CCTA-Contraindications

1
RADIOLOGY REPORT

• 64 Detector CT
• P.A.C.S.
• Stroke Program Update
• Neuro Interventional Update

2
LightSpeed VCT 64-Slice CT Scanner

• Helps us obtain the information we need to
  diagnose disease and life-threatening illnesses,
  including cardiovascular disease, chest pain and
  stroke.
• The worlds first volume CT (VCT) system,
  captures images of a beating heart in five
  heartbeats, an organ in one second, and performs
  whole body trauma in ten seconds, more than twice
  as fast as conventional multi-slice CT scanners.

3
Target Audience Community
4
Coronary CTA-Overview
5
Appropriate CT Angio Indications

• Chest pain, intermediate pretest probability, and
  either
• uninterpretable ECG or unable to exercise
• No ECG changes and serial enzymes negative
• Suspected anomalous coronary artery anatomy or
  other complex congenital heart disease
• Evaluation of coronaries for etiology of new
  onset heart failure
• Evaluation of cardiac mass, tumor or thrombus, or
  pericardial disease when echo, TEE or MRI
  technically limited

6
Appropriate CT Angio Indications-continued

• Evaluation of pulmonary vein anatomy prior to RF
  pulmonary vein isolation
• Mapping of old bypass grafts prior to re-do CABG
• Mapping of coronary veins prior to bi-V pacer
  implantation
• Evaluation of aortic dissection, thoracic aortic
  aneurysm, or pulmonary embolus

7
Uncertain CT Angio Indications

• Chest pain, intermediate pretest probability of
  CAD, able to exercise with interpretable ECG
• Chest pain, low or high pretest probability of
  CAD, no ECG changes and enzymes negative
• Chest pain, post coronary stent or CABG
  procedures
• Triple rule out (ECG and enzymes negative)
• Detection of CAD in asymptomatic patients at
  moderate or high risk (Framingham)

8
Uncertain CT Angio Indications-continued

• Preoperative assessment before intermediate or
  high-risk noncardiac surgery (intermediate risk
  patient)
• Evaluation of LV function (technically limited
  echocardiogram)
• Evaluaiton of native or prosthetic cardiac valves
  (technically limited echo, TEE or MRI)

9
Inappropriate CT Angio Indications

• Chest pain and
• High pretest probability of CAD
• ST elevation or positive enzymes
• Ischemia on stress testing
• dkajflaksjfd

10
CCTA-Contraindications

• Atrial fibrillation (permanent or AF at the time
  of the study)
• Bigeminy, trigeminy, high degree heart block
• Severe asthma
• Creatinine gt 1.8 (eGFR lt 60)
• Failed steroid prep for contrast allergy
• Morbid obesity (BMI gt 40)

11
Ordering Physician

• Cardiologist
• CT surgeon

12
Interpreting Physician

• ACC/AJR credentialed physician
• Interpreting physician also responsible for
  supervision of the study

13
Cardiology Participation

• Ordering Physician /- review with radiologist
• Interpreting Physician ( pending CPT codes )

14
Patient Preparation

• Prior to procedure patient receives preparation
  packet
• Packet includes cardiac, medical history forms,
  and a brief description of what to expect when
  having CCTA
• Instructed to take meds in am as usual, including
  (especially) beta-blocker

15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Patient Preparation

• No caffeine for 12 hrs prior to exam
• Metoprolol 100mg po one hour prior to study
• Second dose of Metoprolol 50 mg if HR gt 71
• Nitro spray 1/150 gr. sl.
• NTG contraindications
• - allergy
• - Viagra,Cialis,Levitra

19
Target Heart Rate

• Ideal rate is lt 70bpm
• Can be done up to 80 bpm if they have a regular
  rhythm ( images not as good )