Coronary angiography
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Coronary angiography is the gold standard for detecting coronary artery disease. It was first performed by Dr. Mason Sones in 1958 at the Cleveland Clinic. It uses catheters to inject contrast dye into the coronary arteries so they can be visualized on x-ray imaging. The left main, left anterior descending, and left circumflex arteries are visualized from different angles, such as LAO caudal for the "spider view". Angiograms are also used to grade the severity of lesions, flow through blocked vessels (TIMI grade), and collateral vessel development (Rentrop grade).
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Basics of coronary angiography
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 and is used to visualize the coronary arteries and assess for stenosis. It can determine treatment options and prognosis. Complications are rare but include vascular injury and contrast reactions. Proper angiographic views are important for evaluating different coronary artery segments.
Diagnostic catheters for coronary angiography
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Coronary guidewires
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.
Coronary angiography
Raja Lahiri provides an overview of coronary angiography. Key points include:
- Coronary angiography is the current gold standard for visualizing the coronary arteries through X-ray imaging with contrast injection.
- The history of coronary angiography began in the 1920s-1940s with early experiments in cerebral and cardiac catheterization.
- Modern techniques involve accessing arteries typically through the femoral or radial arteries to insert a catheter for contrast injection into the coronary arteries under X-ray imaging.
- Multiple angiographic views are needed to visualize different segments of the left and right coronary arteries. Coronary angiography is used to evaluate coronary artery disease, graft patency, and left ventricular function.
Coronary guide wires
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
Left ventricular angiogram (1)
Left ventricular angiography is used to assess global and regional left ventricular function and anatomy. It involves inserting a catheter into the left ventricle and injecting contrast dye to visualize the ventricle on x-ray imaging. The procedure provides key information on mitral valve function, ventricular shape and wall motion abnormalities, and congenital defects like VSD. LV volumes and ejection fraction are calculated from the images to quantify function. Regional wall motion is graded and correlated to coronary artery territories. Characteristic appearances are seen in conditions like cardiomyopathy, mitral regurgitation, and septal defects. Potential complications include arrhythmias and endocardial injury.
Cardiac cath complications
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
Coronary anatomy and angiographic views
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
Recommended
Basics of coronary angiography
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 and is used to visualize the coronary arteries and assess for stenosis. It can determine treatment options and prognosis. Complications are rare but include vascular injury and contrast reactions. Proper angiographic views are important for evaluating different coronary artery segments.
Diagnostic catheters for coronary angiography
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Coronary guidewires
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.
Coronary angiography
Raja Lahiri provides an overview of coronary angiography. Key points include:
- Coronary angiography is the current gold standard for visualizing the coronary arteries through X-ray imaging with contrast injection.
- The history of coronary angiography began in the 1920s-1940s with early experiments in cerebral and cardiac catheterization.
- Modern techniques involve accessing arteries typically through the femoral or radial arteries to insert a catheter for contrast injection into the coronary arteries under X-ray imaging.
- Multiple angiographic views are needed to visualize different segments of the left and right coronary arteries. Coronary angiography is used to evaluate coronary artery disease, graft patency, and left ventricular function.
Coronary guide wires
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
Left ventricular angiogram (1)
Left ventricular angiography is used to assess global and regional left ventricular function and anatomy. It involves inserting a catheter into the left ventricle and injecting contrast dye to visualize the ventricle on x-ray imaging. The procedure provides key information on mitral valve function, ventricular shape and wall motion abnormalities, and congenital defects like VSD. LV volumes and ejection fraction are calculated from the images to quantify function. Regional wall motion is graded and correlated to coronary artery territories. Characteristic appearances are seen in conditions like cardiomyopathy, mitral regurgitation, and septal defects. Potential complications include arrhythmias and endocardial injury.
Cardiac cath complications
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
Coronary anatomy and angiographic views
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
Right heart catheters
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
Trans septal puncture
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
PBMV:Tips and Tricks
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
Cardiac catheters
This document provides information about cardiac catheters and guidewires used in cardiac catheterization procedures. It discusses the history of cardiac catheters, ideal characteristics, parts of a catheter, materials used in construction, types of catheters including pigtail catheters, and features of guidewires. Characteristics such as size, stiffness, memory, and friction coefficient are compared for different catheter materials. The document also includes images and descriptions of specific catheters and guidewire tips.
Choice of guiding catheters in PCI
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
Catheters used in Angiography & angioplasty
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
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Angiographic projections
This document discusses angiographic projections and views used for imaging specific coronary artery segments and congenital heart diseases. It provides the standard angiographic views and degrees of angulation used for visualizing the left main, left anterior descending, circumflex, right coronary arteries, pulmonary arteries, and structures like VSDs and ASDs. The document also lists patient, angiographer, and equipment factors that can cause poor angiograms.
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The document discusses optimal angiographic views for visualizing coronary artery segments. It provides an overview of coronary artery anatomy, including typical vessel course and branching patterns. It then describes the optimal angiographic projections for imaging specific segments of the left main, left anterior descending, left circumflex, and right coronary arteries. These include the left anterior oblique, right anterior oblique, lateral, and anteroposterior views with varying degrees of cranial or caudal angulation. The document aims to help angiographers select views that clearly show coronary anatomy and guide interventional procedures like angioplasty.
LEFT HEART CATHETERIZATION
This document provides an overview of cardiac catheterization procedures. It discusses indications, contraindications, techniques, views obtained, and interpretation of pressure waveforms. Key points include that cardiac catheterization guides treatment decisions by measuring pressures, outputs, and obtaining images. It is now often used therapeutically for procedures like angioplasty and device closures. The document outlines patient preparation, access methods, catheters used, views obtained, and complications that can occur.
PTMC/PBMC
This document provides information about percutaneous transvenous mitral commissurotomy (PTMC), a procedure used to treat mitral stenosis. It discusses the stages and severity of mitral stenosis, indications and contraindications for PTMC, assessment of valve morphology, the PTMC procedure technique, instruments used, balloon size selection, post-procedure evaluation, complications, follow-up care, and long-term prognosis. PTMC is performed to improve the opening of a stenosed mitral valve by splitting the fused commissures using a balloon catheter, and is an important therapeutic option for treating symptomatic mitral stenosis.
Coronary angiogram
Coronary angiography is a procedure that uses dye and x-rays to see how blood flows through the coronary arteries of the heart. It is the gold standard for evaluating coronary artery disease and can identify the location and severity of any blockages. A coronary angiogram involves inserting a catheter into the heart and injecting dye so that blockages are highlighted on x-ray images. Potential complications are rare but can include heart attack, stroke, or kidney injury from the dye. The results of the angiogram are used to determine if further procedures like angioplasty or bypass surgery are needed.
Rotablation
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
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This document describes equipment, catheters, and basic intervals used in electrophysiology (EP) studies. It discusses radiographic tables, EP equipment like cardiac stimulators and mapping/ablation catheters. Patient preparation includes fasting, IV access, monitoring equipment. EP catheters come in different sizes and have electrodes for recording electrical activity. Basic intervals measured include P wave to atrial interval, atrial-His bundle interval, His-ventricular interval, and sinus node recovery time. Drive train stimulation with single, double, or triple extra stimuli is used. The document continues with further discussions of EP protocols, arrhythmias, ablation, and pre-excitation pathways.
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This document discusses the clinical utility of echocardiography in ischemic heart disease. Echocardiography is useful for diagnosing IHD and its complications through detection of wall motion abnormalities. It can assess haemodynamic status, viability, and guide therapy. Key uses include diagnosing acute MI, evaluating chest pain, detecting complications like thrombus, assessing viability for revascularization, and prognosticating post-MI risk through evaluation of ejection fraction and diastolic function. New technologies like 3D echo, myocardial contrast echo, and speckle tracking further improve detection of IHD, perfusion defects, and quantitative assessment of function.
INTRACARDIAC ECHOCARDIOGRAPH (ICE)
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ice techniques ,
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ice application ,
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Distal balloon occlusion devices and distal filter devices are the main types of embolic protection devices (EPDs) used during percutaneous coronary intervention (PCI). Distal balloon occlusion devices use a balloon to occlude blood flow distal to the lesion during PCI, while distal filter devices use a nitinol mesh filter to capture debris without interrupting blood flow. Major trials have shown the benefits of EPDs for saphenous vein graft interventions and for STEMI patients undergoing PCI. EPD selection depends on lesion location and vessel characteristics. EPDs are recommended for saphenous vein graft PCI but their routine use is not supported for native coronary artery PCI.
Angulated views in coronary angiography,an introductory lecture for cath lab ...
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Angulated views in coronary angiography,an introductory lecture for cath lab technicians dr awadheshCoronary Ostial stenting techniques:Current status
Ostial lesions, located within 3 mm of a vessel origin, pose unique challenges for percutaneous coronary intervention (PCI). Precise stent placement is required to avoid geographic miss and ensure optimal coverage of the lesion. Several techniques have been developed to aid accurate stent placement for ostial lesions, including aorto-free floating wire, stent pull-back, and Szabo/anchor wire methods. The use of these targeted approaches can reduce the risk of additional stenting and reintervention compared to conventional PCI for ostial lesions.
coronary angiography, LV angiogram and coronary anomalies
Coronary angiography is a procedure that uses dye and x-rays to visualize blood flow through the coronary arteries. It remains the gold standard for detecting significant coronary artery disease. The procedure involves passing a catheter into the heart and injecting contrast dye to see blockages. Coronary angiography is indicated when objective demonstration of the coronary anatomy could help resolve a problem, with competent staff and facilities. It provides information on stenosis levels and collateral circulation. Different views are used to visualize different coronary artery segments. Cannulation techniques depend on arterial origins and graft types.
Carotid Doppler
This document provides an overview of carotid Doppler ultrasound. It begins with the anatomy of the carotid arteries and their branches. It then discusses the technique of carotid Doppler ultrasound, including instrumentation, examination protocol, and interpretation of ultrasound findings. It provides details on evaluating the internal carotid, external carotid, and vertebral arteries for stenosis or occlusion. The document also covers characterizing carotid plaques and differentiating true findings from artifacts.
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This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
Trans septal puncture
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
PBMV:Tips and Tricks
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
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This document provides information about cardiac catheters and guidewires used in cardiac catheterization procedures. It discusses the history of cardiac catheters, ideal characteristics, parts of a catheter, materials used in construction, types of catheters including pigtail catheters, and features of guidewires. Characteristics such as size, stiffness, memory, and friction coefficient are compared for different catheter materials. The document also includes images and descriptions of specific catheters and guidewire tips.
Choice of guiding catheters in PCI
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
Catheters used in Angiography & angioplasty
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
BMV,PTMC,BALLOON MITRAL VALVOTOMY, BAL, VIRBHAN BALAI, DR VIRBHAN
This document discusses balloon mitral valvuloplasty (BMV) and balloon aortic valvuloplasty (BAV). It describes the indications for BMV as symptomatic or asymptomatic severe mitral stenosis. The Inoue technique for BMV is explained in detail, including transseptal puncture and sequential balloon inflation. Complications of BMV include severe mitral regurgitation, mortality, and cardiac perforation. BAV was used historically but was abandoned due to high restenosis rates and no improvement in patient survival.
Step by Step Rotational Athrectomy
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This document discusses angiographic projections and views used for imaging specific coronary artery segments and congenital heart diseases. It provides the standard angiographic views and degrees of angulation used for visualizing the left main, left anterior descending, circumflex, right coronary arteries, pulmonary arteries, and structures like VSDs and ASDs. The document also lists patient, angiographer, and equipment factors that can cause poor angiograms.
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This document provides an overview of cardiac catheterization procedures. It discusses indications, contraindications, techniques, views obtained, and interpretation of pressure waveforms. Key points include that cardiac catheterization guides treatment decisions by measuring pressures, outputs, and obtaining images. It is now often used therapeutically for procedures like angioplasty and device closures. The document outlines patient preparation, access methods, catheters used, views obtained, and complications that can occur.
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This document provides information about percutaneous transvenous mitral commissurotomy (PTMC), a procedure used to treat mitral stenosis. It discusses the stages and severity of mitral stenosis, indications and contraindications for PTMC, assessment of valve morphology, the PTMC procedure technique, instruments used, balloon size selection, post-procedure evaluation, complications, follow-up care, and long-term prognosis. PTMC is performed to improve the opening of a stenosed mitral valve by splitting the fused commissures using a balloon catheter, and is an important therapeutic option for treating symptomatic mitral stenosis.
Coronary angiogram
Coronary angiography is a procedure that uses dye and x-rays to see how blood flows through the coronary arteries of the heart. It is the gold standard for evaluating coronary artery disease and can identify the location and severity of any blockages. A coronary angiogram involves inserting a catheter into the heart and injecting dye so that blockages are highlighted on x-ray images. Potential complications are rare but can include heart attack, stroke, or kidney injury from the dye. The results of the angiogram are used to determine if further procedures like angioplasty or bypass surgery are needed.
Rotablation
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Electrophysiology study basics
This document describes equipment, catheters, and basic intervals used in electrophysiology (EP) studies. It discusses radiographic tables, EP equipment like cardiac stimulators and mapping/ablation catheters. Patient preparation includes fasting, IV access, monitoring equipment. EP catheters come in different sizes and have electrodes for recording electrical activity. Basic intervals measured include P wave to atrial interval, atrial-His bundle interval, His-ventricular interval, and sinus node recovery time. Drive train stimulation with single, double, or triple extra stimuli is used. The document continues with further discussions of EP protocols, arrhythmias, ablation, and pre-excitation pathways.
Echocardiography in ischemic heart disease
This document discusses the clinical utility of echocardiography in ischemic heart disease. Echocardiography is useful for diagnosing IHD and its complications through detection of wall motion abnormalities. It can assess haemodynamic status, viability, and guide therapy. Key uses include diagnosing acute MI, evaluating chest pain, detecting complications like thrombus, assessing viability for revascularization, and prognosticating post-MI risk through evaluation of ejection fraction and diastolic function. New technologies like 3D echo, myocardial contrast echo, and speckle tracking further improve detection of IHD, perfusion defects, and quantitative assessment of function.
INTRACARDIAC ECHOCARDIOGRAPH (ICE)
ICE
intracardiac echocardiography ,
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ice techniques ,
ice views ,
ice application ,
recent advances in intracardiac echocardiography
Distal protection device
Distal balloon occlusion devices and distal filter devices are the main types of embolic protection devices (EPDs) used during percutaneous coronary intervention (PCI). Distal balloon occlusion devices use a balloon to occlude blood flow distal to the lesion during PCI, while distal filter devices use a nitinol mesh filter to capture debris without interrupting blood flow. Major trials have shown the benefits of EPDs for saphenous vein graft interventions and for STEMI patients undergoing PCI. EPD selection depends on lesion location and vessel characteristics. EPDs are recommended for saphenous vein graft PCI but their routine use is not supported for native coronary artery PCI.
Angulated views in coronary angiography,an introductory lecture for cath lab ...
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Angulated views in coronary angiography,an introductory lecture for cath lab technicians dr awadheshCoronary Ostial stenting techniques:Current status
Ostial lesions, located within 3 mm of a vessel origin, pose unique challenges for percutaneous coronary intervention (PCI). Precise stent placement is required to avoid geographic miss and ensure optimal coverage of the lesion. Several techniques have been developed to aid accurate stent placement for ostial lesions, including aorto-free floating wire, stent pull-back, and Szabo/anchor wire methods. The use of these targeted approaches can reduce the risk of additional stenting and reintervention compared to conventional PCI for ostial lesions.
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Coronary Ostial stenting techniques:Current status
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Echocardiography is used to evaluate the mitral valve and assess mitral regurgitation (MR). Key questions addressed include the mechanism of MR, severity of MR, and impact on heart structures. Severity is determined semiquantitatively by measuring jet size, density, and width of the vena contracta, as well as assessing pulmonary vein flow. Leaflet morphology, motion, chordae, annulus, and left ventricular size and function are evaluated to identify the etiology and type of MR based on the Carpentier classification system. Anatomic features are also assessed for surgical or transcatheter treatment options.
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CT angiography plays an important role in diagnosing coronary artery anomalies. It provides detailed 3D images of the coronary arteries with high spatial and temporal resolution in a noninvasive manner. Proper patient preparation including beta blockers to lower heart rate and nitroglycerin to dilate arteries is important for optimal imaging. CT angiography can detect various types of anomalies such as anomalous coronary artery origins, fistulas, myocardial bridging, and duplication of arteries. It serves as a roadmap for cardiologists in guiding patient management.
Anomalous coronary arteries: Challenges in Access and Intervention
This is a ppt i presented during my residency at GB Pant hospital, 2019-2022. I have included many angiogram videos but unfortunately they are not playable on slideshare. I hope this will cardio residents and consultants during their day to day practice.
Dr. Ghazi Muheeb
Senior resident (DM),
GB Pant Hospital and MAMC, New Delhi.
Myocardial infarction: introduction, clinical manifestation, classification, ...
i went through all the ECG books i could have access to, none of them included a full classification of myocardial infarction. since few of its types, such as: transmural, non- transmural, Q-wave MI, non-Q wave MI are no longer recommended. many books didn't mention them at all, and the ones which did, excluded others such as STEMI & NSTEMI or the classification by anatomical sites. so it's rather a stumbling rock when it comes to finding everything about its classification. well, i gathered data from a lot of sources: books, websites, my college notes, etc. and combined them up into this.
btw, it is detailed. (and i made this two years back, so forgive me if they found some new information)
if you'd like a PDF, drop a comment.
CORONARY ANGIOGRAPHY.pptx
This document provides information on coronary angiography views and angiographic anatomy. It discusses the clinical divisions of the major coronary arteries and defines what constitutes significant coronary artery disease. Standard angiographic views are described for visualizing different segments of the left and right coronary arteries. Lesion classification systems and other angiogram interpretation elements like TIMI frame count are also summarized.
coronaryangiography-220330142539 (1).pdf
This document provides information on coronary angiography views and angiographic anatomy. It discusses the clinical divisions of the major coronary arteries and defines what constitutes significant coronary artery disease. Standard angiographic views are described for visualizing different segments of the left and right coronary arteries. Lesion classification systems and other angiogram interpretation elements like TIMI frame count are also summarized.
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The document discusses tricuspid valve disease, including causes of tricuspid regurgitation and stenosis. It describes how tricuspid regurgitation and stenosis are quantified by echocardiography. Surgical options for tricuspid valve annular dilatation are presented, including bicuspidization/plication, De Vega annuloplasty, and ring annuloplasty techniques. Risks of tricuspid valve surgery include damaging structures located in the triangle of Koch.
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- 2. CORONARY ANGIOGRAPHY GOLD STANDARD FOR DETECTING CLINICALLY SIGNIFICANT ATHEROSCLEROTIC CORONARY ARTERY DISEASE. FIRST PERFEROMED BY DR. MASON SONES AT THE CLEVELAND CLINIC (1958) CORONARY ARTERY IS A VASA VASORUM THAT SUPPLIES THE HEART CORONARIUS MEANING CROWN
- 3. CATHETERS : JUDKIN’S RIGHT 4 –RCA JL4 – LCA AMPLATZ CATHETER – ALTERED ANATOMY CONTRAST: NON IONIC CONTRAST – IOHEXOL 30-40ML
- 6. CORONARY TREE SEGMENTS RCA PROXIMAL FROM OSTIUM TO ONE HALF OF ACUTE MARGIN OF HEART RCA MID FROM END OF FIRST SEGMENT TO ACUTE MARGIN OF HEART RCA DISTAL ACUTE MARGIN OF HEART TO ORGIN OF PDA
- 7. LAD LAD PROXIMAL PROXIMAL TO AND INCLUDING 1ST SEPTAL BRANCH LAD MID FIRST SEPTAL TO ONE HALF THE DISTANCE OF APEX DISTAL LAD PREVIOUS SEGMENT TO APEX
- 8. LCX PROXIMAL LCX ORIGIN TO 1ST OM DISTAL LCX DISTAL TO 1ST OM
- 10. LEFT CAG
- 11. 1. CRANIAL LAO OR RAO : LAD RAO CRANIAL FOR BODY OF LAD MAINLY LAO CRANIAL FOR DIAGNOL BRANCHES 2. RAO CAUDAL: LCX 3. LAO CAUDAL : SPIDER VIEW FOR LEFT MAIN AND OSTIAL STENOSIS OF LAD, LCX
- 12. RAO VS LAO SPINE AND CATHETER ARE RIGHT OF THE IMAGE ----LAO SPINE AND CATHETER ARE LEFT OF THE IMAGE -------RAO IF CENTRE ----- PA VIEW CRANIAL VS CAUDAL: DIAPHRAGM SEEN: CRANIAL VIEW
- 14. DEFINITIONS TOTAL OCCLUSION :A LESION IS CHARACTERISED AS A TOTAL OCCLUSION WHEN NO ANTEGRADE FLOW IS VISIBLE DISTAL TO THE OBSTRUCTION. OSTIAL LESION: WHEN IT IS LOCATED IMMEDIATELY AT THE ORIGIN OF CORONARY ARTERIES DIFFUSE DISEASE : PRESENT WHEN ATLEAST 75% OF THE LENGTH OF THE SEGMENT DISTAL TO THE LESION HAS A VESSEL DIAMETER OF <2MM, IRRESPECTIVE OF THE PRESENCE OR ABSENCE OF DISEASE AT THAT DISTAL SEGMENT.
- 16. CALCIFICATION
- 17. TIMI GRADING SYSTEM GRADE 0 COMPLETE OCCLUSION OF INFARCT RELATED ARTERY GRADE 1 SOME PENETRATION OF CONTRAST MATERIAL BEYOND THE POINTOF OBSTRUCTION BUT WITHOUT PERFUSION OFDISTAL CORONARY BED GRADE 2 PERFUSION OF ENTIRE INFARCT VESSEL INTO DISTAL BED BUT WITH FLOW THAT IS DELAYED COMPERED WITH THAT OF NORMAL ARTERY GRADE 3 FULL PERFUSION OF INFARCT VESSEL WITH NORMAL FLOW
- 18. RENTROP CLASSIFICATION GRADE 0 NO VISIBLE FILLING OF ANY COLLATERAL CHANNEL GRADE 1 FILLING OF THE SIDE BRANCHES OF INFARCT RELATED ARTERY GRADE 2 PARTIAL FILLING OF EPICARDIAL VESSEL OF INFARCT RELATED ARTERY GRADE 3 COMPLETE COLLATERAL FILLING OF EPICARDIAL VESSEL
- 19. RAO CAUDAL
- 20. RAO CRANIAL
- 22. THANK U