Procedures

Question 1

Define coronary angiography?

Answer 1

mimimally invasive procedure to access the coronary circulation and blood filled chambers of heart using a catheter

catheter is inserted into heart via femoral or radial artery or venous system

Question 2

What is PCI?

Answer 2

percutaneous coronary intervention– a non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries

A coronary angiogram is used to visualise the vessels, and then an angioplasty is performed using a balloon catheter.

Stents can be used to keep the vessel open.

Question 3

What is done in coronary angiography and PCI?

Answer 3

• Sample blood to assess oxygen saturation and measure pressures
• Inject radiopaque contrastmedium to image cardiac anatomy and blood flow
• Perform angioplasty (+/- stenting), valvuloplasty, and cardiac biopsies, or to do procedures
• Perform intravascular ultrasound or echocardiography

Question 4

what are the indications for coronary angiography and PCI?

Answer 4

• Coronary artery disease: diagnostic and therapeutic (angioplasty, stent insertion)
• Valvular disease: diagnostic to assess severity, therapeutic (valvuloplasty if patient too ill for valve surgery)
• Congenital heart disease: diagnostic and therapeutic (balloon dilatation)
• Cardiomyopathy
• Pericardial disease
• Endomyocardial biopsy

Question 5

what are the possibel complications of coronary angiography and PCI?

Answer 5

Haemorrhage

Contrast reaction

Loss of peripheral pulse due to dissection/thrombosis/arterial spasm

Angina

Arrhythmias

Pericardial tamponade

Infection

Question 6

Define a coronary artery bypass graft?

Answer 6

Surgical procedure to restore normal blood flow to an obstructed coronary artery

Question 7

what are the 2 approaches for a CABG?

Answer 7

Left internal thoracic artery ( Left internal mammary) is diverted to the left anterior descending branch of the left coronary artery

A great saphenous vein is removed from a long, one end is attached to the aorta (or one of its major branches) and other end to the obstructed artery immediately after the obstruction to restore blood flow

Question 8

describe the procedure of a CABG?

Answer 8

heart is stopped and blood pumped artificially by a machine outside the body (cardiac bypass). Patient’s saphenous vein or internal mammary artery is used as the graft. Severeal grafts may be placed. >50% of grafts close in 10 years.

Question 9

summarise the indications for CABG?

Answer 9

• Left main stem disease
• Multi vessel disease – triple vessel disease involving proximal part of the left anterior descending
• Multiple severe stenosis
• Unsuitable for angioplasty
• Failed angioplasty
• Refractory angina, angina unresponsive to drugs
• When CABG and PCI are both clinically valid options, NICE recommends that the availability of new stent technology should push the decision towards PCI.

Question 10

what are the complications of CABG?

Answer 10

MI

Bleeding

Chest infection

Lung complications

Stroke

Question 11

Define DC cardioversion?

Answer 11

Procedure to convert arrhythmias into sinus rhythm using direct current electricity.

Question 12

what is the difference between synchronised and non-synchronised cardioversion?

Answer 12

Synchronised electrical cardioversion= uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle, restoring the activity of the electrical conduction system of the heart.

Note: defibrillation (unsynchronised) uses a therapeutic dose of electric current to the heart at a random moment in the cardiac cycle – used for resuscitation in cardiac arrest i.e. ventricular fibrillation/tachycardia

Question 13

what are the indications for DC cardioversion?

Answer 13

Ventricular fibrillation

Ventricular tachycardia

Atrial fibrillation

Atrial flutter

SVTs if haemodynamically unstable or other treatments failed

Question 14

what are the complications of DC cardioversion?

Answer 14

Dislodge of blood clots leading to stroke or PE

Other arrhythmias

Skin burns

Question 15

Define an implanted cardiac defibrillator?

Answer 15

Automated implantable cardioverter defibrillator implantable inside the body – able to perform cardioversion, defibrillation and SOMETIMES – pacing of the heart

Question 16

summarise the indications for implanted caridac defbrillator?

Answer 16

prevent sudden cardiac death.

For primary (not yet suffered lift threatening arrhythmia episode) and secondary prevention (survivors of cardiac arrest secondary to VF/VT)

Question 17

what are the possible complications of an implanted cardiac defibrillator?

Answer 17

Infection at the implant site

Allergic reaction to the medications used during the procedure

Swelling, bleeding or bruising where your ICD was implanted

Damage to the vein where your ICD leads are placed

Bleeding around your heart, which can be life-threatening

Blood leaking through the heart valve where the ICD lead is placed

Collapsed lung (pneumothorax)

Question 18

Define permanent pacing?

Answer 18

Transvenous placement of one or more pacing electrodes within a chamber, or chambers, of the heart while the pacemaker is implanted under the skin under the clavicle. It generates electrical impulses delivered by electrodes to contract the heart muscles and regulate the electrical conduction system of the heart

– can be single-chamber, dual-chamber or rate-responsive pacemaker (has sensors that detect changes in physical activity and adjusts pacing accordingly)

Question 19

what are the indications for permanent pacing ?

Answer 19

Sinus node dysfunction

high grade AV block

Question 20

what are the complications of permanent pacing?

Answer 20

Infection where the pacemaker was implanted

Allergic reaction to the dye or anesthesia used during your procedure

Swelling, bruising or bleeding at the generator site, especially if you take blood thinners

Damage to your blood vessels or nerves near the pacemaker

Collapsed lung