CC1: Introduction Flashcards by Michael Amarin

How to access left heart with catheter?

-Femoral artery
-Aortic arch
-Left ventricle

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How to access right heart with catheter?

-IVC
-Right atrium
-Right ventricle
-Pulmonary artery (PCW)

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Is left or right side of heart harder to access via catheter?

-Right side is harder to access via catheter

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What is the Seldinger technique?

-Method of accessing vein/artery using a catheter

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Which chamber cannot be accessed by a catheter?

-Left atrium

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How is left atrium accessed?

-Directly by transeptal method
-Indirectly by pulmonary capillary wedge (PCW)

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Theory behind PCW

-Pressure in lungs is low
-Any pressure picked up is from left atrium

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What is a common consequence of valvuloplasty?

-Valve gets stretched
-Regurgitation

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Why do cardiac catheterisation?

-Provides anatomical information through angiography
-Provides physiological information through haemodynamic data, pressure measurement, cardiac output and blood
-Accurate and immediate pressure and ECG recording during cath procedure
-Information is coupled with images to confirm diagnosis

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What is point of access for catheter?

Radial/femoral artery - left side
Radial/femoral vein - right side
-Femoral requires 6 hours of bed rest afterwards

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Indications for cardiac catheterisation

-STEMI - PCI
-Valve repair/replacement - TAVI
-EP study - ablation
-Congenital defects - ASD, VSD, ToF

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What are the 4 features of Tetralogy of Fallot

-RVH
-VSD
-pulmonary stenosis
-Overriding aorta

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Contraindications for cardiac catheterisation

-End stage heart failure
-Kidney disease
-Systemic infection
-Severe bleeding
-Unstable arrhythmias

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Risk factors for CAD

Behavioural:
-Smoking
-Diet
-Physical inactivity
-Alcohol consumption

Medical:
-Blood pressure > 140/90
-Obesity (BMI>30)
-Diabetes
-Cholesterol

Irreversible:
-Age
-Gender

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Investigations for CAD

-ECG - to detect changes
-Blood test - elevated cardiac biomarkers
-Stress test - ST elevation/depression
-Stress echo - regional wall abnormality
-Cardiac catheterisation
-PET scan
-Cardiac MRI

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Risk of death in cardiac catheterisation

<0.2%

Major and minor risks of cardiac catheterisation

Major:
-MI
-CVA
-Life threatening arrhythmias

Minor:
-Contrast reaction
-Haemorrhage
-Infection

What is the role of physiologist in cardiac catheterisation?

-Putting leads on patient
-Take resting HR/rhythm and BP
-Responsible for defibrillator

Steps of preparation in cath lab

What is an Allen’s test?

-Checks blood flow through radial and ulnar arteries

Before cardiac catheterisation procedure:

-Patient is starved and sedated
-Performed in x ray or cardiac lab with facilities for angiography
-Pressure measurement, monitoring and life support

Which view is x ray taken in?

Posterior - anterior projection

List some left heart procedures

-Coronary study/Graft study
-LV angiogram
-Aorta gram
-Pressure measurement
-Pressure wire

List some right heart procedures

-Valve assessment - pressure measurement (one or two transducers)
-Coronary study/Graft study
-LV angiogram
-Aorta gram

Describe the Seldinger technique of catheter insertion

1) Syringe into vessel 2) Guide wire through syringe 3)Syringe is removed 4) Sheath is put in (sheath has dilator) 5)Dilator is removed

Which coronary artery is nearest the spine on imaging?

Circumflex

Which arteries come off the LAD and Circumflex?

-LAD -> Diagonal -Circumflex -> Obtuse marginal

What are the phases in the cardiac cycle?

-Atrial contraction -Iso-volumetric ventricular contraction -Rapid ventricular ejection -Reduced ventricular ejection -Isovolumetric ventricular relaxation -Rapid ventricular filling -Reduced ventricular filling

What is and how do you calculate the ejection fraction?

-The ratio of the stroke volume to the end-diastolic volume -Stroke volume/EDV ~60%

What is and how do you calculate stroke volume?

-Amount of blood ejected from the ventricle during systole -LVEDV-LVESV ~70ml

What happens during atrial contraction?

-Atrium contracts forcing blood into the ventricle -Atrioventricular valves open

What happens during Iso-volumetric ventricular contraction?

-Atrioventricular valves close -Pressure is not enough to open semi lunar valves -No change in EDV

What happens during ventricular ejection?

-As pressure in ventricles exceeds pressure in atria, semi lunar valves open and blood leaves the ventricle

What is the ESV?

-Amount of blood in the ventricle at the end of systole ~50ml

What is EDV?

-Amount of blood in the ventricle before contraction ~120ml