CARDIAC CATHETERIZATION.pptx

cardiac diagnostic

1. Cardiac catheterization oih 28 /02/2022

2. 2 What is a cardiac Catheterization Cardiac Catheterization is the insertion and passage of small plastic tubes ( catheters ) into the arteries & veins up to the heart to obtain X-ray pictures of coronary arteries and cardiac chambers as well as to measure pressures in the heart ( intra-cardiac hemodynamics ). A diagnostic cardiac catheterization procedure is made up of a left heart catheterization (LHC), a right heart catheterization (RHC), or both. .

3. 3 History and Evolution This amazing history started with Dr Wenner Frossman in 1929, passed a ureteral catheter into his left antecubital vein under local anesthesia, and with fluoroscopic guidance advanced until the right atrium .

4. 4 History and evolution 1941 – Right Heart Catheterization in Humans to study cardiac physiology 1950 – First retrograde left heart catheterization, by Zimerman & co-workers and late the selective coronary angiography

5. 5 History and evolution 1960s(Late) – Development of aorto-pulmonary bypass surgery 1970 – Balloon tipped flow directed catheters introduced by Swan & Ganz 1977 – Percutaneous transluminal balloon angioplasty, by Gruntzig In the 1980s , the scope of interventional Cardiology increased with the introduction of new therapeutic modalities( Valvuloplasty,Stent etc. )

6. 6 Right Heart Catheterization In Right Heart Catheterization , the right heart and pulmonary system are accessed via the body’s venous system, usually through the femoral vein. This procedure serve to pressure measurements, but cardiac and pulmonary structures can also be visualized by using angiography.

7. 7 Left Heart Catheterization Left Heart Catheterization is accomplished by accessing the arterial system and navigating in a retrograde fashion to the heart. Is used to visualize the coronary arteries and the pumping action of the left ventricle (LV).

8. 8 Indications for procedure Cardiac catheterization can be either a diagnostic or a therapeutic procedure. The procedure is done in the evaluation and the treatment of the following conditions. Coronary artery disease Measuring the hemodynamics in the right and left side of the heart Evaluate the left ventricular function Evaluation and treatment of cardiac arrhythmias Evaluation and treatment of valvular heart disease

9. 9 Indications for procedure Assessment pericardial and myocardial diseases Assessment of the congenital heart diseases Evaluation of heart failure

10. 10 Indications Shock Sudden cardiovascular arrest Positive exercice tolerance test Aortic dissection Aortic aneurysm Pericardial constriction or tamponade Initial and follow-up assessment for heart transplantation

11. 11 Contraindications By definition, a contraindication means that a procedure should not be performed. Absolute Contraindications Inadequate equipment or catheterization facility Patient refusal Relative Contraindications Uncontrolled hypertension Severe anemia Ventricular fibrillations

12. 12 Contraindications Acute stroke GI bleeds Allergy to contrast Renal failure Uncompensated congestive failure Active infection or febrile illness Electrolyte abnormalities Severe coagulopathy

13. 13 Personnel A cardiac catheterization procedure is usually performed in a cardiac catheterization laboratory with the help of fluoroscopy to guide and position the catheters in the appropriate position. Along with the experienced operator, support from registered nurses and radiologic technologists is needed for safely performing the procedure. Most of the procedures can be performed with minimal or moderate sedation with the help of a local anaesthetic,.

14. 14 Preparation Preparation for the cardiac catheterization procedure starts with a thorough history of the patient along with a detailed examination. After defining the clinical question, the performing interventional cardiologist will decide on the access for the procedure. These procedures may need either arterial or venous access or both. Physical examination should specifically focus on assessing the suitability of the patient for the planned procedure. Special attention has to be paid to reviewing drug allergies of the patient and routine lab work.

15. 15 Preparation Basic workup includes a complete blood count (CBC), basic metabolic panel (BMP), prothrombin time, electrocardiogram, and chest X-ray. Patients with documented allergy to radio-iodinated contrast material will need premedication with corticosteroids and antihistamines. Patients with chronic kidney disease will also need adequate planning and pre-hydration to reduce the risk of worsening renal function.

16. 16 Procedure – arterial acess The choice of vascular access is dependent on the patient’s anatomy In our days , puncture is generally done via right radial artery Alternative sites ( vascular anomalies or medical reasons ) include femoral and brachial arteries

17. 17 Artery puncture

18. 18 Artery puncture

19. 19 Inserting catheter The catheter is then inserted over the guidewire but through the sheet and advanced into placement via the inferior vena cava to the aorta Movement of catheter is monitored under fluoroscopy (x-ray movies) with the cardiologist manipulating its movements When catheter is in place , wire can be removed and contrast administered (ANGIOGRAPHY)

20. 20 Coronary angiography Coronary angiography remains the gold standard for detecting clinically significant atherosclerotic coronary artery disease To visualize coronary arteries, branches, collaterals and anomalies Precise localization relative to major and minor side branches, thrombi and areas of calcification To visualize vessel bifurcations, origin of side branches and specific lesion characteristics (length, eccentricity, calcium etc )

21. 21 Coronary angiography Left coronary artery shown with contrast

22. 22 Coronary angiography

23. 23 Coronary angiografy

24. 24 complications Many factors contribute to complications, including procedural length, contrast dose, equipment available, radiation exposure, extent of cardiovascular disease, and comorbidities Cardiac arrest Cerebrovascular accident Myocardial infarction Respiratory arrest Ventricular tachycardia, fibrillation , or serious arrythmia Death

25. 25 Other complications A hole going through your blood vessel (perforation) Air embolism (when air gets into your blood vessel) Allergic reaction to dye Bleeding Blood clots Infection Kidney damage from the dye

26. 26 Finished procedure The procedure is complete when the cardiologist has seen all the view and anatomy desired and all pressures recorded The catheter can be removed and could be used two ways to closed the artery: Manual pressure must be applied at entry site for for 15 minutes or a closure device applied ( Angio seal for femoral and Triband for radial ) The experience say that for radial we will used Triband and for femoral , manual pressure

27. 27 Arterial Closure Applying Trband Manual pressure

28. 28 After the recovery room, the patient should be transferred to his room. The length of the patient’s stay will be dependent on their condition. Some patients who have had a straightforward procedure may even be discharged on the same day, whereas others who have had an additional procedure such as an angioplasty or insertion of a stent will be required to stay overnight. Conclusion

29. THANK YOU شكراً 29 ISABEL PAULO