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Cardiac Cath and Angiocardiography SPRING 2012. 2 Definition of Cardiac Catherization Comprehensive term to describe minor surgical procedure for diagnostic.

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Presentation on theme: "Cardiac Cath and Angiocardiography SPRING 2012. 2 Definition of Cardiac Catherization Comprehensive term to describe minor surgical procedure for diagnostic."— Presentation transcript:

1 Cardiac Cath and Angiocardiography SPRING 2012

2 2 Definition of Cardiac Catherization Comprehensive term to describe minor surgical procedure for diagnostic evaluation or interventional (therapeutic) purposes Diagnostic –Collects data to evaluate PT’s condition Therapeutic –To intervene by mechanical means to treat disorders of the vascular and conduction systems within the heart

3 Principles of Cardiac Catheterization

4 4 Indications Suspected or known coronary heart disease Myodcardial infarction Sudden cardiovascular death Valvular heart disease Congenital heart disease Aortic dissection Pericardial constriction Cardiomyopathy Initial and follow up assessment for heart transplant

5 5 Contraindications Active GI bleed Renal failure Recent stroke Fever from infection Electrolyte imbalance Anemia Short life expectancy Digitalis intoxication PT refusal Uncontrolled hypertension Bleeding disorders Pulmonary edema Uncontrolled ventricular arrhythmias Aortic valve endocarditiis Allergic to contrast

6 6 Complications and Risks Death Myocardial infarction CVA Arrhythmia Hemorrhage Contrast Hemodynamic Perforation

7 Angiographic Supplies and Equipment Catheters Contrast Media Pressure Injector

8 8 Catheters For LT cardiac cath similar to those for angio RT cath requires specialized catheters –Typically flow directed catheters –With manifolds

9 9 Contrast Media High Osmolar Ionic –Sometimes causes ECG changes Widely used –Non-ionic –Ionic low osmolar Restricted costs causes limited use of low osmolar contrast agents.

10 10 Pressure injector

11 Imaging Image chain Digital Angiography imaging equipment

12 12 Image chain Similar to angio suites High resolution imaging and recording C-arms must be able to be on for extended periods of time –Withstand great heat load –Multi focal-spot –High speed rotating fluoro tubes –Short exposure times –15-30 frames per second Often have a video camera

13 13 Digital Angiography Imaging equipment Long term storage of large amounts of digital files has benefited from advances in computer technology DICOM

14 Ancillary Equipment and Supplies Physiologic Equipment Other equipment

15 15 Physiologic Equipment Equipment to monitor –ECG –Hemodynamic pressures Vital signs to record PT function

16 16 Other Equipment Crash cart Oxygen and suction Defibrillator Temporary pacemaker Pulse oximeter Blood pressure cuff Equipment to perform cardiac output studies Activated clotting time (ACT) equipment

17 17 Patient Positioning for Cardiac Catheterization PT must be positioning so that they will not have to be moved during procedure Must be positioned so anatomic structures of interest are demonstrated PT is supine with shielding as appropriate

18 Catheterization Methods and Techniques

19 19 Pre-Catheterization Care Informed consent obtained PT history Physical exam CXR Blood work ECG Echocardiogram Exercise stress test Nuclear Medicine cardiac perfusion studies

20 20 Pre-Catheterization Care IV started –Sedation and nausea Nothing to eat 4-6 hours before procedure Records of procedure –PT hemodynamic data –Fluoro times –Medications administered –Supplies used –Other pertinent information

21 21 Catheter Introduction Prepare catheter introduction site with aseptic technique –Shaved and cleaned Can be at femoral (most common), brachial, radial, axillary, jugular and subclavian areas Selinger technique used

22 22 Selinger Technique Needle with cannula inserted Needle withdrawn until there is blood flow Inner cannula removed & guidewire inserted Needle removed Catheter over guidewire Guidewire removed leaving catheter in artery

23 23 Data Collection Physiologic data unusually collected –Hemodynamic parameters Includes blood pressure Cardiac output Vascular pressures (inside & outside the heart) –ECG –Oximetry readings –Cardiac output –Blood samples to measure oxygen saturations levels in various parts of the heart

24 Catherization Studies and Procedures Adults Children

25 Basic Diagnostic Studies of the Vascular System for Adults

26 26 Cath of the LT side of the heart: ADULTS Catheter introduced into the radial, brachial or femoral artery to the ascending aorta Aortic root angio is performed to document competence of the aortic valve

27 27 Aorta Root Angiography Normal means backward flow of the contrast media into the LT ventricle during injection Atrial oximetry and blood pressure within aorta are measured Then advanced into the LT ventricle

28 28 LT Ventriculography Provides info on valvular competence Interventricular septal integrity Efficiency of the pumping action of LT ventricle Pressure measurements are made When systolic (LT ventricle) does not match systolic (aorta)- could mean aortic stenosis

29 29 Coronary Angiography Allows the extent of intracoronary stenosis to be evaluated

30 30 Coronary Angiography

31 31 Coronary Angiography Normal LT coronary Artery LT coronary artery

32 32 Cath of the RT side of the heart: ADULTS

33 33 Cath of the RT side of the heart: ADULTS Pressure measurements –Used to determine valvular heart disease –Congestive heart failure –Pulmonary hypertension –Cardiomyopathies

34 34 Exercise Hemodynamics For evaluation of valvular disease –When fatigue and dyspnea are present Simultaneous catherization is done and pressure measurements of RT & LT heart is taken –At rest –With exertion Catheter is placed in: –An artery (femoral or brachial) –Vein (femoral or basilic)

35 35 Basic Diagnostic Studies of the Vascular System for Children For evaluation of specific hemodynamic data –Selected aspects of cardiac function –Congenital heart defects Methods are different according to age and size of the heart

36 36 Advanced Diagnostic Studies of the Vascular System for Adults & Children Biopsy catheter with bioptome tip is inserted into jugular or femoral vein into RT ventricle Jaws are opened and many biopsies are taken

37 37 Bioptome Biopsies Used to monitor cardiac transplants for tissue rejection And to differentiate between various types of cardiomyopathies

38 38 Studies of the Conduction System for Adults & Children Mulipolar catheters are inserted in High RT atrium near sinus node Atrioventricular apex Coronary sinus

39 39 Studies of the Conduction System for Adults & Children Sometimes 3 introducer sheaths are placed in one vein –Femoral –Internal jugular vein –Subclavian vein Cathodes serve a dual function –Record electrical signals –Pace the heart

40 40 Interventional Procedures of the Vascular System: Adults Percutaneous Transluminal Coronary Angioplasty (PTCA) –Also known as balloon angioplasty –Employs balloon to dilate the coronary artery stenosis The placement of the catheter is placed much in the same way as standard coronary angiography

41 41 PTCA cont Special steerable PTCA guidewire is used. Guidewire is advanced to stenotic area through the balloon catheter Balloon is pushed through to the stenotic area Balloon is inflated and compresses fatty deposits

42 42 PTCA cont Followed by arteriography to make sure it blood is flowing This may be done repeated times to assure maximum dilatation Restenosis occurs in 30-50% of patients

43 43 PTCA

44 44 PTCA with Stent placement Similar to PTCA alone except a stent is placed Restenosis is lower for pt’s who do this rather than conventional angioplasty alone

45 45 PTCA with Stenting

46 46 PTCA with Stent Placement

47 47 Atherectomy Atherectomy devices remove the fatty deposit or thrombus material within artery Directional coronary atherectomy devices having a specialized cutting device to shave out the plaque There is a special nose cone that collect the free floating particles

48 48 Percutaneous transluminal coronary rotational atherectomy The tip is a football shape and is embedded with diamond particles Special torque guidewire between 160, ,000 rpm The plaque is pulverized into particles the size of RBC’s and removed by the reticuloendothial system

49 49 Interventional Procedures of the Vascular System: Children Balloon Septostomy to enlarge a patent foramen ovale or preexisting atrial septal defect This allows mixing of RT and LT blood –Resulting in improved arterial oxygenation Balloon is passed through atrial septal opening into the LT atrium, inflated with contrast and pulled back through the orifice –Causes septum to tear

50 50 Balloon Septostomy with Transeptal System Approach When there is not a preexisting hole in the atrial septum –Transeptal approach is used –Catheter with knife is employed into LT atrium blade is opened and pulled back through RT atrium –Then balloon septostomy may be performed to open the hole more

51 51 Interventional Procedures of the Conduction System: Adults & Children Antiarrhythmic devices –Pacemakers –Implantable cardioverter defibrillators

52 52 CXR with Pacemaker

53 53 Post Catheterization Care Firm pressure is applied to puncture site for minutes Wound sites are cleaned and dressed The patient will be observed in recovery for 4-8 hours The insertion site will be checked frequently for signs of bleeding. Medications and discharge instructions are given Lots of fluid should be taken in Vital signs should be monitored for 24 hours

54 Cardiac Catheterization Trends

55 55 Trends Vascular brachytherapy- technique where radiation is delivered to an area of a previously stented artery using endovascular techniques Drug eluting stents- drug coated stents used for treatment of CAD to reduce restenosis

56 56 MRI Is becoming more sophisticated and having greater detail and resolution Allows for is to be used more often for the cardiovascular system MRA is now able to assess anomalies in the coronary arteries –And identify calcifications in the coronary arteries and bypass grafts

57 57 Electron Beam CT Can detect heart disease at it earliest and most treatable stages –Measures the amount of coronary calcium, Electron Beam angiography is a simple and noninvasive technique that uses IV contrast media injection –Effective for visualization of great vessels, carotid arteries and peripheral vasculature

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