Interventional Cardiology / PVD Flashcards
1
Q
General Interventional Cardiology Principles
- Non-invasive testing
- Coronary angiogram
- Cath lab
- Mainstays of treatment for CADConditions improved w/ interventional cardiology (angoiplasy, stenting)
A
- Non-invasive testing
- Most diagnostic tests
- Assess ventricular function, valvular disease, & coronary anatomy
- Coronary angiogram
- Invasive gold standard for identifying stenosis due to CAD
- Provides the most reliable anatomical info for determining treatment
- Performed by directly injecting radio-opaque contrast material into coronary arteries & imginag them w/ fluoroscopy
- Cath lab
- Measures hemodynamic & anatomical details
- Diagnoses valvular, pericardial, & myocardial disease states
- Delivers targeted therapeutic interventions
- Mainstays of treatment for CAD
- Medical therapy
- Percutaneous coronary intervention (angioplasy / stent replacement)
- Coronary artery bypass graft surgery
- Conditions improved w/ interventional cardiology (angoiplasy, stenting)
- Angina pectoris (symptomatic CAD)
- Valvular heart disease
- Congenital heart disease
- Extra-cardiac vascular disease
2
Q
Access Sites for Cardiac Procedures
- Most commonly used site for arterial access
- Other access sites
- How access is gained
A
- Most commonly used site for arterial access
- Common femoral artery in the inguinal region
- Other access sites
- Used to improve comfort, safety, &/or efficacy
- Brachial & radial arteries: when needed based on aorto-iliac anatomy
- Internal jugular or common femoral veins: when need venous access
- How access is gained
- Seldinger technique: percutaneous approach
- Needle is placed through the skin & subcutaneous tissue until it enters the vessel lumen
3
Q
Intracoronary Devices & Equipment: CAD
A
- Access gained into a vascular structure
- Intravascular sheath placed to allow equipment to be delivered w/o bleeding
- Catheters
- Long hollow tubes inserted into the body through the sheath
- Placed in various vascular structures
- Contrast dye is injected to obtain digital images
- Wires may be threaded into the vessel & placed in distal portions
- Balloon catheters can be inserted to dilate blood vessels (angioplasty)
- Followed by stent placement to…
- Open narrowed blood vessels
- Treat aneurysmal segments
4
Q
Structural Heart Disease
- Structural heart disease
- Structural heart diseases that can be treated by interventional procedures
A
- Structural heart disease
- Non-coronary CV disease processes & related interventions
- Structural heart diseases that can be treated by interventional procedures
- Hypertrophic cardiomyopathy
- Valvular heart disease
- Patent foramen ovale
- Atrial septal defect
- Ventricular septal defect
- Left atrial appendage
- Left ventricular aneurysm
- Patent ductus arteriosus
- Paravalvular leak
5
Q
Treatment of Symptomatic Severe Aortic Stenosis
A
- Surgical valve replacement
- In ideal candidates
- Transcatheter aortic valve implantation (TAVI) or replacement (TAVR)
- In patients who aren’t ideal candidates due to advanced age or co-morbidities
- Less invasive treatment for aortic valve replacement
- Two major bioprosthetic valves available
6
Q
Treatment of Symptomatic Severe Mitral Regurgitation
A
- Poor prognosis
- Surgical therapy
- Primary means
- Endovascular intervention
- Edge-to-edge repair techniuqe of leaflets w/ a MitraClip device
- Also treats ASDs, VSDs, & patent foramen ovales
- Occlusion devices interrupt the communication b/n chambers of the heart which eliminates blood shunting
7
Q
Treatment of Atrial Fibrillation
A
- AFib
- Can be associated w/ thrombus formation in the LA appendage –> stroke risk
- Medications: warfarin or aspirin
- Standard treatment for stroke prevention
- Non-FDA-approved devices
- In patients who rae at high risk for stoke & can’t tolerage anticoagulation or medical therapy
8
Q
Structural Heart Disease
- Congenital anomlaies
- Acquired heart disease
A
- Congenital anomalies
- Atrial septum
- Ventricular septum
- Pulmonic valve
- Acquired heart disease
- LAA (Watchman)
- Mitral vavle (Mitraclip)
- Aortic valve (TAVR)
- Paravalvular leaks
- Ventricular support
9
Q
Calcific Aortic Stenosis
- General
- Dianosis
- Murmur
- Disease progression
- Echo
- Cardiac cath
- Treatment
A
- General
- Mainly solid Ca2+ deposits within valve cusps
- Similar risk factors for CAD
- High coincidence of CAD & AS
- 6th, 7th, & 8th decades of life
- Diagnosis
- Murmur
- Crescendo-decrescendo SEM radiating to the neck
- Mild: murmur peaks early
- Progressive: murmur becomes louder & peaks progressively later in systole (+/- thrill)
- Disease progression
- Murmur intensity lessens as SV decreases
- Carotid upstrokes are diminished in volume & rate or rise is delayed
- Echo
- Establishes the diagnosis
- LV function / hypertrophy
- Extent of Ca2+
- Transvalvular pressure gradient
- Aortic valve area (dimension / velocity)
- Cardiac cath
- Gold standard
- Gradient & CO needed to calculate valve area
- Simultaneous pressure measurement in LV & aorta
- Murmur
- Treatment
- Surgical aortic valve replacement
- Large mortality benefit in patients w/ symptomatic, severe AS
- Surgical aortic valve replacement