Ict136 - Unit 2 - Ppt 2.1 - Angiography

Front 1

List Artery sections from inside out

Back 1

lumen
tunica intima
elastic band - part on tunica media
muscle - part of tunica media
tunica adventitia

Front 2

What do you look for when viewing a coronary angiogram?

Back 2

- entire lumen should fill with contrast in one smooth injection with "spilling" into aorta at ostium
- lesions
- collateral flow
- competitive flow
- myocardial bridging

Front 3

Name the different type of lession

Back 3

Eccentric and Concentric

Front 4

What are some complications of LV-gram?

Back 4

- myocardial "staining"
- dislodgement of thrombus
- air embolus
- arrhythmias
- contrast allergy

Front 5

TIMI 2, what does it represent?

Back 5

delayed filling and washout, entire lumen seen

Front 6

Name complications associated with an aortogram

Back 6

* intra-aortic staining
* embolization (air or other)
* contrast allergy
* nausea/vomiting
* dissection or perforation (aortic A., Illiac A., or Femoral A.)

Front 7

Name the walls seen when assessing regional ventricular function in LAO

Back 7

superolateral,
posterolateral,
inferolateral,
apical septum,
basal septum

Front 8

What are some contraindications for an Aortogram?

Back 8

- contrast allergy
- known aortic dissection
- Imminent or potential renal impairment (unless benefit outweighs the risk of renal failure)

Front 9

If spine is on the right, which view is it?

Back 9

LAO

Front 10

what is the PSI for LV/AO injection?

Back 10

usually from 700 psi - 1,200 psi

Front 11

What is a Pressure Injector?

Back 11

it's a high pressure injection of precise amount of contrast over specific period of time

Front 12

System of rating quality/quantity of blood flow through vessels during angiography

Back 12

Thrombolysis in Myocardial Infarction (TIMI) Scale

Front 13

If spine is on the left, which view is it?

Back 13

RAO

Front 14

What does a Quantitative Assessment includes?

Back 14

- vessel diameter measurement
- Ejection Fraction (EF)
- Stroke Volume (SV)
- Regurgitant flow

Front 15

1+ measurement of MR means?

Back 15

contrast from LV enters LA but clears with systole of each beat; of no clinical significance

Front 16

3+ measurment of AI, means?

Back 16

contrast from AO enters LV during diastole; AO and LV are seen as equal density; most of LV seen; moderately severe clinical significance

Front 17

Name the indications for an Aortogram

Back 17

- assess for AI
- determine presence of peripheral artery disease, aortic aneurysm, dissections, etc
- search for bypass graft origin (or stump)
- demonstrate supra-valvular stenosis
-assess renal artery disease

Front 18

In this view the RCA resembles a "C" shape

Back 18

LAO

Front 19

In LV/AO injection this is the larger of the two numbers given

Back 19

Volume

Front 20

This angiography assessment of angiogram is "subjective"

Back 20

Qualitative Assessment

Front 21

Describe Eccentric Lession

Back 21

- part of lumen circumference is free of disease
- some projections you see lessions, some you don't

Front 22

1+ measurement of AI, means?

Back 22

contrast from AO enters LV but clears with systole of each beat; of no real clinical sygnificance

Front 23

TIMI 1, what does it represent?

Back 23

very limited flow, incomplete distal filling

Front 24

In a vein graft or a free LIMA/RIMA graft the side that is attached to the aorta is known as?

Back 24

the "Origin"

Front 25

Stroke Volume (SV) formula

Back 25

SV = EDV - ESV
measure in milliliters (ml)

Front 26

2+ measurement of MR means?

Back 26

contrast from LV enters LA during eaxh diastole but fails to clear fully with systole of each beat; moderate clinical significance

Front 27

List the indications for Coronary Artery Bypass Graft (CABG) surgery

Back 27

- severe multi-vessel CAD
- diabetics with moderate-severe disease
- LM disease >50%
- need for valvular repair/replacement surgery

Front 28

Name the different ways a Regional Wall Motion can be define

Back 28

Normal,
Global hypokinesis (hypokinesis)
Regional Hypokinesis (asyneresis)
Akinesis
Dyskenesis
Asynchrony

Front 29

If the Innominate Artery arises from: below bottom plane of aortic arch, which aortic arch type is it?

Back 29

Type III

Front 30

TIMI 3, what does it represent?

Back 30

normal flow and washout, all anatomy seen

Front 31

3+ measurement of MR means?

Back 31

contrast from LV fills entire LA; LA and LV seen as equal density; entire atrium (but not pulmonary veins) are seen; moderately severe clinical significance

Front 32

2+ measurement of AI means?

Back 32

contrast from AO enters LV during each diastole but fails to clear fully with systole of each beat; moderate clinical significance

Front 33

Which arteries are use for an arterial bypass graft?

Back 33

- Internal Mammary Arteries (LIMA/RIMA)
- Radial Arteries

Front 34

In which projection is the Circumflex/OMB and grafts better viewed?

Back 34

Primarily Caudal views

Front 35

0+ measurement of MR means?

Back 35

normal flow across valve

Front 36

what might happen if catheter placement is too high?

Back 36

it might induced AI

Front 37

How is the Aortic Arch Type determined?

Back 37

based on where the Innominate Artery arises from

Front 38

Explain how an Internal Mammary Artery graft is done

Back 38

Usually a LIMA/RIMA used, separated from chest wall, leave proxumal end on Subclavian Artery, attached distal end to coronary artery below blockage

Front 39

In which projections are the RCA/PDA better viewed?

Back 39

Same as for the Native RCA
(LAO = "C" shape, RAO = "L" shape)

Front 40

What is the life expectancy of a Saphenous Vein Bypass Graft (SVBG)?

Back 40

average life 9-10 years
- they fill with "grumus" and become dysfunctional

Front 41

If image intensifier is above the head, which view is it?

Back 41

cranial

Front 42

Benefit of Radial arteries bypass graft?

Back 42

dual blood supply

Front 43

This is the amount of time the machine takes to reach chosen psi. if gove , will usually be a decimal

Back 43

Rise

Front 44

this involves the entire circumference of the vessel segment, resulting in a cylindroid dilatation in that segment

Back 44

Fusiform aneurysm

Front 45

0+ of AI measurement, means?

Back 45

normal flow across valve

Front 46

What is a free graft?

Back 46

when an artery/vein is removed from a different part of the body and attached to disease artery

Front 47

Name types of aneurysms

Back 47

Saccular, Fusiform, and Ruptured

Front 48

If image intensifier is above abdomen/pelvis, which image is it?

Back 48

caudal

Front 49

which artery usually lies closest to the spine?

Back 49

circumflex

Front 50

TIMI 0, what does it represent?

Back 50

no flow, completely occluded vessel

Front 51

What are the important factors before using a pressure injector?

Back 51

volume, rates and "rise"

Front 52

when can the pressure injector be used?

Back 52

can be used to image any chamber/vessel in circulatory system, arterial or venous

Front 53

4+ measurment of AI, means?

Back 53

most of contrast from AO enters LV during diastole; density of LV is greater than AO; all of LV seen; severe clinical significance

Front 54

Describe concentric lession

Back 54

entire circumference of arterial lumen is diseased

Front 55

what is the Rate (ml/sec) for LV/AO injection?

Back 55

usually around 10-20 ml/sec for LV/AO

Front 56

In a vein graft or free LIMA/RIMA graft, this side of the graft connects to the disease artery

Back 56

Anastamosis

Front 57

In this view, this artery, lies to the left

Back 57

LAO, LAD

Front 58

what is the best position for catheter for LV/AO gram?

Back 58

*acoid papillary muscles
* does not i terfere with miteal valve function
* as close to apex as possible

Front 59

If the Innominate Artery arises from: between top and bottom of aortic arch, which aortic arch type is it?

Back 59

Type II

Front 60

Is an aortogram used to determine the presence of Aortic Stenosis (AS)?

Back 60

No

Front 61

how do you measure Mitral regurgitation?

Back 61

In a 0+ - 4+ scale

Front 62

If the Innominate Artery arises from: on top plane of aortic arch, which type of aortic arch is it?

Back 62

Type I

Front 63

In RAO, the apex of the heart points to?

Back 63

Right of screen

Front 64

What is a Jump-Graft?

Back 64

a graft that covers 2+ arteries, it has a side-to-side and end-to-side anastamosis

Front 65

How do you assess coronary blood flow?

Back 65

using the TIMI scale (thrombosis in MI)

Front 66

List the indications for an LV-gram

Back 66

- evaluate for MR & AI
- demonstrate VSD ot other congenital heart defects
- evaluate for the presence of cardiomyopathy
- determine regional wall motion abnormality
- acquire angiographic data (SV, CO)
- determine presence of ventricular aneurysm or tumor

Front 67

what might happen if catheter placement is too low?

Back 67

it may produce arrhythmias

Front 68

Ejection Fraction (EF) formula

Back 68

EF = {EDV-EDS/EDV} x 100

example: {150ml-70ml/150ml} x 100 = 53%

Front 69

What should you look for during angiography in a patient with SVBG's?

Back 69

- TIMI flow rating
- Competitive Flow
- Occlusions or lessions

Front 70

What might you see during angiography if the patient has SVBG's?

Back 70

graft markers may be seen

Front 71

In which projection are the LAD/Diagonals and grafts better viewed?

Back 71

Primarily Cranial views

Front 72

What is a benefit of an arterial graft vs a vein graft?

Back 72

arterial bypass graft last longer

Front 73

What is the general accepted threshold for percutaneous coronary intervention?

Back 73

70% stenosis

Front 74

4+ measurement of MR means?

Back 74

most contrast from LV enters LA during diastole; demsity in LA is greater than LV; pulmonary veins are seen; Severe clinical significance

Front 75

this aneurysn is roynded berry like outpouching that may arises from arterial bifurcations

Back 75

Saccular aneurysm

Front 76

Which radial artery may be use first for an arterial bypass graft?

Back 76

usually the one in the non-dominant arm is taken first

Front 77

This angiography assessment of angiogram is "objective"

Back 77

Quantitative

Front 78

Type of catheters used for LV/AO-gram

Back 78

* pigtail (straight or angled, with side holes)
* multi-purpose (with side holes)
* radial catheters

Front 79

In LV/AO injection, this is the smaller of the two numbers given

Back 79

Rate

Front 80

Name the walls seen when assessing regional ventricular function in RAO

Back 80

anterobasal,
anterolateral,
apical,
diagphragmatic,
posterobasal

Front 81

what is the volume for LV/AO injection?

Back 81

usually around 20-40 ml volume for LV/AO

Front 82

List Vein sections from inside out

Back 82

lumen
tunica intima
tunica media
tunica adventitia