Diagnostic Coronary Angiography

Question 1

What is a Coronary Angiography?

Answer 1

Examination of the coronary arteries that is performed by the injection of contrast media directly into the Ostium of the coronary arteries

Question 2

What is the absolute contraindication of Coronary Angiography?

Answer 2

Lack of patient consent

Question 3

Where does the RCA (Right coronary artery) arise from?

Answer 3

Right Coronary Sinus

Question 4

What does the conus artery supply?

Answer 4

Right ventricular outflow tract

Question 5

Where does the sinoatrial nodal and AV nodal branches arise from?

Answer 5

Right Coronary Artery

Question 6

What arises from the mid Right coronary artery?

Answer 6

Marginal branches

Question 7

What does the Marginal branches supply

Answer 7

Right ventricular wall

Question 8

What does the distal Right Coronary Arteries give rise to?

Answer 8

Right Posterolateral branches and the Posterior descending artery (PDA)

Question 9

What percentage of cases is right dominant? PDA arises from the distal RCA

Answer 9

85%

Question 10

What percentage of cases is left dominance? PDA arises from LCX

Answer 10

8%

Question 11

What percentage of cases is the PDA co dominant? PDA arises from both the RCA and LCX

Answer 11

7%

Question 12

What groove does the PDA run in and what does it supply?

Answer 12

1: Posterior Interventricular grove
2: Posterior Interventricular septum

Question 13

Where does the left main coronary artery arise from?

Answer 13

Left Coronary Sinus

Question 14

What does the Left Coronary Artery do?

Answer 14

Birfurcates into the Left anterior descending and Left Circumflex Artery

Question 15

In a minority of cases, what does the left main coronary artery do?

Answer 15

Trifurcates into the LAD, Ramus intermedius artery, and LCX.

Question 16

What does the Left Anterior Descending artery supply?

Answer 16

Anterior wall of the left Ventricle

Question 17

Where does the LCX artery run through?

Answer 17

Left AV groove

Question 18

What does the LCX artery supply?

Answer 18

Obtuse marginal branches that supply the posterolateral wall of the left ventricle.

Question 19

What percentage of coronary artery anomalies are found

Answer 19

1 to 1.5 %

Question 20

What is the most common coronary artery anomaly?

Answer 20

Presence of separate origins of the LAD and LCX

Question 21

What do you need for the Preprocedural evaluation?

Answer 21

-History
-Physical Examination
-Routine lab data
-12 lead ECG
-Transthoracic ECHO

Question 22

What are the indications of Diagnostic Coronary Angiography

Answer 22

-Acute coronary syndrome
-ST elevation myocardial infarction (STEMI)
-Unstable Angina
-High Risk Features (Electrical instability or Cardiogenic Shock)

Question 23

When should a patient undergo diagnostic coronary angiography with acute coronary syndrome?

Answer 23

Emergent or urgent

Question 24

When should a patient undergo diagnostic coronary angiography with STEMI?

Answer 24

Emergent with goal to establish reperfusion within 90 minutes

Question 25

When should a patient undergo diagnostic coronary angiography with unstable angina?

Answer 25

24 to 72 hours

Question 26

When should a patient undergo diagnostic coronary angiography with high risk features (rafractory angina, hemodynamic, electrical instability, cardiogenic shock)?

Answer 26

within a few hours of clinical presentation

Question 27

What are relative contrindications for diagnostic coronary angiography?

Answer 27

Co-morbidities Renal failure Electrolyte abnormalities Active bleeding Decompensated Heart Failure Severe Aortic Stenosis Uncontrolled hypertension Pulmonary Edema Respiratory Failure Active Infection Allergic Reaction to contrast Pregnancy Peripheral vascular disease

Question 28

What is PCI?

Answer 28

Percuteanous Coronary Intervention

Question 29

What artery is becoming popular in patients with obesity, decompensated heart failure and severe peripheral artery disease

Answer 29

Radial artery

Question 30

What is the anatomic landmark for vessel puncture in the femoral artery?

Answer 30

Upper one third of the femoral head.

Question 31

What is used to prevent vasospasm in the radial approach?

Answer 31

Vasodilator such as verapamil in the sidearm of the sheath after obtaining radial access

Question 32

What guidewire is introduced in the sheath for coronary artery cannulation?

Answer 32

0.035 in J tipped guidewire

Question 33

What should be done with patients with a history of CABG

Answer 33

All bypass conduits should be investigated.

Question 34

Most common views for RCA Angiography

Answer 34

RAO projection LAO projection AP projection with cranial angulation

Question 35

Most common views for Left Coronary Angiography

Answer 35

RAO projection with cranial and caudal angulation LAO projection with cranial and caudal angulation AP Projection with cranial and caudal angulation

Question 36

What is the Thrombolysis in Myocardial Infarction (TIMI) flow grading scale?

Answer 36

TIMI 3: normal flow with complete filling of distal vessel TIMI 2: Delayed or sluggish flow with complete filling of the distal vessel TIMI 1: Faint flow beyond the stenosis with incomplete filling of the distal vessel TIMI 0: Completely occluded artery with no distal flow beyond the lesion

Question 37

What is CAD?

Answer 37

Coronary Artery Disease

Question 38

What are the major complications of coronary angiography

Answer 38

Death Myocardial Infarction Stroke

Question 39

What is the percentage risk of major complications in coronary angiography?

Answer 39

0.3%

Question 40

What are the minor complications of coronary angiography?

Answer 40

Coronary artery dissection Bleeding Vascular complications Arrhythmias Contrast reactions

Question 41

Risk percentage of minor complications during coronary angiography?

Answer 41

<2%

Question 42

What is PCI?

Answer 42

Percutaneous Coronary Intervention

Question 43

What is the limitations of Coronary Angiography in evaluation of CAD:

Answer 43

Severity of CAD can be underestimated Unable to provide accurate information about the vessel wall Cannot exclude underlying disease in the coronary endothelium Improper interpretation of stenosis severity

Question 44

What is the critical reference point used to assess the severity of coronary artery narrowing

Answer 44

An adjacent normal appearing segment

Question 45

What are the potential complications of the arterial puncture above the ingunial ligament

Answer 45

Retroperitanal Bleeding Hematoma

Question 46

What is the purpose of FFR (Fractional Flow Reserve)

Answer 46

To measure intracoronary pressure and assess lesion hemodynamic significance

Question 47

Which factors may contribute to the underestimation of coronary artery disease (CAD) severity during coronary angiography?

Answer 47

Two-dimensional imaging of three-dimensional coronary anatomy. Difficulty in identifying an appropriate reference segment.

Question 48

What can be assessed using both IVUS and OCT in coronary artery evaluation?

Answer 48

The size of the artery, vascular wall, and plaque composition.