coronary angio and PCI

Question 1

definition of PCi

Answer 1

a balloon is inflated inside a stenosed vessel = opening the lumen

stent usually inserted to reduce the risk of re-stenosis

Dual antiplatelet therapy (DAPT; usually aspirin and clopidogel) is recommended for at least 12 months after stent insertion to reduce the risk of in-stent thrombosis

Question 2

definition of coronary angiography

Answer 2

Inject radiopaque contrast medium to image cardiac anatomy and blood flow

Question 3

Ix for PCI and coronary angiography

Answer 3

• coronary artery diseaseangiography: to assess the exact location and extent of coronary vessel narrowing before possible PCI/surgery
  
  • unstable angina
  • adverse effects from medical therapies
  • conservative control of symptoms has failed
  • high risk pts
• PCI - therapeutic

valvular disease: diagnostic - pressures indicate severity

Congenital heart disease:

• diagnostic (assessment of severity of lesions by measuring pressures and saturations);
• therapeutic (balloon dilatation or septostomy).

cardiomyopathy

pericardial disease

endomyocardial biopsy

PCI: acute and chronic occlusion of coronary arteries - MI, occlusion of bypass grafts and stents, recurrent ischemia after PCI or bypass surgery

angiography: recurring chest pain with unknown cause, preop evaluation prior to surgery in high risk pts, detect and quantify presence of intracardiac shunt

Question 4

complications of coronary angiography and PCI

Answer 4

Haemorrhage: apply firm pressure over puncture site. If you suspect a false aneurysm, ultrasound the swelling and consider surgical repair. Haematomas are high risk for infections.

•Contrast reaction: usually mild with modern contrast agents

.•Loss of peripheral pulse: may be due to dissection, thrombosis, or arterial spasm. Occurs in <1% of brachial catheterizations. Rare with femoral catheterization.

•Angina: may occur during or after cardiac catheterization. Usually responds to sublingual GTN; if not, give analgesia and IV nitrates.

•Arrhythmias: usually transient. Manage along standard lines.

• Pericardial effusion: suspect if unexplained continued chest pain. May need drain depending on severity and haemodynamic status.
• Pericardial tamponade: rare, but should be suspected if the patient becomes hypotensive and anuric. Urgent pericardial drain.

•Infection: post-catheter pyrexia usually due to a contrast reaction. If it persists for >24h, take blood cultures before giving antibiotics.