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In normal fetal circulation the path of oxygenated blood returning from the placenta passes though several fetal shunts. One of these normal fetal pathways between the aorta and PA can be described as a: a- L>R shunt termed the PDA b- R>L shunt termed the PDA c- L>R shunt termed the foramen ovale d- R>L shunt termed the foramen ovale - ✔✔the PA-AO shunt is the PDA and its right to left. When the left heart pressure begins to exceed the right heart pressure, that such a shunt would switch to left to right What is the name of the coronary arteries which normally branch off the Cx artery towards the apex of the heart? a- diagonal branches b- OM branches c- acute marginal branches d- posterior descending branches - ✔✔The left sided AV groove artery is the Cx and its branches are termed OMs The aortic dicrotic notch marks the beginning of ventricular: a- systole b- isometric relaxation c- end diastolic pressure d- slow filling phase - ✔✔B. The systolic pulse is divided by a midsystolic dip indicating a sudden ejection followed by increased resistance and then secondary release. End-diastolic stretching of the ventricular muscle fibers is termed: a- preload b- afterload c- inotropism
d- chronotropism - ✔✔Preload refers to the filling of the ventricular chambers in diastole The greatest expenditure of O2 during the cardiac cycle is used to: a- open the aortic valve (isometric contraction) b- open the mitral valve (diastolic filling) c- eject blood out of the LV and into the AO (SEP) d- overcome friction of blood viscosity and muscle compliance - ✔✔A. One of the chief benefits of IABP is to lower the pressure at which the aortic valve opens, which decreases pressure work. This pressure work account for 90% of the work done by the LV Which of the following is a common result of right sided heart failure? a- dyspnea b- pulmonary congestion c- pulmonary hypertension d- neck vein distension - ✔✔When the right side of the heart fails the RA and systemic veins become engorged with blood. Pulmonary hypertension is only a compensation to left sided failure Which of the following is NOT a clinical manifestation of shock? a- pallor b- metabolic acidosis c- slow bounding pulse d- falling blood pressure - ✔✔Slow bounding pulse. Tachycardia usually results to compensate for decreased tissue perfusion If an embolus were to lodge in the distal RCA at the crux, which segment of the heart would suffer damage? a- RV b- inferior LV wall c- anterior LV wall d- posterior lateral LV wall - ✔✔Inferior infarctions usually result from RCA infarction. The distal RCA feeds the lower 1/3 of the IV septum and the inferior aspect of the LV depending on the extent of posterior lateral RV branches
b- RA rises and PW falls c- RA falls and PW falls d- RA falls and PW rises - ✔✔In tamponade all venous pressures rise What type of chamber enlargement is associated with MR? a- LA dilation b- LA hypertrophy c- LV dilation d- LV hypertrophy - ✔✔LA Dilation. Regurgitation of a valve leads to dilation fo the chamber upstream, while stenosis of a valve leads to hypertrophy of the chamber upstream Following a cath lab cardiac arrest and resuscitation a pt's arterial blood gases are as follows: pH-7.3, PCO2-52, pO2- 96. The most probable acid base diagnosis is: a- pure respiratory acidosis b- pure metabolic acidosis c- compensated respiratory acidosis d- partially compensated respiratory acidosis - ✔✔Pure respiratory acidosis. The pH is acid (down .10) while the Co2 is up 12. When this ratio is kept around (.10:10) the bicarb and BE remain normal indicating a pure respiratory component When a patient with COPD comes for a heart cath which of the following sets of blood gases represent a situation in which giving high concentrations of oxygen would be dangerous? a- pO2-55, pCO2- 36 b- pO2-55, pCO2- 62 c- pO2-65, pCO2- 28 d- pO2-65, pCO2- 42 - ✔✔B. Its the high CO2s and acidotic pH that indicates a chronic lunger who has lost his normal CO2 drive to breath due to chronic high CO2s How long is the standard femoral LV pigtail catheter? a- 100 cm b- 110 cm c- 125 cm
d- 145 cm - ✔✔Most doctors use 110 cm LV catheters due to the longer distance the catheter must traverse. (coronaries are usually only 100 cm) Which of the following is a relative contraindication for a heart cath, and should be brought to the catheterizing doctors attention before he begins the case? a- 4 PVCs/min b- hypotension (98/70) c- hypokalemia d- compensated CHF - ✔✔Hypokalemia is a contraindication leading to arrhythmia can usually be corrected prior to cath What french size is a catheter with a diameter of 2.66mm? a- 5 Fr b- 6 Fr c- 7 Fr d- 8Fr - ✔✔8 Fr. Each french size is 1/3 of a mm so 6Fr=2mm, 9Fr=3mm. The IMA catheter looks similar to what other catheter? a- MPA b- Arani- double loop c- Judkins left coronary d- Judkins right coronary - ✔✔IMA is like a JR catheter with a more angulated primary bend In relationship to the femoral artery, the femoral vein lies: a- superior b- inferior c- medial d- lateral - ✔✔Remember NAVL, landmarks for the right groin are Nerve, Artery, Vein, Ligament Transseptal heart caths utilizes all of the following EXCEPT: a- brockenbrough catheter
What angiography best diagnoses a VSD? a- RV gram in RAO b- RV gram in LAO c- LV gram in RAO d- LV gram in LAO - ✔✔LV gram injection in LAO because they are usually a L-R shunt. The best view is LAO because it arranges the 2 ventricles so they do not overlap, and the shunt can be seen connecting the 2 adjacent chambers Which type of angiogram would be most likely to define mitral insufficiency due to a flail leaflet: a- aortic root, LAO b- aortic root, RAO c- LV gram, LAO d- LV gram, RAO - ✔✔LV gram in RAO, Use RAO to see the valve on edge and the LA and LV where they dont overlap In an person with a horizontal heart what fluoro view best defines the area where the LM bifurcates into the LAD and Cx coronary arteries: a- cranial RAO b- cranial LAO c- caudal RAO d- caudal LAO - ✔✔Caudal LAO (spider view) What ECG change is seen on lead II immediately after injecting the RCA with angiographic dye? a- t wave inversions b- elevated t waves c- ST elevation d- tachycardia - ✔✔t wave inversions. Like an inferior infarction leads II, III, and aVF best show the inverted T waves and injury changes VT may be mimicked by: a- disconnected leads
b- paroxysmal atrial tachycardia c- SVT with aberrancy d- mobitz II block with rapid ventricular response - ✔✔SVT with aberrancy. VT and SVT with aberrancy are both wide complex tachycardia, but with totally implications and treatments The mean QRS axis shows left axis deviation when the majority of the QRS complex is: a- upright in lead I & upright in lead aVF b- upright in lead I & down in lead aVF c- down in lead I & upright in lead aVF d- down in lead I & down in lead aVF` - ✔✔Upright in lead I and down in lead aVF. Upright lead I means the depolarization is leftward. Down in lead aVF means the depolarization is away from the positive foot lead. Which physiologic pacemaker mode is rate responsive? A sensed P wave precedes each ventricular artifact? a- AAI b- VAT c- VVT d- DVi - ✔✔VAT is an atrial triggered ventricular pacer, an artificial AV node. This pacer requires 2 leads, one sensor in the atrium and one pacing lead in the ventricle A HIS bundle electrogram has the following measurements: AH interval= 100 ms, HV interval= 90 ms. Which diagnosis is most likely? a- BBB b- AV node disease c- SA node disease d- WPW with preexcitation - ✔✔BBB, Normal AH intervals vary from 60-140 msec and HV intervals from 30 - 55 msec. Thus the HV conduction time is prolonged indicating a delay below the His bundle where the bundle branches are Which HIS bundle electrogram most indicates the need for permanent pacemaker implantation? a- reduced AH interval b- reduced HV interval
d- decrease refractory period - ✔✔Decrease the sensitivity so that it will detect fewer and fewer QRS signals until none can be detected by the sensing amplifier. This is VOO, fixed rate, or asynchronous mode When you are monitoring the V lead ECG from a TAP needle, what ECG change will you observe when the needle touched the epicardium? a- ST elevation b- broadened QRS c- deep broad Q waves d- T wave depression - ✔✔ST elevation. Injury current monitoring can avoid accidental coronary artery laceration In a pacemaker set to DVI mode, how many chambers are sensed and paced? a- 1 chamber sensed, 1 chamber paced b- 1 chamber sensed, 2 chambers paced c- 2 chambers sensed, 1 chamber paced d- 2 chambers sensed, 2 chambers paced - ✔✔1 chamber sensed, 2 chambers paced. The D in the first position of the code indicates 2 chambers paced, atrium and ventricle. The second letter is V, indicating only the ventricle is sensed Successful defibrillation depends on all of the following EXCEPT: a- duration of V fib b- amount of chest resistance c- amount and type of electrode placement d- defibrillator electrode placement - ✔✔C. Chest resistance is reduced by electrode paste, and it is an important element is successful defibrillation. But all commercially available available pastes/pads adequately reduce skin resistance ACLS protocols recommend that the first defibrillation attempt in unconscious adults be performed at what energy level:a a- 200 - 300 watt/sec of stored energy b- 200 - 300 watt/sec of delivered energy c- 300 - 360 watt/sec of stored energy
d- 300 - 360 watt.sec of delivered energy - ✔✔B. ACLS protocols not recommend starting lower than maximum, or around 200-300 joules. Then increasing to 360 later What is the average 6 month restenosis rate in coronary angioplasty patients? a- 1% b- 5% c- 15% d- 30% - ✔✔30%. 1/3 of patients return within 6 months due to restenosis of the angioplastied lesion When advancing a PTCA balloon dilation catheter into a "shepards crook" right coronary artery the guiding catheter frequently backs out of the coronary ostium. What term describes this problem? a- torque loss b- power failure c- deep throating d- coaxial engagement - ✔✔B. This backing out problem requires stronger guiders, deep seating and buttressing to hold the guider in place How would you assure the best blood flow through a perfusion balloon? a- expand the balloon to less than 6 atm and advance the wire tip to the distal vessel b- expand the balloon to more than 6 atm and advance the wire tip to the distal vessel c- expand the balloon to less than 6 atm and pull back the wire tip 2-3 inches into the catheter d- expand the balloon to more than 6 atm and pull back the wire tip 2-3 inches into the catheter - ✔✔C. Expand the balloon to less than 6 atm so that it does not collapse the inner lumen where he blood flow occurs. Also pull back the wire tip 2-3 inches into the catheter so it will not interfere with blood perfusion through the same lumen What type of valvuloplasty requires two balloons (or a single Inoue balloon) through a transseptal technique? a- aortic b- mitral c- pulmonic d- tricuspid - ✔✔Mitral valvuloplasty
a- .5 sq cm b- 1.0 sq cm c- 1.5 sq cm d- 3.5 sq cm - ✔✔< 1.0 sq cm is the critical mitral valve size, where symptoms begin and surgery should proceed The systolic ejection time for the aortic valve area calculation may be measured between the: a- AO dicrotic notch to next AO upstroke b- AO upstroke to next dicrotic notch c- ECG R wave to next AO dicrotic notch d- AO dicrotic notch to next ECG R wave - ✔✔B. Systolic ejection time is between aortic opening and aortic closure. These times are measured after shifting the aortic pressure and superimposing it accurately on the LV tracing. It should be measured horizontally between pressure crossover points
