Cardiology Diagnostic Evaulation Flashcards
what is a CCTA?
what is the procedure
CCTA: Cardiac CT anigography (with contrast)
- using at EKG: the contrast dye is timed so that it is entering the cornary vessels and entering the left ventricle at the proper point (administered into venous)
- CT imaging with the contrast shows the perfusion of the vessels – no cath used – just inserted dye to look at the left heart
- reported as a CAD-RAD score of % stenosis
procedure
- beta blockade, nitroglycerin (vasodilator) & IV contrast administered to the pt.
- “gate” the CT image so that you are seeing it during diastole with the EKG as a guide
when is CCTA used (2 indications)
Indications:
Stable Angina: those with an intermediate pre-test probability can get a CCTA to…
- detect an obstruction with CAD highly sensitive as the an noninvasive test, variable specifictiy get some false positives but its good at getting for those who have >50%
- detects cornary plauqe without an obstruction see the % of the vessel that is narrowed risk is based on degree of plaque not degree of obstruction
Acute Cornary Syndrome: NOT often used in this context: those with a low pre-test probability
- usually instead these people (becuase low probability of having a CVD) we observe, trend cardiac enzymes & serial EKG (and if there is something – to the cath lab for catheter)
- if these is absence of CVD on the CCTA = very low risk of an event happening in 2 years
for those with HIGH test probability –> we are skipping a CCTA because then need immediate left heart catheterization as they most likely have obstruction or blockage & need to be stented/ballooned
CCTA Contraindications
these are all relative contraincidations
- allergy to iodine
- renal insufficiency
- irregularities or tacharrythmias (because we cant block with EKG)
- inability of pt. to lie flat and hold their breath 5-10 seconds
what is a CAC Score? what does it indicated
- can get a CAC score (cornary artery calcium score) to see how calcified the vessel is
- CAC is done withOUT contrast— you cannot see the calcium with the contrast
- amount of calcium is related to the amount of burden
what is a Left Heart Catheterization?
possible sights of entrance
how is it monitored (what imagining)
Left Heart Cath–> a diagnostic procedure conducted in which a catheter is threaded through the arteries to get to the left heart (from the aorta) and into the cornary vessels through to ostia in the aorta
- follows the Seldinger Technique
- uses contrast and real time CT imaging as you thread the wire to the cornary vessels
Entranct Points
- Femoral Artery
- Radial Artery
- Brachial Artery
what is a Left Heart Catheterization?
possible sights of entrance
how is it monitored (what imagining)
Left Heart Cath–> a diagnostic procedure conducted in which a catheter is threaded through the arteries to get to the left heart (from the aorta) and into the cornary vessels through to ostia in the aorta
- follows the Seldinger Technique
- uses contrast and real time X ray imaging (fluroscopy) as you thread the wire to the cornary vessels
Entranct Points
- Femoral Artery
- Radial Artery
- Brachial Artery
what is a percutaneous conarary intervention (PCI)
3 types of PCI
a therapeutic process done through the process of a left heart cath. procedure (need the left heart cath. to do the procedure)
- the PCI is the process of ballooning, opening the vessel and possibel stenting of the vessel to ensure it stays open
- done with continuous monitoring of the placement through xray technology
Types of PCI
- ballooning: rarely done alone used to deploy the stent & squish the plaque to the sides (blow it up and place the stent) – if there contraindication to placing a stent (inability to have long-term platlet therapy or problem with leaving a stent) –> then would just balloon
- Stenting: balloon and then place meshwire stent to ensure vessel stays open ( predilate the vessel then place stent) must put pt. on antiplatlet therapy for 30 days.
- Thrombectomy: the process of physicailly removing the clot(can be done with a variety of different tools)
Indications for a Left Heart Cath & PCI (acute cornary syndromes)
- elective
- urgent
- emergency
- salavage
Emergency: MUST INTERVENE – STEMI this is the “door to balloon time” we think about
Urgent: must intervene while they’re in the hospital – within the next few hours — NSTEMI, unstable angia (if pre-test prob. indicates) need to get done while theyre here but not in the next minutes
Elective: will help them, do within the next days/weeks — Stable angina
Salvage: unknown time in Vfib/VTach cath to help salavage what remains of the heart function (while your doing compressions or ECMO)
non acute cornary syndrome indications for a left herat cath.
- evaluate cornary artery bypass graft (prior to)
- assessment of vavlular disease (atrial/mitral = left heart) (tricuspid & pulm. = right heart)
- percutaneous interventions of valves & closure of congenitial defects (ASD,VSD,PDA)
- cardiac arrythmias (ablations of the foci)
contracindications for a left heart cath.
all relative– if they need it, theyll get it
- severe peripheral vascular disease (all collateral, tortous veins, with now clear path)
- severe HTN
- unable to lie flat as pt.
- renal insufficiency
- acute CVA
- active bleeding/coagulopathy
- allergey to iodine contrast
- untreated sepsis/infection
Coronary angiography
placement of a catheter, wire and if necessary stent and balloon into the cornary vessels (entrance through the arteries and in)
- a therapeudic procedure done
- real time monitored through x-ray technology
looking at..
RCA: to the acute marginal & atrial branches & to the right posterior and right posterior atrioventrc.
LCA (left main): to LAD & Circumflex (LAD –> gives off diagonal) (circumflex –> gives off obtuse)
what can be measured through left heart cath. (think hemodynamics)
- aortic pressure
- LV pressure
- LA pressure
- valve pressure & gradients of pressure
what can be detected through a left heart ventriculography
example of a morphologic change you may find on ventriculgraphy
ventrilces, graphy — imagind done as the catether is placed in the let heart and dye is intorduced to see differences in contrast of strcutres
detected
- a measurement of the ejection fraction (% of blood leaving the LV)
- detect morphologic abnormalities
Type of abnormality: Takotsubo Cardiopmyopathy
- see the shaped of the pot as the ventricle –> narrow at top then bowl like and wide toward the inferior
- this is a stress cardiomyopathy (seen when the heart is under stress– pumping)
PCI Long-Term Outcomes
1-year mort. : 3.6% (complications like bleeding and revascualarization decrease this)
5-year mort: 37% : majority of these due to comorbid events
PCI Complications
(7)
- dissection or intraluminal hematoma
- distal embolization & reperfusion injury – once you allow blood flow to restore –> there is a large flood of blood and inflammatory markers which can damage the wall (myocardial and endothelial edema and vasospasms possible)
- cornary artery perforation: serious need immediate surgery
- side branch occlusion (the stent covers the side branch)
- in-stent REstenosis (covers the stent and creates plaque)
- sornary artery aneuryum (wall dialtes)
- access site bleeding & hematoma (at femoral, brachial, etc.)
