vascular assessment Flashcards
- See extent & severity of cardiac dz in pt w/ symptoms (stable angina)
- Exclude severe pt in symptomatic pt w/ equivocal (ambiguous) findings on non-invasive studies
- See if medical, surgical, catheter interventions are needed
- Plan upcoming surgeries
- Intervene on known ischemic heart dz (STEMI or NSTEMI)
Indication for cardiac cath
most common risk/complication of cardiac cath
access site bleeding
these are risks of what procedure
- Arrhythmias
- acute renal failure
- vascular complications
- transient heart block
- contrast rxn
cardiac cath
list some C/I to cardiac cath
- acute renal failure or severe chronic renal insufficiency
- decompensated CHF
- acute stroke
- acute GI bleeding
- severe uncorrected electrolyte issues
- hx of anaphylaxis to contrast
- hx of allergy/bronchospasm to aspirin in pt who need stent
these are indications for what procedure
- Define coronary anatomy
- Determine extent of coronary artery & bypass graft dz
- Assess feasibility of therapy
- Investigation when non-invasive means are inadequate
coronary angiography
this describes which procedure
inject contrast into R & L coronary ostia then radiographic images are recorded in real time
coronary angiography
if pt getting cath has suspected CAD what must you do before hand
aspirin 325 mg
if pt getting cath is likely to need PCI in the procedure, what must you do before hand
clopidogrel 600mg loading
Goal INR pre cath
< 2; hold warfarin
this describes what procedure
Catheter advanced under fluoroscopic guidance: femoral or jugular vein → RA→ RV→ pulmonary artery→ pulmonary wedge position (surrogate for LA pressure)
R heart catheterization
what procedure
measure pressure, obtain blood samples for O2 saturation analysis, consider CO
R heart cath
these are indications for what procedure
- Unexplained dyspnea
- Valvular heart dz, congenital heart dz
- Pericardial dz
- R/L Ventricular dysfunction
- Suspected intracardiac shunt
R heart cath
Catheter advanced under fluoroscopic guidance: femoral, brachial or radial artery > Aorta > LV
L heart cath
what procedure allows to measure pressures & evaluate function and structure of left side of heart
L heart cath
diff between coronary angiogram and coronary CTA
coronary angiogram involves a catheter into the artery and area to be studied, a CT angiogram does not require catheter insertion
- Contrast injected to visualize LV chamber
- Assess for wall motion abnormalities, aneurysm, pseudoaneurysm or diverticulum
- Can assess MVP & MR severity
ventriculography in L heart cath
which procedure is better for
- Left MAIN dz
- 3 vessel dz in reduced LVEF or treated DM
- long lesions >35 mm/diffuse dz
CABG
stent placement needs ____ or other anticlotting therapy
clopidogrel
which type of stent has antiproliferative agent that prevents clotting on it
drug eluting stents (DES)
in pt w/ mild or moderate stable sx (stable angina), ____ & ____ may be preferred initial strategy
aggressive lipid & antianginal therapy
4 factors associated w/ restenosis after stents
- DM
- small luminar diameter
- more complex lesions
- lesion at coronary ostia or LAD
what medication does everyone who gets a stent stay on for life? (2)
atorvastatin 80 mg or Rosuvastatin 20mg
high intensity statins
minimum duration of dual platelet therapy for pt w/ BMS vs DES
- BMS– 1 month
- DES– 6-12 mo
what meds are used in dual antiplatelet therapy after shunt placement?
clopidogrel + aspirin 325 mg
if risk of bleeding is low after 12 mo of dual antiplatelet therapy from stent placement, how much longer do you keep them on it?
another 18-24 month (DAPT score)
When combined w/ perfusion imaging, can provide assessment of the coronary arteries and the cardiac myocardium in one sitting
coronary CT
useful when probability of severe CAD is low to r/o ACS/CAD in setting of chest pain
high sensitivity w/ limited specificity– many lesions that look obstructive on it are non-obstructive on coronary angiography
coronary CT
Non ionizing radiation; high resolution dynamic images of myocardium & heart structures
can add gadolinium to help assess viability
cardiac MRI
continuous ambulatory ECG monitoring for 24-48 hrs; used for daily sx of dizziness, syncope, near syncope, palpitations
also to detect silent preoperative ischemia
holter monitoring
- Tests heart electrical conduction system to assess electrical activity and conduction pathway
- Used to investigate the cause, location of origin, and ideally tx various arrhythmias
- may ablate cells of origin in abnormal activity
electrophysiology study
- evaluation/diagnosis of vasovagal syncope
- May include provoked vasodilation (w/ nitroglycerin)
- test ends when pt faints, develops other sx or specified time elapses
tilt table testing
what is a positive table tilt test (2)
- having sx
- drop in BP or arrhythmia
