Rcis Study Angiographic Views, Coronary Anatomy

Front 1

***1. When do the coronary arteries fill/perfuse

Back 1

During ventricular diastole

Front 2

2. Which coronary arteries run thru the right and left AV (atrial ventricular) grooves?

Back 2

RCA and CX

Front 3

3. Name the coronary artery that runs down the interventricular Septum

Back 3

LAD

Front 4

4. True or False: the Diagonal branches supply the Anterior Lateral free wall of the left ventrical

Back 4

True

Front 5

***5. True or Flase: The obtuse Marginal (OM) supplies the lateral free wall of the LV ?

Back 5

TRUE

Front 6

6. The primary Pathways of collaterals for the LAD?

Back 6

LAD or its branches collateralize to the PDA, also the PDA will collateralize the LAD

Front 7

7. The primary Pathways of collaterals for the RCA

Back 7

RCA to CX
or CX to Distal RCA

Front 8

8. True or False
A Significant Lesion in the Native Vessel is where collaterals come in to play

Back 8

True

Front 9

9. True or False Cannulation of the RIMA may be difficult because of the need to avoid the right internal Carotid artery

Back 9

True

Front 10

***10. True or False: In patients with a short or narrow aortic root, a 3.5mm tip catheter may be needed

Back 10

true

Front 11

12. True or False: Most common grafts to the LCA arise from the LEFT anterior surface of the aorta?

Back 11

True

Front 12

13. True or False Grafts to the RCA usually originate from the RIGHT anterior surface of the aorta?

Back 12

True

Front 13

14. Do the RCA and CX run between the AV Sulcus or the intraventricular sulcus?

Back 13

The AV (atrial ventricular) sulcus.

Front 14

15. True or False
The Conus Branch supplies the RV outflow tract and is the first branch off of the RCA.

Back 14

TRUE

Front 15

16. The Acute Marginal supplies the free wall of the LV True or False

Back 15

False- the Acute marginal branch comes off the RCA and supplies the right ventricular free wall.

Front 16

17. Where do you mostly see dampening?

Back 16

During Right Coronary Artery injection.

Front 17

18. Hand held flow rates (not using a power injector) are how many ml/sec?

Back 17

2-4ml/sec

Front 18

19. How many ml are needed to fill the RCA with contrast?

Back 18

4-8 ml are needed to fill the RCA

Front 19

20. Where do you mostly see Ventricularization?

Back 19

During left coronary artery injections.

Front 20

21. How many ml are needed to fill the LCA?

Back 20

7-10ml

Front 21

22. A frame rate of ____ frames/sec is commonly used?

Back 21

30 fps

Front 22

23. The ideal maximim contrast volume ot be given to the patient is?

Back 22

3ml/kg

Front 23

24. A patient weighing 100kg, what is the ideal maximum amount of contrast to be given?

Back 23

300ml

Front 24

25. Ventricular arrythmias are most common during the injection of whch coronary artery?

Back 24

RCA

Front 25

26. ****How many mm in diameter is a 6 french catheter?

Back 25

2.0mm

Front 26

27. ***How many mm in diameter is an 8 french catheter?

Back 26

2.6mm

Front 27

28.How many mm in diameter is the Left main?

Back 27

4.5mm

Front 28

29. How many mm in diameter is the Circ?

Back 28

3.4mm

Front 29

30. How many mm in diameteris the RCA?

Back 29

2.8mm

Front 30

31. In terms of RAO and LAO the R and the L refer to what?

Back 30

The position of the image intensifier

Front 31

32. Osmolality refers to the ability of the contrast to:

Back 31

Pull fluid into the intravascular space

Front 32

33. The Contrast that is best for a patient is:

Back 32

low osmolality

Front 33

34. ***What is the best view to see the LAD and CX bifurcation

Back 33

Spider View

Front 34

35. ****Spider view

Back 34

50-60 degrees LAO and 10 to20 degrees caudal (spider view)

Front 35

36. Typical settings for power injections of the RCA are____ml/sec and____psi?

Back 35

RCA: 6 ml at 3 ml/sec; maximal psi 450

Front 36

37. Typical settings for power injections of the LCA are_____ml/sec and ____psi?

Back 36

LCA: 10 ml at 4 ml/sec; maximal psi 450

Front 37

38. The absence of reflux of contrast media into the aortic root on left coronary injection is associated with_______ stenosis

Back 37

Ostial (LMCA) left main stenosis

Front 38

39.**** Starting most medial, name the location of the femoral vessels and nerve.

Back 38

Vein, artery ,nerve

Front 39

40. ****Starting laterally, the mnemonic for femoral artery location is NAVL.What does each letter represent?

Back 39

Nerve, Artery, Vein, empty space Lymphatics (deep inguinal lymph nodes are medial to the vein)

Front 40

41.****True or False
In obese patients the inguinal skin crease may be lower than the inguinal ligament so locating the middle of femoral head (medial aspect) under x-ray and marking it with a hemostat, provides a good landmark for arterial puncture.

Back 40

True

Front 41

42. ***Femoral puncture for arterial access should be made above or below the inguinal crease?

Back 41

1-2cm Below the inguinal crease

Front 42

43. ***True or False In the inguinal ligament lies directly below the inguinal skin crease?

Back 42

True

Front 43

44. The _______ artery is the target entry point for femoral arterial access.

Back 43

Common Femoral Artery

Front 44

45. The common femoral artery is located above the bifurcation of what two branches?

Back 44

Profunda and superficial femoral branches

Front 45

46. True or false
VCD's (vascular closure devices) should be used with caution or not at all in patients with a low arterial puncture (at or below the femoral bifurcation).

Back 45

True

Front 46

47.***Wire contact with blood forms thrombi despite anticoagulation. The operator should limit wire-loaded catheter manipulations to _____ minutes, maintain adequate activated clotting time (ACT) and use a meticulous flush technique.

Back 46

2-3minutes

Front 47

48. True or False
The most common complication of femoral cardiac catheterization is hemorrhage and local hematoma formation?

Back 47

True

Front 48

49. True or False
Infections are more common in patients who undergo repeat ipsilateral (same site) femoral punctures or prolonged femoral sheath maintenance (within 1 to 5 days).

Back 48

True

Front 49

50. ***Pseudoaneurysm is associated with low or high femoral arterial puncture?

Back 49

LOW
(usually below the head of the femur).

Front 50

51. ***Two physical findings when diagnosing a Pseudoaneurysm include:

Back 50

1. pulsatile mass ( a pulsatile hematoma)
2. audible systolic bruit

Front 51

52. Name three operator factors that may lead to a psiedoaneurysm formation.

Back 51

1. multiple sheath exchanges,
2. poor hemostasis during the procedure or after catheter removal
3.puncture placed too low (below the common femoral artery, in the superficial or profunda femoral artery)

Front 52

53. ***Name at least 4 Predisposing patient factors that may lead to pseudoaneurysm formation include:

Back 52

1. anticoagulation
2. age greater than 70
3. female gender
4. low platelet count,
5.. hypertension
6.. atherosclerosis
7.. aortic insufficiency

Front 53

54. ***The treatment for pseudoaneurysm?

Back 53

Manual compression of the expansile growing mass guided by Doppler ultrasound with or without thrombin or collagen injection is an acceptable therapy for femoral pseudoaneurysm

Front 54

55. ***Contrast media is radiopaque because it blocks or absorbs x-ray?

Back 54

Contrast media absorbs X-ray

Front 55

56. Risk of death from heart catheterization is ?

Back 55

Less than 0.2%

Front 56

57.***The correct steps of opening a sterile instrument tray when preparing a sterile table include:

Back 56

1. open the first flap away from you careful not to touch the inside of the flap
2. next open the flaps on the sides individually
3. then the final flap is open towards you

Front 57

58.***When holding pressure on an arterial sheath, it is important to hold pressure in what location?

Back 57

2-3 cm or 1 inch above the skin puncture site

Front 58

59. true or false
When holding manual pressure, hold 3 minutes per french size for arterial site and 2 minutes per french size for venous sites.

Back 58

True

Front 59

60. true or false
Diabetic patients with preexisting renal insufficiency are particularly prone to develop contrast induced renal failure.

Back 59

True

Front 60

61.
Recommended Pre procedural IV hydration for renal insufficiency

Back 60

1ml/kg of NS or .45NS for 12 hours before and after the procedure

Front 61

62. True or False
In patients with CKD (Chronic Kidney disease) with a creatinine clearance less than 60ml/min or a creatinine >1.5, the volume of contrast media should be minimized

Back 61

True

Front 62

63. A Sodium Bicarb drip given for Renal insufficiency, What is the rate pre and post procedure?

Back 62

Initial intravenous (IV) bolus of 3 ml/kg/hr for 1 hour immediately before contrast followed by a rate of 1 ml/kg/hr during the contrast exposure and for 6 hours after the procedure)

Front 63

64.*** True or False
The use of radial artery access can be useful to decrease access site complications

Back 63

True

Front 64

65.***high femoral punctures have an increased risk of________?

Back 64

Retroperitoneal hemorrhage.

Front 65

66. True or False

In patients with a synthetic graft, arterial access is possible after the graft is a few months old and complication rates are not increased.

Back 65

True

Front 66

67. Name three conditions in which the Radial artery approach is especially appealing?

Back 66

1. Morbidly Obese patients
2. Patients with a coagulopathy or Patients with an elevated PT/INR from coumadin therapy
3. Patients with PVD

Front 67

68. ***What is the intent of the time-out?

Back 67

The intent of the time-out is for all members of the team to improve patient care by collectively discussing the case.

Front 68

69. The content of a time-out must include a minimum of 5 things, name them.

Back 68

1.confirmation of the correct patient
2.correct side and site
3.agreement on the procedure to be performed
4. correct patient position,
5. availability of needed equipment, supplies, and implants.

Front 69

70. The risk of stent thrombosis is greatest within the first __ days after implantation.

Back 69

30 days

Front 70

71. True or False
The use of Dual antiplatelet therapy is required for 30 days after implantation of BMS (bare metal stent)

Back 70

True

Front 71

72. The biggest cause for DES (drug eluding stent) thrombosis is?

Back 71

Early discontinuation of DAPT(dual antiplatelet therapy)
asa and plavix or asa and effient

Front 72

73. True or False
EDP's (embolic protection device)
ie: Filterwire should be used during saphenous vein graft (SVG) PCI when technically feasible.

Back 72

True

Front 73

74. Patients undergoing cardiac catheterization with contrast media should receive adequate pre procedural hydration

Back 73

1.0 to 1.5 mL/kg per hour for 3 to 12 hours before the procedure and continuing for 6 to 24 hours after the procedure

Front 74

75.***A patient has developed a pericardial tamponade during a myocardial bx. procedure.
What area of the chest should be prepped urgently to peform a pericardialcentesis?

Back 74

subxyphoid area

Front 75

76.*** When starting an IV on a patient for a procedure, supplies include
IV catheter, skin disinfectant, cap, flush and:
a. Blood tubing and an IV pump
b. Sterile dressing with date
c. Blood tubing and tape
d. Paper tape to secure directly over the insertion site

Back 75

b. Sterile dressing with date

Front 76

77. Which of the following is not a sign of a potential airway problem?
a) Stridor
b) Hx of sleep apnea
c) Hypertension
d) Obesity

Back 76

c) Hypertension

Front 77

78. *** The femoral vein is ____ to the femoral artery
a) lateral
b) caudal
c) medial
d) inferior

Back 77

c) medial

Front 78

79. ***If a patient has an AV fistula, dialysis shunt in the right arm, what should be done to perform a radial artery approach?

Back 78

Go to the contralateral side (left radial)

Front 79

80. ***The Seldinger technique employs all the following except:
a) Lumenless needle
b) wire
c) sheath
d) dilator

Back 79

a) Lumenless needle

Front 80

81. ***Patient and family support mechanisms include
a) newsletter
b) support groups
c) educational pamphlets
d) all the above

Back 80

d) all the above

Front 81

82.***When an 18G Cook needle is used to puncture the the front wall of the artery, This technique is known as the ______ technique and prevents posterior arterial bleeding or venous communication from the puncture.

Back 81

Modified Seldinger

Front 82

83. What radiologic view is usually best to image the normal origin of the right coronary ostiuim.

Back 82

30-40 degree LAO

Front 83

84. ***During arterial puncture, the Pt. becomes brady, hypotensive, sweaty, nauseated.
What is happening?

Back 83

Vagal response

Front 84

85. ***How do you treat a Vagal response?

Back 84

Atropine 0.5mg-1.0mg IV, IVF bolus

Front 85

86.***True or False
After injection of the RCA it is normal to get transient hypotension and bradycardia, no need to treat.

Back 85

True

Front 86

87. Hints for identifying vessels
If the spine is on the right it is an ____ view

Back 86

LAO

Front 87

88. If the spine is on the left it is and ____ view

Back 87

RAO

Front 88

89. The ____will always be next to the spine.

Back 88

CX

Front 89

90. The LAD is on the _____ in RAO.

Back 89

Right

Front 90

91. The LAD is on the ____ in LAO.

Back 90

Left

Front 91

92. The Apex points to the ____ in LAO

Back 91

Left

Front 92

93. The Apex points to the ____ in RAO.

Back 92

Right

Front 93

94. ***When doing an LV gram 40ml
@10ml/sec
What is the total time in seconds of the angiogram.

Back 93

4 seconds

Front 94

95. When attempting to engage the right catheter,advance it to the right coronary cusp (facing the left cusp) and rotate it _______to engage the ostium of the RCA.

Back 94

Clockwise

Front 95

96. What is the best view to check for aortic dissection ?

Back 95

LAO, LAO Cranial

Front 96

97. In general , cranial angulation is good for visualizing ____ segments of a vessel

Back 96

Distal

Front 97

98. In general , caudal angulation is good for visualizing ____ segments of a vessel

Back 97

Proximal