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CORONARY ANGIO CARDIAC CATH _ Ablation Procedures Lecture _ 3 A

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                   CORONARY ANGIO
                    CARDIAC CATH
                         & Ablation Procedures
                                                Lecture # 3 A

                                 Cardiac Anatomy & Circulation
                                   & Pathology Review # 3B




    RT 255 (rev 2010)                                        Dawn Charman, M.Ed,R.T
    Reference:
                 Frank. Merrill's Atlas of Radiographic Positioning and Procedures, 11th Ed. Mosby
2
                        What is cardiac cath?


    • Procedure which involves placement of a
      catheter into RT or LT side of heart.
    • Invasive
    • Coronary angiography is often included
      together with cardiac cath
    • Diagnostic procedure and/or
    • a therapeutic procedure
    • Adults & Children

    Check out procedure Video:
    http://www.youtube.com/watch?v=kY5gKdFWT3k&feature=related
3
            Cardiac Catheterization
            also known as a heart cath or
            coronary angiogram
    • This procedures provides the
      doctor with a "road map" of the
      arteries in the heart
    • To find any areas of blockage in
      the arteries that supply the heart
      with blood.
    • May also look at the valves,
      chambers & heart muscle
    • Can help in making decisions
      about the treatment of heart
      disease.
    • It is a usually performed by a
      cardiologist with assistance by
      RT,(CIT), nursing & support staff*
4
    Who performs the procedure?
                • The Interventional
                  Radiologist /
                  Cardiologist
                • who specializes in
                  the Angioplasty
                  procedure.
                • CIT Technologist
                • Nursing
                • Other support staff
5   Cardiac cath requires special equipment:
    1. Angio supplies & equipment
    2. Fluoro Imaging (w/ Cine – Digital)
    3. & Ancillary equipment *




                                               Type of catheter used will
                                               be dependant on the type
                                               Of Procedure performed
6
7                        Done in a “Cath Lab”
    • Cath lab includes
    •  a special table,
    •  x-ray tube &monitor,
    • supplies (catheter,
      guidewire)
    • automatic injector
      pressure
    • Cardiac monitors
    • Vitals monitors
                 B/P , pulse ox,
    Improvements in digital storage & resolution has largely replaced cine
                     Study can be stored on CD-R or DVD’s for review
8
     Cardiac catheterization

• The oxygen concentration can be
  measured across the valves and
  walls (septa) of the heart
• Pressures within each chamber of
  the heart and across the valves can
  be measured.
• The technique can even be
  performed in small, newborn infants.
• The catheter also serves the
  purpose of monitoring blood
  pressures in these different
  locations inside the heart.
• The angiogram procedure takes
  several hours, depending on the
  complexity of the procedure.
9
       Basic info about procedure
     IV sites in either arm, groin, or neck.
     Flexible catheter inserted to IV through the blood vessel.
     Then, cathether is threaded thorough the blood vessel to
       the heart.
     Pressure measured at this point.
     Iodinated contrast injected through catheter once it
       reaches the heart.
     Fluoroscopy guides the
    cardiologist
    with the catheter location.
10
11
     Normal Rt & Lt Coronary Arteries
12
     What Method is this?




                            12
13
           Catherization: Selinger Technique


      *




 *Modified Seldinger only punctures one side of vessel – this
 Percutaneous method can be used for arteries or veins - describes the
 method of catheter introduction that is not a direct stick
                                                                   13
14
     Seldinger Technique
15     When is it used in
       Cardiac Cath?


 • used to inject a large amount
   (25 to 50 mL) of contrast
   material into either the right
   or left ventricle the aortic root,
   or the pulmonary vessels.
 • Because the coronary arteries
   are of small caliber and of low
   flow rate, administration of
   contrast medium into these
   structures generally does not
   require a high-pressure
   injector.




                                        15
16
        CARDIAC CATHETERS
 •    May be inserted in an artery or vein
 •    information is collected on the valves, chambers,
      and arteries, as well as the structure and function
      of the heart
 •    A cardiac cath can show a cardiologist the precise
      location of a blockage or defect
 • The advantages of
   catheterization are as follows:
    1. The risk of extravasation is
       reduced.                                                       A:Judkins RT
                                                                      B:Judkins LT C:
    2. Most body parts can be                                         Pigtail
       reached for selective injection.
    3. The patient can be positioned
       as needed.
    4. The catheter can be safely left
       in the body while radiographs
       are being examined.



     Cardiac cath video: http://www.youtube.com/watch?v=yzxSrLa1d0g
17                                                • Catheter can be introduced
                                                    through femoral, brachial or carotid
                                                    artery to the knob of the aorta for
                                                    coronary arteries
                                                  • It may be advanced to the left heart
                                                    to look at the LT ventricle




                                                                   •   Radial, Subclavian & jugular may also be
     •   Seldinger Tech is a percutaneous method for the femoral
                                                                       used depending on Physician choice and
         approach
                                                                       Pt condition
18
     Guidewires & Needles
19          Percutaneous Transluminal Coronary Angioplasty (PTCA)

•    Otherwise known as:

• Balloon Angioplasty
• Angioplasty
• PTCA




     • Balloon Angioplasty is a technique used to dilate an area
       of arterial blockage with the help of a balloon catheter.
     • It is a way of opening a blocked blood vessel.
20
                Balloon Angioplasty
• A small area of the
  groin or arm is shaved
  and cleaned where the
  catheter is inserted.
• Medication is used to
  anesthetize the area so
  a small incision can be
  made where the
  catheter will be
  inserted.
• A catheter with a
  deflated balloon on the    One Possible Complication:
  tip is inserted through
  the artery in the groin    •Plaque material or blood
  or arm.                    clots dislodging and
• X-ray is used to guide     floating downstream,
  the catheter up into the   leading past the treated
  heart.                     area
21   Balloon angioplasty and a stent are used to open up
     the stenotic left brachiocephalic vein. Excellent
     blood flow was restored in subsequent images.
22         Equipment Used During a Procedure:
     • Balloon Catheter
     • Metal mesh stent
     • Pump for balloon


     • Usually a metal stent is
       placed in the opened artery
       to make sure restenosis
       does not reoccur
     • Following the procedure,
       the balloon is deflated and
       additional x-rays are taken
       to determine how much
       blood flow has increased.
23
     Prevention of
                     •     Lifestyle Change
      Restenosis
                     •     Healthy diet
                     •     adequate exercise
                     •     No Smoking
                     •     Medicine coated
                           stents
                         Although Balloon Angioplasty is a
                         valuable tool it is not a cure for
                         Artherosclerosis.
                          It is only a treatment,
                          Patients should try to lead a healthy
                         life which will be the best treatment for
                         their arteries.
24
       Coronary Artery Bypass Graft Surgery
     • is a surgical procedure to treat severe coronary
       artery disease (heart disease).
     • Part of a vein or artery (called a graft) from
       another part of the body is used to bypass a
       blockage in one or more of the coronary arteries.
     • The type of graft used,
     • a vein* from the leg,
     • or an artery from the chest,
     • depends on the number
     • and location of the blockage.
25
                           Stent Placement




     • http://images.google.com/imgres?imgurl=http://www.nhlbi.nih.gov/he
       alth/dci/images/stent_restenosis.gif&imgrefurl=http://www.nhlbi.nih.g
       ov/health/dci/Diseases/stents/stents_all.html&usg=__xDlbsaX9JhuY
       bpVojLcz19apr-
       I=&h=513&w=450&sz=59&hl=en&start=20&tbnid=vWwqaG-
       RNW7M-
       M:&tbnh=131&tbnw=115&prev=/images%3Fq%3Dabdominal%2Bst
       ents%26gbv%3D2%26hl%3Den
                                                                          25
26
     AAA




           26
27
     A stent graft or endograft used to repair aneurysm in the aorta and iliac region.
28
                         CARDIAC
                        ABLATION


     Cardiac Ablation
29
     RF ABLATION
30
     In cardiac ablation, a form of energy renders a small
     section of damaged tissue inactive. This puts an end
     to arrhythmias that originated at the problematic site
                                  •   Most often, cardiac ablation is used to
                                      treat rapid heartbeats that begin in the
                                      upper chambers, or atria, of the heart.
                                      As a group, these are know as
                                      supraventricular tachycardias, or
                                      SVTs. Types of SVTs are:

                                  INDICATIONS
                                  • Atrial Fibrillation
                                  • Atrial Flutter
                                  • AV Nodal Reentrant
                                    Tachycardia
                                  • AV Reentrant
                                    Tachycardia
                                  • Atrial Tachycardia
31
                    Cardiac Ablation
     • Minimally invasive treatment for arrhythmias
     • Live fluoroscopy and angiography techniques
       are used along with special electro physiologic
       equipment and catheters
     • Performed by a doctor specializing in the hearts
       electrical system
                                      •   Pulse
                                      •   ECG
                                      •   Chest pain
                                      •   Nausea
                                      •   Syncope
32

     • Catheter positions for routine
       electrophysiologic study.
     • Multipolar catheters
     • are positioned in the
     • high right atrium near
     • the sinus node,
     • in the area of the
     • atrioventricular apex,
     • and in the coronary
     • sinus.
33                     Your Hearts
                     Electrical System
     • Sinoatrial node-
       – “Natural Pacemaker”
       – Upper Right Atrium
       – Produces electrical signal 60-100 times a min
     • Atrioventricular node-
       – The bridge that connects Atriums to Ventricles
       – Special cells allow electrical signals to pass
34
                         CINE
     • HIGHEST IN RADIATION DOSE
     • TO THE PATIENT / TECHNOLOGIST

     • 1 MR/FRAME X 60 FRAMES/SEC FOR 30
       MINUTES = ?

     • HEAT LOADS?????
35
        1 MR/FRAME X 60 FRAMES/SEC FOR
                 30 MINUTES =
     • 1 X 60 = 60 mR/sec
     • 60 mR/sec x 60 sec = 3600mR/min

     • 3600mR/min x 30 min =
     • 108000 mr OR 10.8 R


      CINE DOSE
36
                     Imaging Considerations
     •   Magnetic resonance imaging (MRI)
          – Recently gained in popularity for use in cardiac studies
          – Uses cine loop
          – May be ECG gated
     •   Magnetic resonance angiography (MRA)
37
                    Nuc Med / Pet scanning
                     Perfusion Scanning

                                        •Myocardial perfusion scan
                                                 •Most widely used
                                                 procedure
                                        •Gated cardiac blood pool
                                        scans
                                                 •Used to evaluate
                                                 ventricles
                                        •Positron emission
                                        tomography (PET)




     Nuclear cardiology
        Used to diagnose CAD,
        congenital heart disease, and
        cardiomyopathy
38
     Doppler Ultrasound




                          •Echocardiography
                          •M-mode echocardiography
                          •2-D echocardiography
                                   •Real-time imaging
                                   •Transesophageal
                                   echocardiography (TEE)
                          •Spectral Doppler
                          •Color Doppler
                                   •Carotid stenosis, DVT
                          •Stress echocardiography
39   Imaging Considerations Computed tomography (CT)
                          •
                                         •  Cardiac scoring
                                                  • EBCT
                                               • Spiral CT
                                  •   CT angiography (CTA)




                          Heart CT 3D
40
     Name of Exam?
41
              CHECK OUT THE LIVE ACTION!

     • http://images.google.com/imgres?imgurl=http://w
       ww.heartsite.com/assets/images/cardiac_cath_
       man.jpg&imgrefurl=http://www.heartsite.com/htm
       l/cardiac_cath.html&h=350&w=269&sz=88&tbni
       d=KtrNOVmZWv3nhM:&tbnh=116&tbnw=89&hl=
       en&start=57&prev=/images%3Fq%3Dcardiac%2
       Bc


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        Review of Cardiac Anatomy, Pathology
              & Circulation - Lect # 3b