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ARRT Cardiac-Interventional Radiography study materials
ARRT Cardiac-Interventional Radiography study resources

ARRT Cardiac-Interventional Radiography practice questions

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Question 1Cardiac Anatomy and Physiology

Which coronary artery supplies the anterior two-thirds of the interventricular septum?

  1. Acute marginal
  2. LAD Correct answer.
  3. LCx
  4. RCA

Explanation

Septal perforator branches of the left anterior descending artery penetrate the septum and supply its anterior two-thirds, along with the anterior wall of the left ventricle. The posterior third of the septum is supplied by the posterior descending artery instead.

Question 2Cardiac Anatomy and Physiology

The normal intrinsic pacemaker of the heart is the

  1. Purkinje fibers
  2. AV node
  3. Bundle of His
  4. SA node Correct answer.

Explanation

The sinoatrial node has the fastest spontaneous depolarization rate of the conduction system, so it normally sets the rhythm at 60 to 100 beats per minute. Lower pacemakers fire only when the sinus node fails or conduction is blocked.

Question 3Cardiac Anatomy and Physiology

Which chamber of the heart has the thickest myocardial wall?

  1. Right ventricle
  2. Right atrium
  3. Left atrium
  4. Left ventricle Correct answer.

Explanation

The left ventricle pumps against systemic arterial pressure, so its myocardium hypertrophies to roughly three times the thickness of the right ventricular wall. The atria work at low pressure and have thin walls.

Question 4Cardiac Anatomy and Physiology

The valve situated between the left atrium and the left ventricle is the

  1. Aortic valve
  2. Mitral valve Correct answer.
  3. Pulmonary valve
  4. Tricuspid valve

Explanation

The mitral valve is a bileaflet atrioventricular valve that guards the left atrial outlet into the left ventricle. It prevents backflow into the left atrium during ventricular systole.

Question 5Cardiac Anatomy and Physiology

Deoxygenated blood leaves the right ventricle through which vessel?

  1. Superior vena cava
  2. Aorta
  3. Pulmonary trunk Correct answer.
  4. Pulmonary artery branches

Explanation

The pulmonary trunk arises from the right ventricular outflow tract and divides into the right and left pulmonary arteries, carrying deoxygenated blood to the lungs. Oxygenated blood then returns by the pulmonary veins.

Question 6Cardiac Anatomy and Physiology

Ventricular filling occurs during which phase of the cardiac cycle?

  1. Systole
  2. Diastole Correct answer.
  3. Isovolumetric contraction
  4. Isovolumetric relaxation

Explanation

Diastole is the relaxation and filling period, during which blood flows from the atria into the ventricles. Ventricular volume rises through rapid filling, diastasis, and the atrial kick.

Question 7Cardiac Anatomy and Physiology

Which layer of the heart generates the contractile force?

  1. Myocardium Correct answer.
  2. Pericardium
  3. Endocardium
  4. Epicardium

Explanation

The myocardium is the middle muscular layer composed of cardiac muscle fibers and is responsible for force generation. The endocardium lines the chambers and the epicardium is the outer serosal surface.

Question 8Cardiac Anatomy and Physiology

Most venous blood from the myocardium drains into the

  1. Pulmonary artery
  2. Coronary sinus Correct answer.
  3. Azygos vein
  4. Superior vena cava

Explanation

The great, middle, and small cardiac veins converge into the coronary sinus, which empties into the right atrium near the inferior vena cava. A small fraction drains by anterior cardiac and Thebesian veins.

Question 9Cardiac Anatomy and Physiology

A heart is classified as right-dominant when the posterior descending artery originates from the

  1. Right coronary artery Correct answer.
  2. Left main coronary artery
  3. Left circumflex artery
  4. Left anterior descending artery

Explanation

Dominance is defined by which artery gives rise to the posterior descending branch that supplies the inferior septum and inferior wall. The right coronary artery does so in roughly 85 percent of people.

Question 10Cardiac Anatomy and Physiology

Cardiac output is calculated by which relationship?

  1. Stroke volume multiplied by heart rate Correct answer.
  2. End-diastolic volume minus end-systolic volume
  3. Stroke volume divided by heart rate
  4. Heart rate divided by stroke volume

Explanation

Cardiac output equals the volume ejected per beat multiplied by the number of beats per minute, giving liters per minute. A typical resting value is about 5 L/min.

Question 11Cardiac Anatomy and Physiology

Within physiologic limits, an increase in ventricular preload produces which change?

  1. Increased stroke volume Correct answer.
  2. Decreased contractility
  3. Increased afterload
  4. Decreased stroke volume

Explanation

The Frank-Starling mechanism states that greater diastolic stretch of myocardial fibers increases the force of contraction and therefore stroke volume. This relationship holds until overstretch begins to impair effective contraction.

Question 12Cardiac Anatomy and Physiology

The left main coronary artery typically divides into the

  1. RCA and circumflex arteries
  2. Circumflex and acute marginal arteries
  3. LAD and circumflex arteries Correct answer.
  4. LAD and posterior descending arteries

Explanation

The left main trunk bifurcates into the left anterior descending and left circumflex arteries after a short course. In some hearts a ramus intermedius arises at the bifurcation.

Question 13Cardiac Anatomy and Physiology

Normal left ventricular end-diastolic pressure is approximately

  1. 2 mm Hg
  2. 8 mm Hg Correct answer.
  3. 35 mm Hg
  4. 20 mm Hg

Explanation

Left ventricular end-diastolic pressure normally ranges from about 5 to 12 mm Hg. Values well above this range suggest elevated filling pressures from volume overload or diastolic dysfunction.

Question 14Cardiac Anatomy and Physiology

Which structure normally delays impulse transmission between the atria and ventricles?

  1. Sinoatrial node
  2. Purkinje network
  3. AV node Correct answer.
  4. Bundle of His

Explanation

Slow conduction through the AV node creates a delay of roughly 0.1 second that allows the atria to finish emptying before ventricular contraction. This delay is also why the PR interval appears on the ECG.

Question 15Cardiac Anatomy and Physiology

Papillary muscles and chordae tendineae are components of which valves?

  1. Aortic and mitral valves
  2. Pulmonary and tricuspid valves
  3. Aortic and pulmonary valves
  4. Mitral and tricuspid valves Correct answer.

Explanation

The two atrioventricular valves are anchored by chordae tendineae to papillary muscles, which prevent leaflet prolapse during systole. Semilunar valves have no such anchoring apparatus.

Question 16Cardiac Anatomy and Physiology

The acute marginal branch supplies the right ventricle and arises from the

  1. Left anterior descending artery
  2. Left main coronary artery
  3. Left circumflex artery
  4. Right coronary artery Correct answer.

Explanation

The acute marginal branch leaves the right coronary artery along its course in the right atrioventricular groove and supplies the right ventricular free wall. It is a landmark used when assessing right coronary dominance and stenosis.

Question 17Cardiac Anatomy and Physiology

A normal aortic valve consists of how many cusps?

  1. 1
  2. 3 Correct answer.
  3. 4
  4. 2

Explanation

The aortic valve is tricuspid, with right, left, and noncoronary cusps. A two-cusp valve is a common congenital variant associated with accelerated calcification.

Question 18Cardiac Anatomy and Physiology

The first heart sound is produced by

  1. Opening of the atrioventricular valves
  2. Closure of the atrioventricular valves Correct answer.
  3. Rapid ventricular filling
  4. Closure of the semilunar valves

Explanation

S1 results from closure of the mitral and tricuspid leaflets at the onset of ventricular systole. The second heart sound instead reflects semilunar valve closure at end systole.

Question 19Cardiac Anatomy and Physiology

Left ventricular myocardial blood flow occurs predominantly during

  1. Ventricular diastole Correct answer.
  2. Isovolumetric contraction
  3. Ventricular systole
  4. Atrial systole

Explanation

During systole, contracting myocardium compresses intramural coronary vessels and raises resistance to flow. Left coronary perfusion therefore peaks in diastole, when the muscle is relaxed and aortic diastolic pressure still drives flow.

Question 20Cardiac Anatomy and Physiology

The triangle of Koch, which contains the atrioventricular node, is bounded by the tendon of Todaro, the septal tricuspid leaflet, and the

  1. Ostium of the superior vena cava
  2. Coronary sinus ostium Correct answer.
  3. Fossa ovalis
  4. Aortic valve annulus

Explanation

The triangle of Koch is the anatomic target for slow pathway ablation in AV nodal reentrant tachycardia. Its boundaries are the tendon of Todaro, the tricuspid annulus, and the coronary sinus ostium, with the AV node near its apex.

Question 21Cardiac Anatomy and Physiology

Coronary perfusion pressure for the left ventricle is best estimated as aortic diastolic pressure minus

  1. LV end-diastolic pressure Correct answer.
  2. Pulmonary artery pressure
  3. Right atrial pressure
  4. Right ventricular pressure

Explanation

Left coronary driving pressure is the aortic diastolic pressure, and the opposing back pressure is the intramyocardial pressure approximated by left ventricular end-diastolic pressure. This is why hypotension plus elevated filling pressure critically reduces coronary flow.

Question 22Cardiac Anatomy and Physiology

The great cardiac vein courses in which structure?

  1. Coronary sulcus
  2. Posterior interventricular sulcus
  3. Anterior interventricular sulcus Correct answer.
  4. Right atrioventricular groove

Explanation

The great cardiac vein ascends in the anterior interventricular sulcus alongside the left anterior descending artery before curving into the coronary sulcus to reach the coronary sinus. Its position makes it a landmark for identifying the LAD during angiography.

Question 23Cardiac Anatomy and Physiology

A patient has a stroke volume of 60 mL and a heart rate of 80 beats per minute. What is the cardiac output?

  1. 4.8 L/min Correct answer.
  2. 7.5 L/min
  3. 1.33 L/min
  4. 0.75 L/min

Explanation

Cardiac output equals stroke volume multiplied by heart rate: 60 mL times 80 beats per minute equals 4800 mL, or 4.8 L per minute. This falls within the normal resting range.

Question 24Cardiac Anatomy and Physiology

On a left ventricular pressure-volume loop, the width of the loop represents

  1. Stroke volume Correct answer.
  2. Preload
  3. Ejection fraction
  4. Myocardial oxygen consumption

Explanation

The horizontal dimension of the loop is the difference between end-diastolic and end-systolic volumes, which is the stroke volume. Loop height reflects developed pressure and area relates to myocardial work and oxygen demand.

Question 25Cardiac Anatomy and Physiology

The sinoatrial node is located in which region of the heart?

  1. At the apex of the left ventricle
  2. At the junction of the inferior vena cava and right atrium
  3. At the junction of the superior vena cava and right atrium Correct answer.
  4. Within the interatrial septum near the fossa ovalis

Explanation

The sinoatrial node is a cluster of pacemaker cells in the upper right atrium at the junction of the superior vena cava and the right atrial wall. It lies near the crista terminalis and initiates normal sinus rhythm.

Question 26Cardiac Anatomy and Physiology

The mitral valve is composed of how many primary leaflets?

  1. Four
  2. Three
  3. One
  4. Two Correct answer.

Explanation

The mitral valve is a bicuspid valve with an anterior leaflet and a posterior leaflet. These leaflets coapt during systole to prevent left ventricular blood from entering the left atrium.

Question 27Cardiac Anatomy and Physiology

How many cusps does a normal pulmonary valve have?

  1. One
  2. Four
  3. Two
  4. Three Correct answer.

Explanation

The pulmonary valve is a semilunar valve with three cusps. It guards the right ventricular outflow tract and opens during ventricular ejection.

Question 28Cardiac Anatomy and Physiology

Stroke volume is calculated as which difference?

  1. Preload minus afterload
  2. End-systolic volume minus end-diastolic volume
  3. Cardiac output minus heart rate
  4. End-diastolic volume minus end-systolic volume Correct answer.

Explanation

Stroke volume is the amount of blood ejected per beat and equals end-diastolic volume minus end-systolic volume. It reflects the difference between ventricular filling and residual volume.

Question 29Cardiac Anatomy and Physiology

The left anterior descending artery primarily supplies which territory?

  1. Inferior left ventricular wall
  2. Lateral left ventricular wall
  3. Right ventricular free wall
  4. Anterior wall and anterior septum Correct answer.

Explanation

The left anterior descending artery supplies the anterior wall of the left ventricle and the anterior portion of the interventricular septum. Its septal branches are important for septal perfusion.

Question 30Cardiac Anatomy and Physiology

The coronary sinus empties into which chamber?

  1. Right atrium Correct answer.
  2. Right ventricle
  3. Left ventricle
  4. Left atrium

Explanation

The coronary sinus is the main venous channel of the heart and drains into the right atrium near the inferior vena cava. Its ostium is guarded by the Thebesian valve.

Question 31Cardiac Anatomy and Physiology

The second heart sound is produced by closure of which valves?

  1. Tricuspid and pulmonary valves
  2. Mitral and tricuspid valves
  3. Aortic and pulmonary valves Correct answer.
  4. Mitral and aortic valves

Explanation

The second heart sound results from closure of the aortic and pulmonary semilunar valves at the end of ventricular ejection. It marks the beginning of isovolumetric relaxation.

Question 32Cardiac Anatomy and Physiology

A normal left ventricular ejection fraction is best described as

  1. 55% or greater Correct answer.
  2. 40% to 50%
  3. 80% or greater
  4. 30% to 40%

Explanation

A normal left ventricular ejection fraction is generally 55% or greater. Values below this range suggest reduced systolic function.

Question 33Cardiac Anatomy and Physiology

During isovolumetric ventricular contraction, which statement is true?

  1. The aortic valve is open and ejection occurs
  2. The tricuspid valve is open and filling occurs
  3. All valves are closed with constant volume Correct answer.
  4. The mitral valve is open and volume increases

Explanation

Isovolumetric contraction begins after atrioventricular valve closure and before semilunar valve opening. Ventricular pressure rises while all valves remain closed, so volume does not change.

Question 34Cardiac Anatomy and Physiology

In most individuals, the sinoatrial node receives its blood supply from which artery?

  1. Right coronary artery Correct answer.
  2. Left circumflex artery
  3. Left anterior descending artery
  4. Left main coronary artery

Explanation

The right coronary artery supplies the sinoatrial node in approximately 60% of people. The remaining cases are supplied mainly by the left circumflex artery.

Question 35Cardiac Anatomy and Physiology

The left circumflex artery most commonly supplies which region?

  1. Inferior wall of the right ventricle
  2. Posterior wall of the right atrium
  3. Anterior interventricular septum
  4. Lateral wall of the left ventricle Correct answer.

Explanation

The left circumflex artery courses in the atrioventricular groove and supplies the lateral and posterolateral left ventricular wall. Its obtuse marginal branches perfuse the lateral territory.

Question 36Cardiac Anatomy and Physiology

In a right-dominant heart, the atrioventricular node is usually supplied by a branch of which artery?

  1. Left circumflex artery
  2. Left anterior descending artery
  3. Posterior descending artery Correct answer.
  4. Left main coronary artery

Explanation

In right dominance, the posterior descending artery arises from the right coronary artery and gives off the atrioventricular nodal branch. This branch perfuses the atrioventricular node region.

Question 37Cardiac Anatomy and Physiology

Mean arterial pressure is estimated as

  1. Systolic pressure plus diastolic pressure divided by three
  2. Systolic pressure minus one-half of the pulse pressure
  3. Diastolic pressure plus twice the pulse pressure
  4. Diastolic pressure plus one-third of the pulse pressure Correct answer.

Explanation

Mean arterial pressure is approximately diastolic pressure plus one-third of the pulse pressure. The pulse pressure is systolic minus diastolic pressure.

Question 38Cardiac Anatomy and Physiology

Cardiac index is defined as cardiac output divided by

  1. Heart rate
  2. Stroke volume
  3. Body surface area Correct answer.
  4. Mean arterial pressure

Explanation

Cardiac index normalizes cardiac output to body size by dividing by body surface area. It allows comparison of cardiac performance among patients of different sizes.

Question 39Cardiac Anatomy and Physiology

Normal resting pulmonary artery systolic pressure is approximately

  1. 8 mmHg
  2. 15 mmHg
  3. 25 mmHg Correct answer.
  4. 50 mmHg

Explanation

Normal pulmonary artery systolic pressure is about 15 to 30 mmHg, with 25 mmHg as a typical value. Mean pulmonary artery pressure is normally about 15 mmHg or less.

Question 40Cardiac Anatomy and Physiology

The visceral layer of the serous pericardium is also known as the

  1. Parietal pericardium
  2. Endocardium
  3. Epicardium Correct answer.
  4. Fibrous pericardium

Explanation

The visceral layer of the serous pericardium is the epicardium, which covers the outer surface of the heart. The parietal serous layer lines the fibrous pericardium.

Question 41Cardiac Anatomy and Physiology

The fossa ovalis is located on which structure?

  1. Mitral valve annulus
  2. Aortic root
  3. Interventricular septum
  4. Interatrial septum Correct answer.

Explanation

The fossa ovalis is a depression on the right atrial side of the interatrial septum. It is the remnant of the foramen ovale.

Question 42Cardiac Anatomy and Physiology

The moderator band is a muscular structure located within which chamber?

  1. Right atrium
  2. Left ventricle
  3. Right ventricle Correct answer.
  4. Left atrium

Explanation

The moderator band is a muscular ridge in the right ventricle that carries part of the conduction system. It helps prevent overdistention of the right ventricle.

Question 43Cardiac Anatomy and Physiology

The plateau phase of the ventricular myocyte action potential is primarily caused by

  1. Potassium efflux alone
  2. Rapid sodium entry
  3. Chloride efflux
  4. Calcium entry via L-type channels Correct answer.

Explanation

The plateau phase reflects a balance of inward calcium current through L-type channels and outward potassium current. This prolonged depolarization supports contraction and refractoriness.

Question 44Cardiac Anatomy and Physiology

At rest, the myocardium extracts approximately what fraction of delivered oxygen?

  1. 25% to 30%
  2. 10% to 15%
  3. 40% to 50%
  4. 70% to 75% Correct answer.

Explanation

The myocardium normally extracts about 70% to 75% of the oxygen delivered by coronary blood flow. Because extraction cannot rise much further, increased oxygen demand is met mainly by increasing coronary flow.

Question 45Cardiac Anatomy and Physiology

Coronary flow reserve is best defined as

  1. Systolic coronary flow divided by diastolic coronary flow
  2. Maximum coronary flow divided by resting coronary flow Correct answer.
  3. Coronary perfusion pressure divided by vascular resistance
  4. Resting coronary flow divided by maximum coronary flow

Explanation

Coronary flow reserve is the ratio of maximal hyperemic coronary flow to resting flow. It reflects the capacity of the coronary circulation to increase flow above baseline.

Question 46Cardiac Anatomy and Physiology

According to the Laplace relationship, wall stress in a dilated left ventricle increases because

  1. Intraventricular pressure always falls
  2. Chamber radius increases relative to wall thickness Correct answer.
  3. Wall thickness increases faster than chamber radius
  4. Myocardial fiber shortening increases

Explanation

Laplace wall stress is proportional to pressure times radius divided by wall thickness. When the chamber dilates, the radius rises relative to wall thickness, so wall stress increases.

Question 47Cardiac Anatomy and Physiology

The ostium of the coronary sinus is guarded by which structure?

  1. Crista terminalis
  2. Eustachian valve
  3. Thebesian valve Correct answer.
  4. Chiari network

Explanation

The Thebesian valve is a fold of endocardium at the coronary sinus opening in the right atrium. It can partially cover the ostium and may affect catheter engagement.

Question 48Cardiac Anatomy and Physiology

Most venous blood from the anterior surface of the right ventricle drains directly into the

  1. Coronary sinus
  2. Pulmonary veins
  3. Right atrium Correct answer.
  4. Left atrium

Explanation

Anterior cardiac veins drain directly into the right atrium rather than into the coronary sinus. This provides a separate route for part of the right ventricular venous return.

Question 49Cardiac Anatomy and Physiology

According to the Fick principle, cardiac output is calculated by dividing oxygen consumption by the

  1. Pulmonary capillary wedge pressure
  2. Instantaneous heart rate
  3. Mean systemic arterial pressure
  4. Arteriovenous oxygen difference Correct answer.

Explanation

The Fick principle states that cardiac output equals oxygen consumption divided by the arteriovenous oxygen content difference. It depends on the lungs adding a measurable amount of oxygen to the blood.

Question 50Cardiac Anatomy and Physiology

Which anatomic structures tighten the chordae tendineae during ventricular systole and thereby prevent eversion of the mitral leaflets into the left atrium?

  1. Pectinate muscles
  2. Trabeculae carneae
  3. Papillary muscles Correct answer.
  4. The annulus fibrosus

Explanation

The chordae tendineae tether the mitral leaflets and are anchored at their ventricular ends to the papillary muscles. Because papillary muscles depolarize and contract with the ventricular myocardium, they shorten during systole and hold the chordae taut, keeping the leaflets from prolapsing back into the atrium. The annulus fibrosus forms the ring to which the leaflets attach but does not actively tension the chordae.