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Evaluation of the Cardiac System > Left and Right Heart Catheterization > Flashcards

Left and Right Heart Catheterization Flashcards

1
Q

What does left heart catheterization help find?

A

-Hemodynamic Data
-Performance of Left ventricular systolic function
-Aortic and Mitral valvular function

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2
Q

What does Right heart catheterization generally involve?

A

Introduction of a balloon tipped catheter into the right atrium, right ventricle, and pulmonary artery

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3
Q

What does a PA (Swan Gannz) catheter have and what is the size of it?

A

Distal Port on the distal tip.
Proximal Port 30 cm to the distal tip

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4
Q

Where is the inflatable balloon and thermistor on the PA Catheter?

A

Balloon= Distal Tip
Thermistor=Near the distal tip

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5
Q

What do the distal and proximal ports on the PA catheter do?

A

-Transduce pressures
-Access for fluids and medications

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6
Q

What can the balloon temporarily do when inflated in the PA catheter

A

Temporarily occlude the PA which allows the distal port to transduce a wedge pressure

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7
Q

What does the thermistor in the PA catheter do?

A

Measure temperature change of fluid injected into the proximal port for calculation of cardiac output

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8
Q

What is needed in the pre-procedural evaluation of Right Heart Catheterization? (5)

A

-History
-Physical Examination
-Labs
-12 led ECG
-Transthoracic ECHO

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9
Q

What are some common indictions for Right Heart Catheterization? (8)

A

-Cause of Shock
-Acute MI cardiogenic shock
-Ischemia of RV during MI
-Inter cardiac shunts
-Cause of Pulmonary Edema
-Congestive Heart Failure
-Cardiomyopathy
-Pericarditis

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10
Q

Central venous access for Right Heart Catheterization can be obtained where?

A

-Femoral Vein
-Internal jugular vein
-Brachial Vein
-Subclavian Vein

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11
Q

What should assess the access vein in a patient pre Right heart Cath?

A

Vascular Ultrasound

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12
Q

How is the sheath placed in the vein?

A

Modified Seldinger technique with ultrasound guidance

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13
Q

What needs to be done after the PA catheter is introduced into the venous sheath?

A

Distal balloon is inflated to advance the PA catheter

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14
Q

What can be used to guide the advancement of the PA catheter?

A

-Fluoroscopic visualization
-Pressure monitoring

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15
Q

What is examined in each chamber in Right Heart Cath?

A

Pressure Waveform

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16
Q

Once the PA catheter reached the main Pulmonary Artery, what is next?

A

It is advanced into the distal Pulmonary artery and occludes that area.

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17
Q

When the PA cath has occluded the pulmonary artery, what is recorded? (3)

A

-Pulmonary Capillary Wedge Pressure
-Left Atrium Pressure
-Left Ventricle diastolic pressure

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18
Q

When the pressures are recorded in the occluded distal pulmonary artery, what is done with the PA catheter? (3)

A

1) Balloon is deflated
2) Catheter is withdrawn back into the proximal PA
3) Blood samples are collected from the PA to measure the mixed venous saturation

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19
Q

What does Right Heart Catheterization provide in hemodynamic information? (3)

A

-Ventricular Preload
-Ventricular after load
-Cardiac Output

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20
Q

What is PCWP?

A

Pulmonary Capillary wedge pressure

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21
Q

What is SVR?

A

Systemic vascular resistance

22
Q

What pressures can be directly measured with the PA catheter (6)

A

-RA
-RV
-PA
-Vena Cava
-PCWP
-Mixed venous saturation

23
Q

What two methods can measure Cardiac Output and Cardiac Index?

A

-Thermodilution Method
-Fick Method

24
Q

How to calculate Cardiac Output thermodilution method?

A

Room temp Saline is injected through the proximal port of the PA catheter. Temperature change is calculated by the thermistor.

25
Q

What is the Fick principle?

A

Total uptake or release of a substance by an organ is the product of blood flow to that organ.

26
Q

What are the three categories of potential complications with Right Heart Cath

A

-Central venous access
-PA cath associated complications
-Misinterpretation of data

27
Q

What needs to be prepared for patients with left heart block completing a right heart cath?

A

Temporary pacing capabilities in case complete heart block occurs from complications

28
Q

What happens with prolonged inflation of the balloon within a branch of the PA?

A

Pulmonary infarction

29
Q

What is the highest mortality rate with Right Heart Cath and what is the cause?

A

Rupture of a Pulmonary Artery due to overinflation of the distal balloon or repeated trauma.

30
Q

What is the percentage of fatal cases in PA rupture?

A

50%

31
Q

What are the factors of risk of PA rupture? (4)

A

-Pulmonary artery hypertension
-Age
-Female sex
-Frequent wedging of the balloon

32
Q

What is left heart catheterization?

A

Cannulation and interrogation of the coronary arteries

33
Q

What is the common indicators of Left Heart Cath? (5)

A

-Eval of LV hemodynamics
-LV systolic function
-Cardiomyopathy
-Valvular disease
-Intracardiac shunts

34
Q

What is the absolute contraindications for Left Heart Cath? (3)

A

-Patient Refusal
-LV thrombus
-Mechanical Prosthetic aortic valves

35
Q

What are the relative contraindications for left heart cath? (7)

A

-Active bleeding
-Severe thrombocytopenia
-Severe coagulopathy
-Active infection
-Severe peripheral vascular disease
-Pregnancy
-Inability to cooperate

36
Q

What is the common access for left heart cath? (3)

A

Femoral Artery
Brachial Artery
Radial Artery

37
Q

What is the size of guide wire for left heart cath

A

0.035 inch J tipped guidewire

38
Q

What are the most common left heart cath catheters? (2)

A

-Pigtail
-Judkins Right

39
Q

How is the pigtail catheter advanced through the aorta? (2)

A

1) Rotate to make pigtail resemble a 6
2) Advance until it pushes up against the aortic valve and prolapses into the LV

40
Q

How is the JR catheter advanced in 6 steps?

A

1) Catheter is advanced several cm above the aortic valve
2) Rotated so that distal points are between 4:00 and 6:00 oclock
3) Guide wire is then advanced across the aortic valve and JR catheter is advanced into the LV over the wire
4) Distal end of the catheter is positioned in the mid LV and guide wire is removed
5) Catheter is connected to the manifold and pressure transducer.
6) LV pressure waveform is examined and recorded

41
Q

What is the typical radiographic view for crossing the aortic valve?

A

RAO projection

42
Q

How can pressure gradient be measured in left heart cath? (3)

A

-Pullback across the aortic valve
-Recording of LV and femoral arterial pressure simultaneously
-Recording of LV and aortic pressure simultaneously

43
Q

While recording a simultaneous LV and aortic pressure, what is needed?

A

Dual lumen catheter with one lumen in LV and other lumen in aorta

44
Q

How does the location of the obstruction estimate in Left Heart Cath?

A

Slowly retracting the end hole catheter from the LV apex and noting where the pressure decreases

45
Q

Dynamic LV outflow tract obstruction can be provoked by? (3)

A

Various maneuvers that decrease either preload or after load. Increases cantractility

46
Q

After hemodynamic assessment what can be preformed for Left Heart Cath? (4)

A

Left ventriculography to estimate LV ejection fraction, function of LV walls, measure mitral regurgitation, and identify any ventricular septal defects

47
Q

How is left ventriculography performed?

A

Cineradiography and simultaneous power or manual injection of contrast.

48
Q

What is the typical angiographic views for left ventriculography?

A

RAO and LAO projections

49
Q

What does RAO projection provide?

A

Inferior, apical and anterior walls

50
Q

What does LAO projection provide? (5)

A

Septal, lateral, and posterior walls.
LV outflow tract
Aortic root

Evaluation of the Cardiac System (10 decks)

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