Chapter 65 - Left Heart Catheterization

Question 0

Name the class I indications for left heart catheterization.

Answer 0

1 – acute STEMI, NSTEMI with elevated cardiac troponin comment ST segment depression, heart failure, hemodynamic instability, ventricular tachycardia, prior bypass surgery, prior coronary stent in the last six months. No evidence of reperfusion after thrombolytic therapy.

2- unstable angina that cannot be controlled by medical therapy

3- chronic stable angina refractive to medical treatment.

4- Stress test is positive it a low workload (6.5 METS). Positive high-risk stress test.

5- sustained polymorphic ventricular tachycardia without obvious metabolic cause

6 – LVEF <40% unknown cause

7 – patients requiring the valve surgery who are at risk for coronary artery disease.

Question 1

The first left heart catheterization with selective coronary angiography took place by who, when, and where?

Answer 1

Dr. Mason Sones, 1958, Cleveland clinic.

Question 2

Name the features of a high-risk positive stress test.

Answer 2

ST elevation of 2 mm in leads without Q waves. ST depression of 2 mm, especially multiple leads or persisting into recovery six minutes. A drop in blood pressure >10 mmHg, or development of ventricular tachycardia with exercise.

Question 3

Name the class two indications for left her catheterization.

Answer 3

Post thrombolytic therapy in a patient who appears to have clinically reperfused.

Positive stress test without high-risk criteria

Question 4

Name the absolute contraindications to left heart cath.

Answer 4

Active bleeding