Coronary angiography and PCI Flashcards
A patient had MI 48hrs ago treated with PCI. He now develops shock; cardiac catheterisation shows oxygen saturation pressures as below:
Superior vena cava = 74%
Right atrium (mean) = 75%, 7mmHg
Right ventricle = 87%, 50/12mmHg
Pulmonary capillary wedge = 16mmHg
Left ventricle = 96%, 140/12mmHg
Aorta = 97%, 110/60mmHg
Increase in oxygen sats between the right atrium to right ventricle means that there must be a VSD
Who is part of the MDT in the cath lab?
Interventional cardiologist
Scrub nurse
Cardiac physiologist - monitors ECG
Radiographer - takes XR images of the heart
Running nurse - get any equipment that is not on operating table
What procedures happen in a cath lab?
PCI = coronary angioplasty (balloon) + stenting
Pacemaker insertion
Percutaneous TAVI
Define PCI.
Procedure (aka percutaneous transluminal coronary angioplasty) to open a blocked or partially occluded coronary artery e.g. in MI. It is a type of coronary revascularisation technique, alternative to CABG.
What are the indications for PCI?
Recommended by NICE for :
1. Stable angina - if medical treatment not sufficient
1. MI with STEMI - if the person presents within **12 hours of onset **of symptoms and primary PCI can be delivered within 120 minutes of the time when fibrinolysis could have been giv
1. NSETMI and unstable angina - if high risk of ischaemia
What are the complications of PCI?
- Bruising or infection at site of entry (femoral or radial)
- Failure
- Allergic reaction to dye
- Renal damage from contrast
Serious: - Blockage of the artery
- MI, stroke, death
- Damage to the artery
- Regrowth of atheroma over the stent
- Cardiac tamponade
- Systemic bleeding
Describe what happens during PCI step by step.
- Patient sedated (not anaesthetised) and local anaesthetic given
2.Inducer needle is inserted and guide wire passed to the coronary arteries where it is visualised by XR with opaque dye - Heparin is given
- Balloon tipped catheter is inserted and inflated, leaving a stent in place - may occlude the artery for a short time –> angina but should resolve once deflated
The procedure lasts 30mins-2hrs
What is the efficacy of PCI?
90% successful in reducing severity of angina and increasing bloodflow x4 over the affected artery
What is the alternative to PCI and what is better?
CABG
* Recovery is faster from PCI rather than CABG
* May not always be able to choose between PCI and CABG
Percutaneous transluminal coronary rotational atherectomy (PTCRA)
* a small rotating device is used to remove the fatty deposit
Percutaneous laser coronary angioplasty
* a laser is used to burn through the fatty deposit
Last 2 are used when there is a high amount of calcium in the vessel. Once the deposit is removed then PCI is done as usual.
Describe the recovery after PCI.
- Avoid strenuous activity and heavy lifting for 1 week after procedure.
- Do not drive for a week after successful PCI
- Return to work after a week
- Take medications as advised (aspirin and clopidogrel/ticagrelor/prasugrel)
- Cardiac rehabilitation- starts in hospital then another session in 4-8 weeks
- Lifestyle changes should be made
How long should you not drive for after MI?
Do not need to inform the DVLA for normal car/motorbike drivers:
* 1 week after successful PCI
* 4 weeks if you had angioplasty after a heart attack but it wasn’t successful
* 4 weeks if you had a heart attack but didn’t have angioplasty
NB: this differs for HGV or bus drivers. They must inform the DVLA.
Define cardiac angiography.
Invasive diagnostic procedure for visualisation of coronary arteries using X rays to produce coronary angiograms (images).
What are the indications for coronary angiography/catheterisation?
Diagnosis of:
* Coronary heart disease e.g. post-MI, angina
* Congenital heart disease
* Cardiomyopathy
* Valvular disease
Plan interventional or surgical procedures
When can the patient go home after coronary angiography?
Same day after a period of rest and observation
What are the complications of coronary angiography/catheterisation?
- Allergic reaction to contrast dye
- Bleeding at site of entry
- Damage to the artery
- Mi, stroke, death
- AKI from dye
