Cath

Question 1

Oxygen capacity formula

Answer 1

Amount of oxygen that can be carried by Hgb if 100% saturated
- 13.6 x Hgb

Question 2

Oxygen content

Answer 2

Oxygen in blood (bound to Hgb and dissolved)
- 13.6 x Hgb x O2 sat + 0.03 x PaO2

Question 3

What causes falsely elevated O2 sat

Answer 3

High bili
Carboxyhemoglobin (smokers)

Question 4

Qp:Qs quick calc

Answer 4

SA - SV / PV - PA

Question 5

Fick equation

Answer 5

VO2 / 13.6 x Hgb x (difference in sat / 100)
Need to add paO2 if not on room air

Question 6

Q effective calculation

Answer 6

VO2 / 13.6 x Hgb x (PV - SVC / 100)
Volume of blue blood that goes to lungs and volume of red blood that goes to body

Question 7

Left to right shunt calculation

Answer 7

Qp - Qeff

Question 8

Right to left shunt calculation

Answer 8

Qs - Qeff

Question 9

PVR/SVR calculations

Answer 9

Change in pressure / flow over that bed

If indexed Q then its WU * m2
If not indexed need to MULTIPLY PVR times BSA to get indexed (not divide)

Question 10

What is a wave in RA pressure and what causes elevation

Answer 10

Atrial systole - immediately after p wave
Corresponds with RVEDp if no TV abnormalities
TV closes at end of atrial contraction
Increased a wave in stiff RV (PS, RVH, tamponade), TS, arrhythmia (cannon A waves)

Question 11

What is x descent in RA pressure

Answer 11

Fall of RA pressure after TV closes

Question 12

What is v wave in RA pressure and what causes elevation

Answer 12

• Rise in atrial pressure during atrial filling and ventricular contraction
• At peak of v wave, RV pressure falls below RA pressure and TV opens
• Increased in TR, ASD, LV to RA shunt

Question 13

What is y descent in RA pressure

Answer 13

• Rapid fall in RA pressure during ventricular filling
• Prominent in restrictive physiology

Question 14

Normal A and V wave in LA pressure

Answer 14

A is lower than V in LA (opposite of RA)
- Mean LA pressure about 2 higher than RA pressure

Question 15

Increased v wave in LA pressure

Answer 15

• MR, tri atresia with ASD

Question 16

Increased a wave in LA pressure

Answer 16

• MS, poorly compliant LV, large ASD, TAPVR, arrhythmia

Question 17

Different causes for high ventricular pressure with flat plateau vs early systolic rise that falls

Answer 17

• Broad flat = VSD, severe PH, systemic hypertension
• Early systolic rise = pulmonary valve stenosis/aortic valve stenosis

Question 18

Cath features of DCM

Answer 18

• Increased LA pressure and LVEDp
• Normal RA pressure
• Normal/low CO
• Decreased PVR

Question 19

Cath features of RCM

Answer 19

• Increased LA pressure
• Normal RA pressure
• Prominent y descent
• Square root sign on ventricular tracing (due to rapid filling)
• Increased PVR

Question 20

Cath features of HCM

Answer 20

• Sub aortic gradient (spike and dome look)
• Decreased pulse pressure after PVC

Question 21

What happens with contrast and metformin

Answer 21

Risk for lactic acidosis with renal insufficiency
- Hold 24 hours pre and post

Question 22

Max contrast dose

Answer 22

6 cc/kg

Question 23

Acute risk (most common side effect) with radiation

Answer 23

Dermal injury (erythema) which is often transient

Question 24

AP cranial imaging good for

Answer 24

PV annulus, RVOT, supravalvar PS, RV-PA conduit

Question 25

AP caudal imaging good for

Answer 25

Underside of arch, branch PAs

Question 26

LAO imaging good for

Answer 26

Arch, proximal LPA, L pulmonary veins

Question 27

RAO imaging good for

Answer 27

LVOT (subAS, AV annulus), anterior muscular/outlet VSDs, R pulmonary veins

Question 28

RAO and long axial oblique imaging good for

Answer 28

Like a parasternal long echo image LVOT, AV annulus, membranous and anterior VSDs

Question 29

Hepatoclavicular imaging good for

Answer 29

Like a 4 chamber view Crux of the art, AV valves, AVSD, inlet/posterior VSDs

Question 30

Indication for balloon pulmonary valvuloplasty

Answer 30

Peak > 40 Or peak < 40 with symptoms or RV dysfunction or cyanosis (critical PS) Balloon:annulus 1.2-1.4

Question 31

Indication for balloon aortic valvuloplasty

Answer 31

Peak > 60 (echo) if asymptomatic, peak > 50 (echo) if wanting to play competitive sports or get pregnant Or peak < 50 with LV dysfunction or PGE dependence Balloon:annulus 0.8-1

Question 32

Indication for balloon mitral valvuloplasty

Answer 32

Rheumatic heart disease is only class 1 indication No if supravalvar mitral ring or in HLHS patients Indications in RHD are peak > 20 or mean > 15

Question 33

PA balloon vs. stent pros and cons

Answer 33

- Balloon if proximal PA stenosis or too small or stent, genetic conditions have poor response - Balloon size 2.5-3.5x diameter of lesion but < 2x surrounding vessel -- use high pressure, low compliance balloons - Stent if can get big enough stent in, better in fold/kink or longer segment, risk for reperfusion injury

Question 34

Coarc balloon vs stent pros and cons

Answer 34

- Indication is re-coarc gradient > 20 or < 20 with ventricular dysfunction or single ventricle - Need to get to adult size for stent - No balloon if arch hypoplasia - Balloon 2-3x diameter of stenosis but < 1 mm larger than surrounding vessel - Increased risk recurrence and aneurysm with ballooning vs stent - Stent size smaller than surrounding vessel - risk for embolization and femoral injury

Question 35

Indications for intervention on RV-PA conduit

Answer 35

- RVOT gradient > 35 or moderate PI or 2/3 systemic RV pressures - Stent if going to prolong life of conduit - Valve if big enough - Risk for conduit disruption as well as coronary injury

Question 36

Indications for ASD cath lab closure

Answer 36

- Qp:Qs > 1.5 - RV volume load or dysfunction or elevated pressures - 5 mm rims

Question 37

What issues can happen with aortic root injection

Answer 37

Acute arrest in graft rejection, coronary disease, aortopathy or cardiomyopathy - Issue likely not related to the contrast but potentially due to injection time limiting myocardial oxygen delivery

Question 38

Definition of adequate result for aortic valuloplasty

Answer 38

Decrease in peak gradient to 20-35 mmHg

Question 39

Risk for sub-optimal result for aortic valuloplasty

Answer 39

Age < 3 months or > 40 years Higher pre-dilation valve gradient Smaller annular Z score Vale calcification Prior procedure Undersized balloon

Question 40

Tachypnea and lower saturations with edema post PA angioplasty

Answer 40

Re-perfusion injury

Question 41

Indication for intervention on PA

Answer 41

- Peak gradient > 20-30 across the stenosis - RV pressure or MPA pressure > 1/2 to 2/3 systemic - Flow discrepency between two lungs of > 35/65% - Angiographic appearance of significant narrowing

Question 42

Goal stent size for pulmonary vein to limit risk for re-stenosis

Answer 42

6-10 mm

Question 43

Is re-intervention rate higher for coarc stents or balloons

Answer 43

Stents -- but most are planned re-interventions

Question 44

Risk of endocarditis in implantable valves

Answer 44

2% per year

Question 45

Risks with ASD cath lab closure

Answer 45

- Minor arrhythmia - Thrombus formation - Device embolization - Serious arrhythmia - Cardiac erosion (0.1%) --> oversizing device, absent/deficient aortic rim - Mortality from erosion - Stroke - Allergic reaction --> Nickel allergy

Question 46

Formula to calculate PVR in differential Qp

Answer 46

- Need lung perfusion scan - Calculate individual PVR for each lung based on pressures and flow (use proportion of flow to that lung) - Total resistance formula: 1/total = 1/right + 1/left

Question 47

Protamine reaction

Answer 47

Flushing, vasodilation, hypotension, cardiovascular collapse Higher risk in patients taking NPH insulin

Question 48

Incidence of device erosion with Amplatzer ASD device

Answer 48

0.1%