Procedures Flashcards
Define coronary angiography?
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
What is PCI?
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.
What is done in coronary angiography and PCI?
- 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
what are the indications for coronary angiography and PCI?
- 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
what are the possibel complications of coronary angiography and PCI?
Haemorrhage
Contrast reaction
Loss of peripheral pulse due to dissection/thrombosis/arterial spasm
Angina
Arrhythmias
Pericardial tamponade
Infection
Define a coronary artery bypass graft?
Surgical procedure to restore normal blood flow to an obstructed coronary artery
what are the 2 approaches for a CABG?
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
describe the procedure of a CABG?
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.
summarise the indications for CABG?
- 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.
what are the complications of CABG?
MI
Bleeding
Chest infection
Lung complications
Stroke
Define DC cardioversion?
Procedure to convert arrhythmias into sinus rhythm using direct current electricity.
what is the difference between synchronised and non-synchronised cardioversion?
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
what are the indications for DC cardioversion?
Ventricular fibrillation
Ventricular tachycardia
Atrial fibrillation
Atrial flutter
SVTs if haemodynamically unstable or other treatments failed
what are the complications of DC cardioversion?
Dislodge of blood clots leading to stroke or PE
Other arrhythmias
Skin burns
Define an implanted cardiac defibrillator?
Automated implantable cardioverter defibrillator implantable inside the body – able to perform cardioversion, defibrillation and SOMETIMES – pacing of the heart
summarise the indications for implanted caridac defbrillator?
prevent sudden cardiac death.
For primary (not yet suffered lift threatening arrhythmia episode) and secondary prevention (survivors of cardiac arrest secondary to VF/VT)
what are the possible complications of an implanted cardiac defibrillator?
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)
Define permanent pacing?
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)
what are the indications for permanent pacing ?
Sinus node dysfunction
high grade AV block
what are the complications of permanent pacing?
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
