Cardiac catheterization Flashcards
Relative contraindications to cardiac catheterization
Fever
Anemia
Hypokalemia and other electrolyte imbalances
Systemic illness –> acute GI bleed, uncontrolled bleeding diathesis, recent CVA (<1 mo)
Renal failure
Uncontrolled CHF, HTN, or arrhythmia
Route for L heart catheterization
Ascending aorta
Across aortic valve
Into LV
Purpose of L heart catheterization
Measures pressures in the L heart as a determinant of LV performance
Route for R heart catheterization
IVC or SVC
R atrium
R ventricle
Pulmonary A –> pulmonary wedge position
Pressure immediately after L atrial contraction
LVEDP
Wave that corresponds to L atrial contraction
a wave
Normal LVEDP
4-12 mmHg
General causes of increased LVEDP
Excessive diastolic volume overload
Impairment of myocardial contractility
Possible causes of impaired myocardial contractility
HTN
Valvular stenosis
Restrictive cardiomyopathy
MI
Reflects RA contraction at the end of diastole on intracardiac pressure tracing
a wave
Reflects from bulging of tricuspid valve during early systole on intracardiac pressure tracing
c wave
Reflects passive filling of the RA from the systemic veins during systole, when the tricuspid valve is closed, on intracardiac pressure tracing
v wave
Downward deflection on intracardiac pressure tracing that follows the c wave
x descent
Downward deflection on intracardiac pressure tracing that follows y wave
y descent
Normal mean RA pressure
1-8 mmHg
Causes of increased a wave
Tricuspid stenosis
RV hypertrophy
Atrioventricular dissociation
Cause of increased v wave
Tricuspid regurgitation
Normal RV diastolic pressure
1-8 mmHg
Peak RV systolic pressure
15-30 mmHg
Causes of increased systolic RV pressure
Pulmonic stenosis
Pulmonary HTN
Causes of increased diastolic RV pressure
RV failure
Cardiac tamponade
RV hypertrophy
Causes of increased RA pressure
RV failure
Cardiac tamponade
Normal systolic pulmonary A pressure
15-30 mmHg
Normal diastolic pulmonary A pressure and PCWP
4-12 mmHg
3 characteristics that indicate entry into pulmonary A from RV
High diastolic pressure
Dicrotic descending systolic portion
Down-sloping of diastolic portion
Causes of increased diastolic and systolic pulmonary A pressure
Pulmonary HTN
LHF
Chronic lung disease
Pulmonary vascular disease
Causes of increased systolic pulmonary A pressure only
Increased flow –> due to L to R shunt
Causes of increased pulmonary capillary wedge pressure
LHF
Mitral stenosis of regurgitation
Cardiac tamponade
Parts of hemodynamic assessment of cardiac catheterization
Determine CO
Measure pressures in cardiac chambers and vessels
Uses of cardiac catheterization
Hemodynamic assessment
Calculating resistance
Assessment of valve area
Intracardiac shunts
At what value of SaO2 in the L heart will cyanosis be present
<80%
