cardiac catheterization
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Introduction
Passage of a catheter into the heart through a blood vessel leading to the heart for the purpose of measuring intracardiac pressure abnormalities, obtaining cardiac blood samples, &/or imaging cardiac structures by injection of radio- opaque dye.
Indications
(applications)
- treatment of coronary stenosis/occlusions
- treatment of valvular stenoses
- balloon valvuloplasty (aortic, mitral, pulmonic)
- treatment of congenital heart disease
- atrial septostomy
- umbrella closure of patent ductus arteriosus & defects in atrial or ventricular septum
- coil closure of undesired collateral vessels
Contraindications
(relative)
- uncontrolled ventricular irritability
- increased risk of ventricular tachycardia & fibrillation
- uncorrected hypokalemia or digitalis toxicity
- uncorrected hypertension
- predisposes to myocardial ischemia &/or heart failure
- intercurrent febrile illness
- decompenstated heart failure, especially pulmonary edema unless catheterization can be done with patient sitting up
- anticoagulation; PT > 18 seconds
- severe allergy to radiographic contrast agent
- severe renal insufficiency &/or anuria, unless dialysis is planned to remove fluid & radiographic contrast load
Advantages
- direct measurement of intracardiac pressures, gradients & shunts
- contrast angiography provides visualization of cardiac anatomy
- allows percutaneous intervention for structure heart disease with intracardiac echocardiographic guidance[1]
Disadvantages
- invasive
- radiation exposure
- radiation exposure risk for health care workers in cardiac catheterization labs[3]
- images are not tomographic, limiting 3-dimensional visualization[1]
Notes
- inappropriated cardiac catheterizations nearly eliminated with education & screening confirming catheterization appropriateness on day of procedure[4]
More general terms
More specific terms
- cardiac catheterization for congenital heart disease
- coronary angiography
- hemodynamic monitoring
- percutaneous coronary intervention (PCI)
- Swan-Ganz catheter (pulmonary artery catheter)
References
- ↑ Jump up to: 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17. American College of Physicians, Philadelphia 1998, 2009, 2015
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 980, 986
- ↑ Jump up to: 3.0 3.1 Andreassi MG, Piccaluga E, Guagliumi G et al Occupational Health Risks in Cardiac Catheterization Laboratory Workers. Circulation: Cardiovascular Interventions. 2016; 9: e003273 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27072525 <Internet> http://circinterventions.ahajournals.org/content/9/4/e003273
- ↑ Jump up to: 4.0 4.1 Lou N. Inappropriate Caths Nearly Eliminated With Education, Screening Program - Center's program for primary, specialty care 'may serve as a template' MedPage Today. October 17, 2017 https://www.medpagetoday.com/PracticeManagement/PracticeManagement/68609