Cardiac CT and Invasive Angiography

Question 1

Evaluation of chest pain

-how to differentiate between typical, atypical and non angina pain

Answer 1

Central chest pain lasting U15mins
Worsened by exertion/stress
Relieved by rest/nitrates

Non angina (U1) - normal ECG
-if abnormal => CTCA

CTCA for angina

Question 2

Comparison of benefit between cardiac CT, coronary angiography and echo

Answer 2

Echo - can only detect v severe stenosis

Invasive angiography - 50% stenosis upwards

• invasive technique
• can detect obstructive disease => treatment with stents, balloons
• can manage NSTEMI, STEMI, unstable angine

Cardiac CT - 20% stenosis onwards

• very early detection
• non invasive, v fast, cheap

Question 3

Cardiac CT

Answer 3

Bb - control HR => U65
-increase diastolic period

Antecubital vein

• CT images taken during diastole
• breath hold => both reduce cardiac motion

Can use this info to assess stenosis in vessels before obstuctive symptoms arise

Question 4

Coronary CT angiography

Answer 4

Can assess for stenosis before obstructive symptoms arise

Question 5

Invasive coronary angiogram

Answer 5

Live xray
Catheter in radial/femoral
Once flashback achieved => sheath introduced
-can now pass tools and contrast into vessels