M2-C5-L43 --> Coronary Anatomy & Angiography

Front 1

CORONARY ANGIOGRAPHY

T/F : Coronary Angiography is the visualization of the Coronary vessels.

Back 1

False.

It is the visualization of the Coronary LUMEN

Front 2

CORONARY ANGIOGRAPHY

- In terms of study, what is the difference between an Angiography & a Catheterization?

Back 2

Angiography studies the Anatomy (A=A)

Catheterization is basically an Angiography + Pressure studies.

Front 3

CORONARY ANGIOGRAPHY

- Coronary Angiography is a definitive, Gold Standard Diagnostic procedure in establishing what 2 things?

Back 3

- Presence of CAD

- Severity of CAD

(CAD = Coronary Angiogram Diagnostic = Coronary Artery Dz)

Front 4

CORONARY ANGIOGRAPHY

- Left heart catheterization is study of the heart during which a catheter is percutaneously inserted into which possible arteries? x3

Back 4

- Femoral (perferred)

- Brachial artery
- Radial artery

Front 5

CORONARY ANGIOGRAPHY

- what approach is the most common form of arterial access during cardiac catheterization?

Back 5

- Femoral artery approach

Front 6

CORONARY ANGIOGRAPHY

- “Left heart” catheterization includes the study of what 4 things?

Back 6

- Aortic pressures

- LV pressures
- LV angiogram

- Selective Coronary Angiogram

Front 7

CORONARY ANGIOGRAPHY

- What are the contraindicaitons for an Angiogram? x9

Back 7

(FREUDS PAD is contraindicated)

- Fever
- Refulsal of pt.
- Electrolyte imbalance
- Uncontrolled HTN
- Decompensated HF
- Severe allergy to contrast

- Pregnant
- ARF
- Digitalis toxicity

Front 8

CORONARY ANGIOGRAPHY

- What are the possible complications of an Angiogram? x9

Back 8

(MD'S PREACH on Complications)

- MI, Death, or Stroke (1:1000)

- Pseudo-aneurysms
- Renal Failure
- Embolization distally
- Arrhythmia
- Coronary Dissections/Spasms
- Hemorrhage

Front 9

CORONARY ANGIOGRAPHY

- Cardiologists who use the femoral artery approach will do what before assessing the artery?

- this is accomplished by doing what?

- this is concomitantly evaluated how?

Back 9

- Confirm Bony Landmarks

- Placing Needle (or Hemostat) on top of groin @ the Anticipated Puncture Site.

- Fluroscopically evaluating the
POSITION of TIP
as it relates to
FEMORAL HEAD

Front 10

CORONARY ANGIOGRAPHY

- The target entry site of the needle is the?

Back 10

Superior half of the Femoral Head

Front 11

CORONARY ANGIOGRAPHY

- Below the mid-portion of femoral head, the common femoral artery bifurcates into what 2 branches?

Back 11

- Superficial branches

- Profunda

Front 12

CORONARY ANGIOGRAPHY

- Low Puncture site possible complication?

- Low Puncture site location?

- Low Puncture site difficulties in procedure?

Back 12

(ABC)

- Pseudo-Aneurysm

- Bifurcation of common femoral artery

- Compression difficult

Front 13

CORONARY ANGIOGRAPHY

- High Puncture site has what possible complication?

- High Puncture site difficulties in procedure

Back 13

- risk of Retroperitoneal Hematoma is increased

- Compression difficulty against bony structure

Front 14

CORONARY ANGIOGRAPHY

- describe the Compression problem associated with a Puncture at an Arterial Bifurcation (i.e.- Low puncture site in Angio)

Back 14

- Difficulty in Hemostasis with either compression or a sealing devine

Front 15

CORONARY ANGIOGRAPHY

- describe the Compression problem associated with a Puncture at a High Puncture site.

Back 15

- difficult to compress the artery against a BONY structure

Front 16

CORONARY ANGIOGRAPHY

- normally, what is the analgesia used?

- normally, where on the body is it used on?

Back 16

- 1% to 2% lidocaine solution

- Groin is infiltrated

Front 17

CORONARY ANGIOGRAPHY

- once the needle is in the femoral artery, what are the procedural steps? x4

Back 17

- Place a Wire through the needle

- Take the needle out.

- Advance a vascular Sheath over the guide-wire and place it in the artery.
(now you have access to artery)

- insert Catheter

Front 18

CORONARY ANGIOGRAPHY

- upon inserting the Catheter, it will be guided by what?

- guided to go where?

Back 18

- Fluoroscopic guidance

- Ostium of the coronary artery

Front 19

CORONARY ANGIOGRAPHY

- during the cath lab, what type of radiograph is used to monitor the VESSELS?

- is this 2D or 3D?

- how is this compensated?

Back 19

- X-ray

- 2D

- able to rotate Left, Right, Cranially, & Caudally.

Front 20

LV ANGIOGRAM

- what type of catheter is used?

- above catheter placed across what valve?

- then placed into where?

Back 20

- pigtail catheter

- aortic valve

- LV

Front 21

LV ANGIOGRAM

- once the pigtail catheter is placed (via aortic valve) in the LV, what is measured? x2

Back 21

- LV Systolic Pressure

- LV End-Diastolic Pressure (LVEDP)

Front 22

LV ANGIOGRAM

- once the LVSP & LVEDP is measured, the contrast is injected via?

Back 22

- Power injector

Front 23

LV ANGIOGRAM

- LV angiogram is performed to serve what 3 functions?

Back 23

- Size visualization

- Ejection Fraction (EF) assessment

- Abnormalities in Segmental Wall Motion

Front 24

LV ANGIOGRAM

- Pressures are also measured as the catheter tip is withdrawn from where to where?

Back 24

- from LV to the Aorta

Front 25

LV ANGIOGRAM

When the catheter is withdrawn, a significant...

- Systolic Pressure gradient across the LV outflow tract is indicative of?

- Pressure gradient across Aortic valve is indicative of?

Back 25

- Hypertrophic Obstructive Cardiomyopathy

- Aortic Stenosis

Front 26

LV ANGIOGRAM

- aka?

- part of what procedure?

Back 26

- Left Ventriculography

- Left Heart Catheterization

Front 27

LV ANGIOGRAM

- Left Ventriculography provides info about what functions? x2

- also provides info on the severity of what condition?

Back 27

- Regional LV F(x)
- Global LV F(x)

- Mitral Regurgitation severity

Front 28

LV ANGIOGRAM

- Left Ventriculography provides info on the presence of what pathologic conditions? x7

Back 28

(Ladies Love VP CAR)
- LVH
- LV clot

- VSD
- PseudoAneurysms

- Coronary anomalies
- Aortic Dz
- RVE

Front 29

LV ANGIOGRAM

- Left Ventriculography may be deferred in cases of? x7

Back 29

(Defer on the MighTy CREAM)
- Mechanical Prosthetic Aortic Valve
- Tenuous Hemodynamics

- Critical AS
- Renal insufficiency
- Elevated LVEDP or PCWP
- Active Aortic valve Endocarditis
- Mobile LV clot

Front 30

CORONARY ANATOMY

- Left Anterior Descending artery is associated with which myocardial segment? x3

Back 30

(LA Dodgers need some ASA)

- Anterolateral

- Septal

- Apical

Front 31

CORONARY ANATOMY

- Dominant Right Coronary artery is associated with which myocardial segment? x3

Back 31

(DRC has PID)

- Posterolateral

- Inferolateral

- Diaphragmatic

Front 32

CORONARY ANATOMY

- Left Circumflex (dominant RCA) artery is associated with which myocardial segment? x2

Back 32

- Posterolateral

- Superolateral

Front 33

CORONARY ANATOMY

- What are the 3 leaflets of the Aortic Valve?

Back 33

- LC (left coronary) cusp

- RC (right coronary) cusp

- NC (non-coronary) cusp

Front 34

CORONARY ANATOMY

- what arises from the LC cusp?
- RC cusp?
- NC cusp?

Back 34

- LCA

- RCA

- nothing

Front 35

CORONARY ANATOMY

- LCA is aka?

- LCA immediately divides into what 2 arteries?

Back 35

- Left Main Coronary artery

- LAD artery
- LCx artery
(Left Circumflex artery)

Front 36

CORONARY ANATOMY

- LCA passes between what 2 structures?

- LCA then settles into what groove?

Back 36

- Left Atrium (LA)
- Pulmonary Trunk (PT)

- Anterior AV groove

Front 37

CORONARY ANATOMY

- LCx artery arises from?

- LCx settles in what groove?

Back 37

- LCA

- Posterior AV groove

Front 38

CORONARY ANATOMY

- LAD artery arises from?

- LAD settles in what groove?

Back 38

- LCA

- Anterior IV groove

Front 39

CORONARY ANATOMY

- at the Inferior border, the LAD will continue traveling into what?

- then what does LAD do?

Back 39

- Posterior IV groove

- Anastomoses with PDA

Front 40

CORONARY ANATOMY

- Diagonal branches arise from?

- OM (obtuse marginal) branches arise from?

- which branches descend on the Anterior surface of the heart?

Back 40

- LAD

- LCX

- Lateral Diagonal branches

Front 41

CORONARY ANATOMY

- Before settling into the Posterior AV groove, the LCX must first travel along what groove?

- LCX gives off what branches proximately

- LCX gives off what branches distally?

Back 41

- Left AV groove (duh)

- OM branches (proximally)

- Postero-Lateral Coronary arteries (distally)

Front 42

CORONARY ANATOMY

- Anterior Septal branches arise from?

- why call them Anterior Septal branches?

- Posterior Septal branches come from?

Back 42

- LAD

- b/c they perforate in to the Anterior IV septum

- PDA

Front 43

CORONARY ANATOMY

- on the Anterior side, list the branches of the RCA in order

Back 43

- SA nodal branch

- Conus artery
(unknown as to what it supplies, possibly collateral)

- Anterior Marginal

Front 44

CORONARY ANATOMY

- on the Posterior side, the RCA gives off what important branch?

- above artery gives off what?

Back 44

- Posterior Descending Artery (PDA)

- Posterior Septal branches
(supplies posterior IV septum)

Front 45

CORONARY ANATOMY

- Dominance implicates what 2 arteries?

- what dictates which one is "Dominant"

Back 45

- RCA
- LCX artery

- the one that gives off the PDA

Front 46

CORONARY ANATOMY

- the AP view on X-ray may be of particular value in evaluating what 2 things?

Back 46

- Ostium of Left Main (LCA)

- Shaft of the mid LAD

Front 47

CORONARY ANATOMY

- the RCA travels along what groove and where?

Back 47

- along the Anterior AV groove to reach the Posterior AV groove

Front 48

CORONARY ANATOMY

- SA nodal artery supplies? x2

- (Anterior) Marginal branches from the RCA supply?

Back 48

- SA node
- RA

- Anterior wall of RV

Front 49

CORONARY ANATOMY

- AV nodal artery branches off of?

- AV nodal artery can be found where?

- AV nodal artery perforates into what?

Back 49

- RCA

- Posterior border of IV septum

- Crux
(junction of Septa & 4 heart chamber walls)

Front 50

CORONARY ANATOMY

- the AV nodal artery perforates into the Crux, which is a junction of what?

Back 50

- Septa
&
4 Heart Chamber walls

Front 51

CORONARY ANATOMY

- if Right Dominant, the PDA branches off of?

- if Left Dominant, the PDA branches off of?

- which is more common?

Back 51

- RCA

- LCX artery

- Right Dominant occurs 80% of time
(per First Aid)

Front 52

CORONARY ANATOMY

- PDA travels along?

- PDA will eventually anastomose with?

Back 52

- Posterior IV groove

- LAD

Front 53

TIMI

- what is TIMI (Thrombolysis In MI) measuring in respect to Angiography?

- Normal TIMI score?

- what does "normal" mean?

Back 53

- Flow of the injected Dye

- TIMI 3 is normal score

- upon injecting contrast, it goes quickly to the very end of the vessel

Front 54

TIMI

- what TIMI score implies slower than normal?

- what TIMI score implies really slow or just Penetration?

Back 54

- TIMI 2

- TIMI 1

Front 55

TIMI

- what does TIMI 0 imply?

Back 55

- Occlusion (or no flow)

(when you inject dye, it just stays there)

Front 56

TIMI

- a TIMI score of 3 is associated with what clinical prognosis?

Back 56

- Improved outcome in the setting of Acute Myocardial Infarction (AMI)

Front 57

TIMI

- the TIMI scores in general have Direct Correlation with what?

Back 57

- Morbidity and Mortality

(someone with normal flow will live longer than someone with slow(er) flow)