Cardiac Catheterization: The Basics

Cardiac Catheterization (cardiac cath)

specialized study of the heart in which a catheter is inserted into an artery and/or vein in the patients arm, neck, or groin

Indications for cardiac cath

identification and extent of CAD, evaluation of LV function, assessment of valvular heart disease, assessment of myocardial disease, myocardial biopsy, verify/support non-invasive data, undergo interventions, determine necessity for surgical correction

Advantages of cardiac cath

evaluation and tx of congenital anomalies and cardiac disease states

Right heart cath

collect blood samples to measure oxygen saturation levels, detect/repair shunt, calculate CO, endomyocardial biopsy, pulmonary angiography, measure right heart pressures, measure LA pressure

Left heart cath

LV angiogram, coronary angiogram, intravascular ultrasonography (IVUS), measure left heart pressures, evaluate valvular disease

Contraindications for cardiac cath

severe HTN, ventricular arrhythmias, acute stroke, severe anemia, active GI bleed, allergy to radiographic contrast, acute renal failure

Risks for cardiac cath

bleeding, infection, injury to nerve and/or blood vessel, cardiac arrhythmias, cardiac tamponade, low blood pressure, reaction to contrast, kidney damage/failure, stroke, heart attack, death

Method most popular for left heart cath

percutaneous femoral artery approach

Method most popular for right heart cath

femoral vein approach

Catheter used in right heart cath

Swanz-Ganz

Catheter used in left heart cath

pigtail

Fluoroscopy (fluoro)

xray technique with a screen that provides immediate visualization inside the body

Best cath technique to evaluate LV function

LV angiogram

Pulmonary embolisms are diagnosed via:

pulmonary angiography

LA pressure is acquired via:

pulmonary capillary wedge pressure

Pressure distal to the pulmonary capillary wedge is the approximate ? pressure

LA

Pressure recorded when the balloon is deflated is the ? pressure

pulmonary artery

Most popular exam performed in the cath lab

coronary angiogram

Occlusion presents as:

disruption or narrowing of the white line on xray

Angioplasty aka

percutaneous transluminal coronary angioplasty (PCTA)

Angioplasty (or PCTA)

catheter is placed within the lumen of the coronary artery and the balloon is inflated at the level of the plaque pressing the plaque against the walls of the artery

Stent

small expandable wire tube inserted into the artery where the angioplasty was performed

Atherectomy

opens a partially block coronary artery by means of a catheter equipped with a cutting device

Intravascular ultrasonography (IVUS)

performed with a coronary artery catheter that is equipped with a miniature ultrasound transducer; images the coronary lumina and walls and outlines blood flow

Peak to peak PG

pressure tracings acquired from the chambers and peak pressures are compared

Peak to peak PG is performed in the ? lab

cath

Peak instantaneous PG

Doppler peak instantaneous PG is acquired at the same time in the cardiac cycle

Peak instantaneous PG is performed in the ? lab

echo

Mean PG

CW Doppler mean PG correlates best with cath lab findings

Artography

AI is detected when contrast leaks from the AO through the AOV baclk into the LV

(T/F) Cardiac cath is a specialized study of the heart in which a catheter is inserted into an artery and/or vein via a designated protocol in the patient's arm, neck, or groin. Once inserted, the catheter is carefully guided to the patient's left or right heart.

true

(T/F) Today, most labs store digital computerized images; this is known as cine

false

The percutaneous femoral artery approach is most popular method for a ? heart cath

left

A left heart cath is frequently performed with a ? catheter

pigtail

(T/F) The CO can be calculated via the indicator-dilution technique, thermodilution method, Fick method, or angiographic technique

true

The femoral vein approach is the most popular method for a ? heart cath

right

A right heart cath is performed with a ? catheter

Swan-Ganz

When the right heart catheter travels from the RA, through the IAS, into the LA, it is called a ?

transeptal procedure

(T/F) Fluoroscopy is an xray technique with a screen that provides immediate visualization inside the body

true

(T/F) The EF can be computed via area-length method that estimates the end-diastolic and end-systolic volumes and from that the EF is calculated

true

Which of the following is an indication for a cardiac cath?

identify and determine the extent of CAD

evaluate LV and valvular function

myocardial biopsy post heart transplant

all

all

When plaque build up inside the wall of the coronary artery it creates a(n) ? and appears as a narrowing of the vessel during the coronary angiogram

occlusion

Typical procedures performed during the right heart cath include:

oxygen saturation levels

pulmonary angiography

PCWP

all

all

(T/F) The pressure distal to the PCWP is an approximate RAP and the pressure recored when the balloon is deflated = PAP

false

Contraindications of cath include:

severe HTN

ventricular arrhythmias

allergy to radiographic contrast

all

all

The LV angiogram is the best cath technique to evaluate ?

LV function

(T/F) A coronary angiogram is probably the most popular examination performed in the cath lab. It evaluates the coronary arteries for CAD

true

When a special catheter is placed within the coronary artery at the level of the plaque and a balloon is inflated pressing the plaque against the walls, what procedure is being performed?

PCTA

When a small expandable wire tube is inserted into the artery after the plaque is pressed against the wall, what procedure is being performed?

stenting

During ?, AI is detected when contrast leaks from the AO, through the AOV, back into the LV

aortography

Used to open a partially block coronary artery by means of a catheter equipped with a cutting device, whirling blade, or laser beam that is used to remove the plaque

Atherectomy

(T/F) Intravascular ultrasonography (IVUS) is performed with a coronary artery catheter that is equipped with a miniature ultrasound transducer that acquires images of the coronary lumina and walls and outlines the blood flow through the lumina

true

In the cath lab, pressure tracings are acquired directly from the chambers and the peak pressures form each chamber are compared. This is called a(n) ?

peak to peak PG

(T/F) Cath is very useful in the evaluation of stenotic and regurgitant valves because we are able to acquire the pressures in the chambers proximal and distal to the diseased valve

true

(T/F) Pulmonary angiography is used to diagnosis pulmonary embolism

true

(T/F) Some patients require CABG which is done via open heart surgery or mini-thoacotomy; however, some patients are candidates for treatment in cath lab

true

Risks associated with cardiac cath include:

bleeding at entry site

cardiac tamponade

reaction to contrast

all

all

(T/F) Shunt size can be calculated during a cath based on the difference between the pulmonary flow and the systemic flow and sometimes the shunt can be treated with a patch.

true

During an ? a radiocontrast agent is inject through a catheter diretly into the structure being examined. The contrast contains iodine which blocks the passage of xrays; therefore, any structure containing contrast will become temporarily visible on xray

angiogram

(T/F) It has been determined that the CW Doppler max PG correlates best with the cath lab findings

false (mean PG)

(T/F) The mean PG provides an average PG derived from all of the velocities within the flow between the two chambers

true

Doppler echo provides the peak instantaneous PG. The peak instantaneous PG is the peak gradient between two chambers at the same instant in the cardiac cycle

true

(T/F) If possible, SE findings and cath findings should be correlated and tracked

true