CC1: Introduction Flashcards
How to access left heart with catheter?
-Femoral artery
-Aortic arch
-Left ventricle
How to access right heart with catheter?
-IVC
-Right atrium
-Right ventricle
-Pulmonary artery (PCW)
Is left or right side of heart harder to access via catheter?
-Right side is harder to access via catheter
What is the Seldinger technique?
-Method of accessing vein/artery using a catheter
Which chamber cannot be accessed by a catheter?
-Left atrium
How is left atrium accessed?
-Directly by transeptal method
-Indirectly by pulmonary capillary wedge (PCW)
Theory behind PCW
-Pressure in lungs is low
-Any pressure picked up is from left atrium
What is a common consequence of valvuloplasty?
-Valve gets stretched
-Regurgitation
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
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
Indications for cardiac catheterisation
-STEMI - PCI
-Valve repair/replacement - TAVI
-EP study - ablation
-Congenital defects - ASD, VSD, ToF
What are the 4 features of Tetralogy of Fallot
-RVH
-VSD
-pulmonary stenosis
-Overriding aorta
Contraindications for cardiac catheterisation
-End stage heart failure
-Kidney disease
-Systemic infection
-Severe bleeding
-Unstable arrhythmias
Risk factors for CAD
Behavioural:
-Smoking
-Diet
-Physical inactivity
-Alcohol consumption
Medical:
-Blood pressure > 140/90
-Obesity (BMI>30)
-Diabetes
-Cholesterol
Irreversible:
-Age
-Gender
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
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
