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Cardiac Cath and Angiocardiography

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Presentation on theme: "Cardiac Cath and Angiocardiography"— Presentation transcript:

1 Cardiac Cath and Angiocardiography

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

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

7 Angiographic Supplies and Equipment
Catheters Contrast Media Pressure Injector

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

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

10 Pressure injector

11 Image chain Digital Angiography imaging equipment

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

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

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 Selinger Technique Inner cannula removed Needle withdrawn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

23 Data Collection Physiologic data unusually collected
Hemodynamic parameters Includes blood pressure Cardiac output Vascular pressures (inside & outside the heart) ECG Oximetry readings 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 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 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 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 Coronary Angiography Allows the extent of intracoronary stenosis to be evaluated

30 Coronary Angiography

31 Coronary Angiography LT coronary artery Normal LT coronary Artery

32 Cath of the RT side of the heart: ADULTS

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

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 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 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 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 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


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 PTCA with Stenting

46 PTCA with Stent Placement

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

52 CXR with Pacemaker

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 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 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 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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