoxaban over Warfarin in nonvalvular A-fib?

Answer 33

**Engage AF-TIMI 48** * Primary Outcome - systemic or embolic event (Modified intention to treat) - p \< 0.001 * Warfarin - 1.5% / year * High dose (60mg) - 1.18% / year * Los dose (30mg) - 1.61% / year * Major Bleeding - p \< 0.001 * Warfarin - 3.43% / year * High dose (60mg) - 2.75% / year * Los dose (30mg) - 1.61% / year

Question 34

What did the RE-VERSE AD trial show?

Answer 34

* Clinical Question * Among patients receiving dabigatran who develop serious bleeding or need an urgent invasive procedure, does idarucizumab reverse the anticoagulatnt effects of dabigatran? * Bottom Line * Among patients receiving dabigatran who develop serious bleedin or need an urgent invasive procedure, **idarucizumab reverses the anticoagulant effects of dabigatran within minutes of administration**

Question 35

What is the reversal agent for Dabigatran?

Answer 35

**Idarucizumab (Praxbind)** * monoclonal antibody fragment that binds dabigatran * rapidly normalizes hemostasis and reduces levels of circulating dabigatran in patients who had serious bleeding or required urgent procedure **(RE-VERSE AD)** * Class I recommendation

Question 36

What is the reversal agent for Rivaroxaban and Apixaban?

Answer 36

**Andexanet alfa (Andexxa)** * coagulation factor Xa [recombinant], inactivated-zhzo * bioengineered, recombinant modified protein designed to serve as an antidote against direct factor Xa inhibitors *

Question 37

Which NOAC is able to be removed with Hemodialysis?

Answer 37

Dabigatran

Question 38

What did the AFFIRM trial show?

Answer 38

* Clinical Question: * Among patients with A-fib and a high risk of stroke or death, what are the effects of rate control versus rhythm control on mortality? * Bottom Line: * In patients with nonvalvular AF, there is **no survival benefit** between rate and rhythm control, but **rhythm trends toward increased mortality**

Question 39

What were the AFFIRM study outcomes: * Primary

Answer 39

**5 year mortality** * Rate control - 25.9% * Rhythm control - 26.7% * **P = 0.08**

Question 40

What were the AFFIRM study outcomes: * Secondary (notable)

Answer 40

* **Hospitalization:** * 73% vs. 80% - p \< 0.001 * **​Ischemic strokes** * **​**5.5% vs. 7.1% (p = 0.79) * mostly in patients whom warfarin had been stopped or INR subtherapeutic * **Torsades, PEA, Bradycardia** * **​**all in favor of rate control

Question 41

Which NOAC has the greatest degree of renal excretion?

Answer 41

**Dabigatran (Pradaxa)** * 80% renal excretion

Question 42

What is the recommended dose reduction for Apixaban (Eliquis)? Dose?

Answer 42

* Age \> 80 years * Body weight \< 60 kg * Serum Cr \> 1.5 mg/dl * 2.5mg BID

Question 43

What is the recommended dose reduction for Rivaroxaban in renal impairment? Renal function cutoff?

Answer 43

* Rivaroxaban 15mg daily * CrCl 15-50 ml/min

Question 44

What is the mechanism of action of edoxaban?

Answer 44

**factor Xa inhibitor**

Question 45

What is the recommended renal function cutoff/dose reduction for Edoxaban?

Answer 45

* CrCl 51-95 mL/min --\> 60 mg daily * CrCl 15-50 mL/min --\> 30mg daily * CrCl \< 15 or \> 95 mL/min --\> not recommended

Question 46

Define supraventricular tachycardia (SVT)

Answer 46

arrhythmia that requires the nonventricular cardiac tissues for maintenance of tachycardia

Question 47

What are the most common SVT's?

Answer 47

* AVNRT (60%) * AVRT (30%) * AT (10%)

Question 48

What is the best way to differentiate: * regular, narrow complex tachycardia

Answer 48

* **Long RP (RP \> PR)** * Sinus tachycardia * Atrial tachycardia * **Short RP (RP \< PR)** * AVNRT * AVRT (Accessory pathway)

Question 49

What is the best way to dist

Question 50

What clinical features can help distinguish between SVT's?

Answer 50

character of symptom onset * AVNRT or AVRT * sudden, abrupt onset and termination without any clear inciting factor * AT * gradual onset and resolution * possible trigger (such as exercise)