Invasive Cardiac Imaging Flashcards
What are the indications of a Right heart Catheterization?
• Indications • Evaluation of hypotensive patient • Valvular heart disease • Pericardial disease • Pulmonary disease • Shunt calculations • Transplantation evaluation
Explain the general concepts of what the normal pressures are in the various parts of the heart and lungs?
Cardiogenic shock characteristics?
Cardiogenic (Low CO, high PCWP)
Septic shock has what characteristics?
Septic (High CO, Low SVR)
Hypovolemic shock characteristics?
Hypovolemia (LOW CO, High SVR)
What do we see with acute mitral regurgitation? Mitral stenosis? Pulmonic stenosis?
- Imperative to delineate valvular disease
- Acute Mitral regurgitation (large V wave)
- Mitral stenosis (gradient between PCWP and LV end diastolic pressure)
- Pulmonic stenosis (gradient between RV systolic pressure and PA pressure)
Explain findings of Tamponade? Constrictive pericarditis?
- Tamponade—Equalization of pressures (right atrial mean, PA diastolic and wedge)
- Constrictive pericarditis-prominent Y descent
- Tamponade-Prominent X descent, slow Y descent
Explain pulmonary wedge pressure?
- Wedge pressure is a reflection of left atrial pressure
- If pulmonary hypertension with high PCWP is more indicative of congestive heart failure or left sided valvular disease
- If pulmonary hypertension with normal or low PCWP then indicative of primary pulmonary etiology (COPD, PPH, etc.)
Right heart catheterizations are utilized for detection of which shunts? Venous saturations are used to see?
- Complex lecture but right heart catheterizations are utilized for detection of ASD/VSD in adults and congenital shunting in children
- Venous saturations employed for revealing inappropriate post lung oxygenation levels and location of shunt (RA for ASD, RV for VSD, PA for ductus) “oxygen step up”
Right heart cath and transplant?
• Yearly biopsies are performed via right heart status post heart transplantation to evaluate rejection
Left heart catheterization?
Left heart catheterization
• Most valuable use is for angiography of left ventricle (ejection fraction) and pressure gradients of LV maximum systolic pressure and end diastolic pressure
- Peak systolic pressure used for aortic stenosis
- End diastolic pressure used for mitral stenosis
Uses of coronary angiography?
- Gold standard for evaluation of coronary anatomy
- Multiple indications but for this lecture
- Myocardial infarction (ST elevation or non ST elevation)
- High risk non invasive study
- Unstable angina
- Recurrent chest pain despite normal non-invasive studies in patients with multiple risk factors
- Before valvular surgery is planned in patient over 45 years of age
Contraindications of coronary angiography?
- Only absolute is inability to obtain informed consent
- Relative
- Bleeding dyscrasias
- Renal failure
- Contrast allergy
- Recent stroke
- Unexplained fever
- Severe anemia (HgB <8) or thrombocytopenia
- Active endocarditis
Intravascular ultrasound use?
- IVUS used to delineate borderline lesions seen on angiography
- Angiogram is only two dimensional view of lumen
- Ultrasound allows view of entire artery and eccentric plaques in reference to entire vessel diameter
invasive vascular imaging?
• In large part CTA and MRA have replaced the majority of invasive diagnostics in the realm of peripheral angiography
