ABIM Interventional Cardiology flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Fractional flow reserve threshold
- FFR ≤0.80 indicates a hemodynamically significant lesion warranting revascularization; measured during maximal hyperemia, typically with intravenous or intracoronary adenosine.
- iFR threshold
- Instantaneous wave-free ratio ≤0.89 identifies significant stenosis without hyperemia; measured during the diastolic wave-free period.
- Minimum stent area
- An IVUS-derived minimum stent area below 5.0 mm² (5.5 mm² in left main) predicts restenosis and stent thrombosis after PCI.
- Primary PCI timing
- Primary PCI should be performed within 120 minutes of first medical contact for STEMI; door-to-balloon ≤90 minutes at PCI-capable centers.
- Right ventricular infarction management
- Suspect with inferior STEMI, hypotension, and clear lungs; treat with volume loading and avoid nitrates and diuretics.
- High-sensitivity troponin rule-out
- A single high-sensitivity troponin below the limit of detection with symptoms >3 hours can rule out acute MI using validated 0/1-hour algorithms.
- Severe aortic stenosis criteria
- Aortic valve area <1.0 cm², mean gradient ≥40 mmHg, or peak velocity ≥4.0 m/s defines severe aortic stenosis by echocardiography.
- TAVR versus surgery
- TAVR is preferred over surgical AVR in patients ≥80 years or with prohibitive or high surgical risk; shared decision-making applies to intermediate risk.
- Paravalvular leak after TAVR
- Mild or greater paravalvular leak after TAVR is associated with increased mortality; assess with echocardiography and consider balloon post-dilation.
- Ankle-brachial index
- An ABI ≤0.90 diagnoses peripheral artery disease; values >1.40 suggest noncompressible calcified vessels requiring further evaluation.
- Chronic limb-threatening ischemia
- Rest pain, ulceration, or gangrene with objective evidence of arterial insufficiency defines chronic limb-threatening ischemia; requires urgent revascularization.
- Iliofemoral DVT management
- Iliofemoral DVT with phlegmasia cerulea dolens warrants catheter-directed thrombolysis or thrombectomy plus anticoagulation to prevent post-thrombotic syndrome.
- Cardiac index in shock
- Cardiac index <2.2 L/min/m² with elevated filling pressures defines cardiogenic shock in the catheterization laboratory.
- Transpulmonary gradient
- Transpulmonary gradient = mean pulmonary artery pressure − pulmonary capillary wedge pressure; >12 mmHg suggests pre-capillary pulmonary hypertension.
- Pulmonary vascular resistance formula
- PVR = (mean PA pressure − PCWP) / cardiac output; normal is <3 Wood units.
- Femoral puncture landmark
- Fluoroscopic landmark at the inferior border of the femoral head; avoid punctures above the inguinal ligament or below the femoral bifurcation.
- Heparin ACT target for PCI
- ACT target 250–300 seconds for PCI without glycoprotein IIb/IIIa inhibitor; 200–250 seconds with one.
- Bivalirudin use
- Bivalirudin is a direct thrombin inhibitor with predictable pharmacokinetics; preferred in heparin-induced thrombocytopenia during PCI.
- Cangrelor characteristics
- Cangrelor is an intravenous, reversible P2Y12 inhibitor with rapid onset and offset, useful when oral absorption is unreliable.
- Contrast-induced nephropathy definition
- Defined as a rise in serum creatinine ≥0.3 mg/dL or ≥50% within 48–72 hours of contrast exposure.
- No-reflow phenomenon
- Impaired myocardial perfusion after PCI despite epicardial patency; treated with intracoronary adenosine, verapamil, or nicardipine.
- Radiation deterministic threshold
- Radiation skin injury thresholds begin around 2 Gy; fluoroscopy time and dose-area product should be tracked for long procedures.
- Coronary air embolism treatment
- Treat with 100% oxygen, Trendelenburg position, and aspiration through the catheter; supportive care for arrhythmias.
- Optical coherence tomography resolution
- OCT provides higher resolution than IVUS (10–20 µm) but limited penetration; useful for plaque characterization and stent strut assessment.
- Intravascular ultrasound guidance
- IVUS provides cross-sectional vessel and plaque imaging; guides stent sizing and detects underexpansion, dissection, and malapposition.
- FFR and iFR discordance
- Discordance between FFR and iFR occurs in about 15–20% of lesions; repeat measurement or use an alternate index when discordant.
- Balloon aortic valvuloplasty role
- Balloon aortic valvuloplasty is a temporizing measure for severe aortic stenosis in patients who are not candidates for TAVR or surgery.
- Bicuspid aortic valve TAVR risk
- Bicuspid aortic valve anatomy increases risk of paravalvular leak and annular injury during TAVR; CT sizing and valve selection are essential.
- Radial artery occlusion prevention
- Radial artery occlusion incidence is reduced with patent hemostasis technique and adequate anticoagulation; assess with reverse Barbeau test.
- Femoral closure device contraindications
- Contraindicated in small vessels, severe calcification, or access above the inguinal ligament; include collagen plug, suture-mediated, and clip-based systems.
- Retroperitoneal hemorrhage signs
- Suspect with hypotension, flank pain, and dropping hemoglobin after femoral access; CT confirms diagnosis and treatment may require coil embolization or surgery.
- Radial access spasm prevention
- Prevented with hydrophilic sheath, intra-arterial vasodilators (nitroglycerin, verapamil), and gentle catheter manipulation.