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Cardiac Cath and Angiocardiography

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Cardiac Cath and Angiocardiography SPRING 2011 * MRI Is becoming more sophisticated and having greater detail and resolution Allows for is to be used more often for ... – PowerPoint PPT presentation

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Title: Cardiac Cath and Angiocardiography


1
Cardiac Cath and Angiocardiography
  • SPRING 2011

2
Catherization Studies and Procedures
  • Adults
  • Children

3
Basic Diagnostic Studies of the Vascular System
for Adults
4
Cath of the LT side of the heart ADULTS
  • Catheter introduced into the radial, brachial or
    femoral artery to the ascending aorta
  • Aortic root angio is performed to document
    competence of the aortic valve

5
Aorta Root Angiography
  • Normal means backward flow of the contrast media
    into the LT ventricle during injection
  • Atrial oximetry and blood pressure within aorta
    are measured
  • Then advanced into the LT ventricle

6
LT Ventriculography
  • Provides info on valvular competence
  • Interventricular septal integrity
  • Efficiency of the pumping action of LT ventricle
  • Pressure measurements are made
  • When systolic (LT ventricle) does not match
    systolic (aorta)- could mean aortic stenosis

7
Coronary Angiography
  • Allows the extent of intracoronary stenosis to be
    evaluated

8
Coronary Angiography
9
Coronary Angiography
LT coronary artery
Normal LT coronary Artery
10
Cath of the RT side of the heart ADULTS
11
Cath of the RT side of the heart ADULTS
  • Pressure measurements
  • Used to determine valvular heart disease
  • Congestive heart failure
  • Pulmonary hypertension
  • Cardiomyopathies

12
Exercise Hemodynamics
  • For evaluation of valvular disease
  • When fatigue and dyspnea are present
  • Simultaneous catherization is done and pressure
    measurements of RT LT heart is taken
  • At rest
  • With exertion
  • Catheter is placed in
  • An artery (femoral or brachial)
  • Vein (femoral or basilic)

13
Basic Diagnostic Studies of the Vascular System
for Children
  • For evaluation of specific hemodynamic data
  • Selected aspects of cardiac function
  • Congenital heart defects
  • Methods are different according to age and size
    of the heart

14
Advanced Diagnostic Studies of the Vascular
System for Adults Children
  • Biopsy catheter with bioptome tip is inserted
    into jugular or femoral vein into RT ventricle
  • Jaws are opened and many biopsies are taken

15
Bioptome Biopsies
  • Used to monitor cardiac transplants for tissue
    rejection
  • And to differentiate between various types of
    cardiomyopathies

16
Studies of the Conduction System for Adults
Children
  • Mulipolar catheters are inserted in
  • High RT atrium near sinus node
  • Atrioventricular apex
  • Coronary sinus

17
Studies of the Conduction System for Adults
Children
  • Sometimes 3 introducer sheaths are placed in one
    vein
  • Femoral
  • Internal jugular vein
  • Subclavian vein
  • Cathodes serve a dual function
  • Record electrical signals
  • Pace the heart

18
Interventional Procedures of the Vascular System
Adults
  • Percutaneous Transluminal Coronary Angioplasty
    (PTCA)
  • Also known as balloon angioplasty
  • Employs balloon to dilate the coronary artery
    stenosis
  • The placement of the catheter is placed much in
    the same way as standard coronary angiography

19
PTCA cont
  • Special steerable PTCA guidewire is used.
  • Guidewire is advanced to stenotic area through
    the balloon catheter
  • Balloon is pushed through to the stenotic area
  • Balloon is inflated and compresses fatty deposits

20
PTCA cont
  • Followed by arteriography to make sure it blood
    is flowing
  • This may be done repeated times to assure maximum
    dilatation
  • Restenosis occurs in 30-50 of patients

21
PTCA
22
PTCA with Stent placement
  • Similar to PTCA alone except a stent is placed
  • Restenosis is lower for pts who do this rather
    than conventional angioplasty alone

23
PTCA with Stenting
24
PTCA with Stent Placement
25
Atherectomy
  • Atherectomy devices remove the fatty deposit or
    thrombus material within artery
  • Directional coronary atherectomy devices having a
    specialized cutting device to shave out the
    plaque
  • There is a special nose cone that collect the
    free floating particles

26
Percutaneous transluminal coronary rotational
atherectomy
  • The tip is a football shape and is embedded with
    diamond particles
  • Special torque guidewire between 160,000- 200,000
    rpm
  • The plaque is pulverized into particles the size
    of RBCs and removed by the reticuloendothial
    system

27
Interventional Procedures of the Vascular System
Children
  • Balloon Septostomy to enlarge a patent foramen
    ovale or preexisting atrial septal defect
  • This allows mixing of RT and LT blood
  • Resulting in improved arterial oxygenation
  • Balloon is passed through atrial septal opening
    into the LT atrium, inflated with contrast and
    pulled back through the orifice
  • Causes septum to tear

28
Balloon Septostomy with Transeptal System Approach
  • When there is not a preexisting hole in the
    atrial septum
  • Transeptal approach is used
  • Catheter with knife is employed into LT atrium
    blade is opened and pulled back through RT atrium
  • Then balloon septostomy may be performed to open
    the hole more

29
Interventional Procedures of the Conduction
System Adults Children
  • Antiarrhythmic devices
  • Pacemakers
  • Implantable cardioverter defibrillators

30
CXR with Pacemaker
31
Post Catheterization Care
  • Firm pressure is applied to puncture site for
    15-30 minutes
  • Wound sites are cleaned and dressed
  • The patient will be observed in recovery for 4-8
    hours
  • The insertion site will be checked frequently for
    signs of bleeding.
  • Medications and discharge instructions are given
  • Lots of fluid should be taken in
  • Vital signs should be monitored for 24 hours

32
Cardiac Catheterization Trends
33
Trends
  • Vascular brachytherapy- technique where radiation
    is delivered to an area of a previously stented
    artery using endovascular techniques
  • Drug eluting stents- drug coated stents used for
    treatment of CAD to reduce restenosis

34
MRI
  • Is becoming more sophisticated and having greater
    detail and resolution
  • Allows for is to be used more often for the
    cardiovascular system
  • MRA is now able to assess anomalies in the
    coronary arteries
  • And identify calcifications in the coronary
    arteries and bypass grafts

35
Electron Beam CT
  • Can detect heart disease at it earliest and most
    treatable stages
  • Measures the amount of coronary calcium,
  • Electron Beam angiography is a simple and
    noninvasive technique that uses IV contrast media
    injection
  • Effective for visualization of great vessels,
    carotid arteries and peripheral vasculature
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