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ABIM Interventional Cardiology study materials
ABIM Interventional Cardiology study resources

ABIM Interventional Cardiology: Hemodynamics, Invasive Assessment, and Vascular Access

ABIM Interventional Cardiology · Work through your exam, one topic at a time.

All guide sections

Hemodynamics, Invasive Assessment, and Vascular Access

Core concepts

Master pressure tracings: aortic, LV, and simultaneous LV-aortic for aortic stenosis (peak-to-peak gradient, valve area by Gorlin). Know cardiac output measurement (Fick, thermodilution), shunt detection (step-up in oximetry), and pulmonary hypertension classification. Understand FFR/iFR and hyperemic agents (adenosine). Know vascular access: radial-first strategy reduces bleeding and access-site complications; ultrasound guidance improves success. Understand sheath sizing, closure devices, and access-site hemostasis. Know how to interpret right heart catheterization data: RA pressure, PCWP, cardiac index, PVR, and transpulmonary gradient.

Traps

  • Using a single pressure tracing to grade aortic stenosis; need simultaneous LV-aortic.
  • Confusing pre-capillary (PVR elevated, PCWP normal) with post-capillary pulmonary hypertension.
  • Forgetting to check for a step-up in oxygen saturation when a shunt is suspected.
  • Missing radial artery spasm or occlusion after transradial access.
  • Overlooking that FFR requires maximal hyperemia; submaximal hyperemia underestimates severity.

Rule of thumb

Radial-first for most PCIs. For aortic stenosis, measure simultaneous LV and aortic pressures; a mean gradient ≥40 mmHg with symptoms generally indicates severe AS. Pre-capillary PH: PVR >3 Wood units with PCWP ≤15 mmHg.

Worked example

A patient has PCWP 12 mmHg, mPAP 40 mmHg, PVR 6 Wood units. This is pre-capillary pulmonary hypertension (normal wedge, elevated PVR). If PCWP were 22 mmHg, it would be post-capillary.