CAG final.pptx

cag

1. CORONARY ANGIOGRAM

2. Overview of Cath Lab

3. Coronary Arteries

4. Cont ….

5. Origin of coronary arteries Coronary artery arises just superior to the aortic valve and supply the heart The aortic valve has three cusp, left coronary cusp Right coronary cusp posterior non coronary cusp

6. Cont ….

7. Coronary Angiogram Coronary angiogram is a diagnostic procedure that uses x-ray imaging to see the heart blood vessels. During the coronary angiogram, a type of dye that’s visible by an x-ray machine is injected into the blood vessels of heart. Coronary angiography remains the gold standard for detecting clinically significant atherosclerotic coronary artery disease.

8. Cont….. The technique was first performed by Dr. Mason Sones at the Cleveland Clinic in 1958. It was started on Ashad 2057 at SGNHC. Started independently on Falgun 2058.

9. Goal To visualize coronary arteries, branches, collaterals and abnormalities. A coronary angiogram can be used to identify the exact location and severity of CAD.

10. Indications Diagnosis of CAD in clinically suspected patient. Determine patency of coronary artery bypass graft. Emergent revascularization in patient with acute STEMI. Abnormal results on a noninvasive heart stress test. A heart valve problem that requires surgery. Left ventricular dysfunction, ventricular arrhythmias.

11. Contraindications No absolute contraindication Relative contraindications, Allergy to contrast (dye) medium Uncontrolled blood pressure Problem with blood coagulation ( coagulopathy ) Kidney failure or dysfunction Severe anemia Fever

12. Cont…. Active systemic infection Transient ischemic attack Uncompensated heart failure Pregnancy Inability for patient cooperation

13. Equipments

14. Cont…. Trolley

15. Cont…. Coronary angiography catheters Guide wires Contrast

16. Cont….. sheath different sizes Inj. 2% xylocaine Inj. heparin Puncture needle (radial/ femoral) Introducer wire (radial/ femoral) Manifold set Syringe different types

17. Approach Radial approach Femoral Ulner Distal radial Brachial

18. Femoral approach

19. Allens test

20. Cont….

21. Steps of Coronary Angiogram Step 1 (pre cath ): Written consent NPO for at least 4 hours Pre cath investigation Selection of arterial access point Shaving of the groin/ wrist according to the choice Opening the I/V line Connect with the cardiac monitor

22. Cont…. Step 2: Radiation protection for the health care personnel An area of the arm or groin, is cleaned with 10% povidine iodine Draping of the patient Using local anesthetics around the puncture site Puncture and introducing the short guide wire through the puncture needle Introducing the sheath and removal of dilator along with short guide wire Flush the channel with heparinized solution

23. Cont…. Steps 3: The cardiologist passes a radio-opaque catheter through an artery and carefully moves it up to the base of coronary artery under fluoroscopic control. X-ray images help the doctor positioning the catheter. Once the catheter is in place, dye is injected into the catheter. X-ray images are taken and help highlight any blockage in blood flow.

24. View of normal coronaries

25. Diseased Right coronary artery (Radiology.rsna.org.)

26. Diseased Left coronary artery

27. Findings of CAG Normal coronaries Non-significant CAD (<50%) Significant CAD (>50%)

28. Complications Access site Bleeding, hematoma, infection, arterial damage or occlusion, distal limb ischemia, emboli Cardiac Myocardial ischemia/ infraction, coronary dissection, cardiac tamponade, arrhythmias systemic Allergic response to radio contrast agent, stroke, shock Death also may occur.

29. Preparation Cath lab preparation: Crash cart must be ready Draw injection like: atropine and adrenaline Standby defibrillator Oxygen, Glucometer ready Check suction machine for working condition Trolley preparation should be done prior to procedure

30. Cont …. Patient preparation: Before procedure, Identification of patient Prepare the patient psychologically Check for all necessary investigations Make sure patient has visitor Financial availability Part preparation Hygiene care NPO status

31. Cont….. Cath dress I v line patency( left hand) Informed consent Vitals sign Allergic history Check for false teeth Remove Jewellery Ask patient for void before taking into the cath lab

32. During procedure Receive the patient with complete handover Help the patient to sleep in the cath table Keep ECG monitoring Start I/V fluid for hydration Provide articles/ catheters as procedure required Be conscious on contrast change Vitals monitoring and take immediate action if any complications arises

33. Post procedure Access puncture site Assist doctor for removal of sheath and apply pressure bandage Vital signs monitoring Proper recording and reporting Inform to the ward sisters Safe transport of patient to ward or CCU Give complete handover to the ward sister

34. THANK YOU