Interventional Procedures and Fluoroscopy - Cardiac Procedures

Interventional Procedures and Fluoroscopy - Cardiac Procedures

Plan for Today

• Focus: Cardiac Examinations
• Key Areas:
  • Review of anatomy
  • Indications for procedures
  • Technique and complication considerations
  • Common findings

Anatomy Revision

• Key Structures:
  • Pulmonary Arteries: Carry deoxygenated blood from the right ventricle to the lungs.
  • Heart Chambers:
  • Right Atrium (RA): Receives deoxygenated blood from superior and inferior vena cava.
  • Right Ventricle (RV): Pumps deoxygenated blood to lungs via pulmonary artery.
  • Left Atrium (LA): Receives oxygenated blood from pulmonary veins.
  • Left Ventricle (LV): Pumps oxygenated blood to the body via aorta.
• Coronary Arteries: Arise at the root of the ascending aorta and supply blood to the heart muscle.
  • Variations in distribution; Dominant right coronary most common.
  • Left coronary artery branches into the left anterior descending (LAD) and circumflex arteries.

Coronary Arteries

• Right Coronary Artery (RCA): Supplies the right atrium, right ventricle, and parts of both the sinoatrial (SA) and atrioventricular (AV) nodes.
• Left Coronary Artery (LCA): Supplies left atrium, left ventricle, and interventricular septum.
• Anatomical Branches:
  • Anterior Descending Artery: Supplies the anterior wall of the heart.
  • Circumflex Artery: Supplies the lateral wall of the left ventricle.

Cardiac Valves

• Aortic Valve: Composed of 3 semilunar cusps that prevent backflow into the left ventricle.
• Pulmonary Valve: Functions similarly to aortic valve but without coronary arteries.
• Tricuspid and Mitral Valves: Control the flow of blood between atria and ventricles; prevent backflow during ventricular contraction.

Cardiac Procedures Terminology

• Cardiac Catheterization: An umbrella term encompassing all right and left heart catheterizations.
• Coronary Angiography: Visualization of coronary arteries; selective intubation required.
• Coronary Angioplasty: Procedure to open narrowed coronary arteries using balloon inflation.

Aetiology of Coronary Disease

• Coronary Atheroma: Plaque formation leading to decreased blood flow.
• Acute Coronary Syndrome (ACS): Sudden reduction in blood flow due to a blood clot, leading to myocardial infarction (heart attack) or unstable angina.

Indications

• Right Heart: Congenital heart disease, ischaemic heart disease, septic shock indications.
• Left Heart: Chest pain investigations, unstable and stable angina, valvular disease.

Contraindications for Cardiac Procedures

• Increased bleeding risk, severe heart failure, renal failure, uncontrolled hypertension, and agitated patients.

Patient Preparation

• Identifying high-risk patients, obtaining consent, baseline vitals, and IV access.
• Sedation and anesthesia considerations (e.g., lidocaine with adrenaline for local anesthesia).

Commonly Used Drugs

• Lidocaine: Local anesthetic.
• Heparin: Anticoagulant used in diagnostic angiography.
• Nitrates: Vasodilators; caution in hypotension.
• Morphine: For moderate to severe pain management.

Access Techniques

• Radial Access: Common approach using the radial artery.
• Femoral Access: Involves accessing the femoral artery.

Goals of Coronary Angiography

• Visualization of coronary arteries, assessment of thrombi and calcifications, and understanding lesion characteristics.

Imaging Techniques

• Various imaging positions include:
  • Posterior Anterior (PA) and Right Anterior Oblique (RAO): For best visualization during procedures.
  • Importance of optimizing screening times and minimizing radiation exposure.

Pitfalls of Coronary Angiography

1. Inadequate vessel opacification: May misrepresent stenosis.
2. Eccentric Stenosis: Illusions of normal caliber due to projection geometry.
3. Superimposition of branches: Overlapping vessels obscure visualization.

Acute Coronary Syndrome (ACS)

• Characterized by severe chest pain, sweating, nausea; increased risk factors include hypertension, diabetes, and obesity.

ECG Indicators of Infarction

• Anterior Infarction: ST elevation in V1-V4 region.
• Inferior Infarction: ST elevation in II, III, aVF.

Cardiac Devices

• Pacemakers: Single, dual chamber, or biventricular devices for arrhythmias.
• ICDs: For those with high-risk ventricular fibrillation.

Complications of Cardiac Devices

• Acute complications include arrhythmias and myocardial injury; chronic issues like twiddler syndrome or lead fracture.

Clinical Case Study

• An example illustrates the approach to a 57-year-old male with acute chest pain, involved interventions, and subsequent cardiac catheterization.

Conclusion

• Emphasis on understanding cardiac anatomy, indications for procedures, patient management, and recognizing potential complications in interventional cardiology procedures.