Lecture - Cardiac Investigations

List the different types of cardiac investigation

• 12- lead ECG

• ambulatory ECG: Holter monitor

• blood pressure: clinic, at -home, ambulatory

• Exercise tolerance testing (ETT)

• Cardiac catheterisation: angiogram, angioplasty,

• Cardioversion?

What happens if patient experiencing cardiac symptoms but 12-lead ECG normal

refer for ambulatory ECG monitoring

What durations can ambulatory ECG monitors monitor for?

24/48/72

up to 7 days

How does cardiac catheterisation complement echo

-echo can give an indication of ischaemic event / coronary artery disease by detecting regional wall motion abnormalities

-to investigate suspected coronary artery disease, catheterisation visualises blood flow in the coronary arteries to locate stenosis that could cause ischaemia

-echo does not assess the coronary arteries

-can perform pressure measurements e.g transaortic or right atrial pressure

-most accurate measurement of right atrial pressure comes from catheterisation

-uses X-ray

Disadvantages of cardiac catheterisation compared to echo?

• invasive: infection risk, perforation/ trauma to vessels

• ionising: uses radiation due to fluoroscopy (X-ray)

What are the uses of ambulatory ECG monitoring

-detect rhythm changes that may occur outside of when patient has had ECG in clinic, such as nocturnal/ during exertion

-to capture paroxysmal arrythmias: paroxysmal AF, palpitation, ectopics

List the different things that happen in Cath lab?

• angiogram: assessing coronary arteries, check for stenosis

• angioplasty (percutaneous transluminal coronary angioplasty (PTCA)

• angioplasty + stent fitting (percutanous coronary intervention - PCI)

• TAVI fitting

• pacemakers implantation

• ablation (heat (RF) or cold) to destroy tissue producing arrythmia

• cardioversion (electric shocks to restore arrhythmia to normal)

What is process of angiogram?

• catheter inserted in peripheral vessel (artery/ vein) depending on which side of the heart to assess.

If want to asses right heart, what type of vessel would you catheter?

veins

• femoral vein

Where would the insertion point be to catheter veins to asssess right heart?

• femoral vein

If want to asses left heart, what type of vessel would you catheter?

• artery

Where could the insertion point be to catheter artery to assess left heart?

• femoral artery

• radial artery

What is the name for a moving real-time X-ray?

fluoroscopy

Term for when a stent narrows

in-stent restenosis (ISR)

Simply how do pacemakers work?

-activated if they see a delay

Where does the lead go in 1 lead

subclavian/ braciocephalic vein

SVC

Right side of heart (RAA) or right atrial

Where does the right atrial lead go?

right atrial appendage

Where does the right ventricular lead go?

apex

What can right pacing cause?

heart failure

How does dual chamber resynchoisation therapy affect risk of heart failure

reduces the risk

Where do the leads go in a 3-lead pacemaker (CRT)

• RA

• RV

• behind LV through coronary sinus

How is pacemaker linked to TR?

lead to the RV goes through the TV

What is ablation?

-burning myocardial tissue which is responsible for producing arrythmias, making it electrically inert