Cardio 25: PCI Flashcards
Indications for Diagnostic Catheterization
Acute coronary syndromes Stable Angina Abnormal stress test Nonspecific chest pain/shortness of breath Evaluation of congestive heart failure Evaluation of valvular heart disease Evaluation of congenital heart disease
Where are common sites of catheter access
Femoral (most common)
Radial
Brachial
Technique
Single puncture technique w/ 18-21guage needle
Place sheath w/ hemostatic check valve (artery and vein?)
Perform right heart catherization
Catheter exchanges over 0.35” guide wire
Engage arteries w/ appropriate cath
Angiograms in multiple views
Which vessel will the catheter enter the heart from ?
Superior Vena Cava –> Right atrium and into the pulmonary artery
Uses of catheterization
Measure left ventricular pressure & perform ventriculogram
Perform intervention as necessary
Remove sheath and gain hemostasis
Types of PCI
Plain old balloon angioplasty (POBA)
Balloon expandable stents
Bare metal (BM)
Drug eluting stents (DES)
Rotational AtherectomyPOBA has a high risk of what occuring after procedure ?
Re-stenosis
Bare Metal Stents decrease elastic recoil after ballon angioplasty. What is the px for antiplatelets after placement ?
ASA for life
Clopidogrel 1 mos minimum
Drug eluting stents do just what they say. They have drugs imbedded that help reduce the risk of restenosis.What is the anti-platelet regimen for these devices post implantation ?
ASA for life
Clopidogrel 12 mos minimum
Prasugrel reasonable choice
List some common druge eluting stents
Cypher™ (Sirolimus)
Taxus™ (Paclitaxel)
Xience™/Promus™ (Everalomous)
Endeavour™ (Zotarolimus)
Rotational atherectomy
Like a drill tip
Used to modify the plaque
Post procedural care
Vitals
Groin care
Bedrest
1-8°
Dont want to rest too long, clotting risk
List other PCI that occur
Treatment of symptomatic mitral stenosis Treatment of severe aortic stenosis Closure of atrial septal defects Closure of symptomatic patent foramen ovale Closure of left atrial appendage Closure of muscular VSD’s
Complications associated with PCI
Local hematoma Retroperitoneal hematoma Pseudoaneurysm (PSA) Acute renal failure (0.37%) Embolization Arrhythmia 0.33% Myocardial infarction 0.03% Stroke 0.06% Death 0.08%\
Overall these are low risk for patients
Risk for hematoma rises with use of …
anti-coagulation
How do you treat a hematoma ?
Obtain local hemostasis w/ manual compression
IV fluid and T+C for blood
Pain control
Rarely requires OR
Describe the symptoms of a retroperitoneal hematoma
Usually sudden onset of hypotension associated w/ back pain, may have bradycardia
Treatments for retroperitoneal hematoma
IV fluids and blood transfusion Manual compression of puncture site Stop anticoagulants (not oral antiplatelets) Can obtain CT scan to confirm Rarely needs OR
How would you diagnose a pseudo-aneurysm following PCI ?
Hear bruit on exam and may feel thrill
Diagnosis w/ ultrasound
How would you treat pseudo-aneurysm following PCI ?
Thrombin injection
Manual compression
Surgical repair
Prevention of Acute Renal Failure following PCI includes
Hydration, hydration, hydration Limit contrast amount Limit repeat exposure Hold metformin for 48° after contrast injection for diabetics Sodium Bicarbonate infusion Mucomyst
What syndrome is associated with Embolization post PCI ?
Blue toe syndrome.
What are the most common arrhyhtmias associated with PCI ?
V. tach
V. fib
A. fib
Bradycardia
Usually self limiting
What kinds of strokes are more common with PCI: Embolic or Hemorrhagic ?
Embolic
All strokes are very rare.
Conscious sedation is more common in …
Elderly
Critical illness
Obesity
Describe long term post procedural anti platelet therapy for patients undergoing PCI
ASA For life 81-325mg Clopidogrel BMS 4 weeks DES 12 mos minimum
Prasugrel and Ticagrelor can also be given…
