Heart catheterization, hemodynamic evaluation Flashcards
Heart catheterization: def
- a procedure used to diagnose and treat cardiovascular conditions.
- Passage of a catheter to cardiac chambers and coronaries via peripheral vessels
Heart catheterization: procedure to get to the left heart, and right heart
Left heart: use femoral/radial/brachial puncture -> aorta/coronaries, left ventricle, mitral valve
Right heart: use femoral/subclavian/antecubital vein -> RA, tricuspid, RV, pulmonary valve+ artery
Heart catheterization: The different uses for diagnostic and therapeutic:
- pressure and flow measurements
- angiography of chambers
- coronary angiography
- PCI: Percutaneous coronary intervention -> stent implantation with the catheter
- atherectomy: is a minimally invasive endovascular surgery technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, and cardiovascular diseases
- biopsy
- intravascualar US imaging
- pericardiocentesis: fluid aspiration used for pericardial effusion
Heart catheterization: techniques
- Seldinger technique (needle placement -> guide wire inserted -> needle removed -> catheter threaded on guide wire -> guide wire removed) + fluoroscopy/digital x-ray recording
- contrast dye injection: for heart and vessel imaging
- perform angioplasty
Heart catheterization: indication
- coronary and CAD (coronary artery disease) investigation
- heart valve disease
- congenial HF diagnosis
- abnormal stress test
- recurrent chest pain
- HF with suspected CAD
Heart catheterization: complications
- haemorrhage
- contrast reaction -> allergy
- loss of peripheral pulse
- arrhythmia
- thrombosis
- stroke
- AMI
- Angina
- infection
- morbidity
Heart catheterization: drugs
- during: GPIIB/IIIa antagonist (anticoagulant), thrombolytic -> used to prevent any thrombus formation
- after: ACEi/ARB, BB, statin, clopidogrel + aspirin used for 6 weeks, 3 months or more depending on the procedure
Hemodynamic evaluation: what is it
- evaluation of the blood flow and cardiac performance by measuring the blood flow at different points in the circulation. Simply consists to feel the pulse.
Heart catheterization: which instrument used for BP
- plethysmograph or cuff connected to a pressure sensor
Heart catheterization: which instrument used to measure the flow
- Doppler measurement -> measures the flow, pressure gradient, pathologic flow etc…
Heart catheterization: what to do to measure the arterial pulse pressure
- place the pressure sensor on artery of the skin, or invasive method using a catheter
Hemodynamics: equation for MAP, BP, CO
MAP = DBP + ((SBP-DBP) BP = CO * TPR CO = HR * SV
Body mechanisms used for compensation and adaptation of hemodynamic changes
- baroreceptors
- RAAS
