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CORONARY__ANGIOGRAM-and-Angiography.pptx
- 2. HISTORY 04 CONTENTS 03 ANATOMY INDICATIONS & CONTRAINDICATIO NS 02 DEFINITION 05 PROCEDURES 01
- 3. HISTORY 01
- 4. HISTORY 1927 • Egas Moniz: Cerebral angiography 1929 • Werner Forssmann: Cardiac catheterization 1940 • Andre Cournand and Dickinson Richards: Catheterization and hemodynamics
- 5. ● Initial attempts focused on non selective contrast injections in aortic root ● Selective injections feared with risk of ventricular fibrillation based on animal studies ● Transient cardiac arrest with aortic occlusion with balloon was used to obtain better quality images ● 1958: Accidental injection of contrast in right coronary artery by Dr. Mason Sones and his associate HISTORY
- 6. HISTORY
- 8. ● Coronary angiography remains the gold standard for detecting clinically significant atherosclerotic coronary artery disease. ● A procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart. ● The technique was first performed by Dr. Mason Sones at the Cleveland Clinic in 1958 CORONARY ANGIOGRAPHY
- 9. ● To visualize coronary arteries, branches, collaterals and anomalies ● Precise localization relative to major and minor side branches, thrombus and areas of calcification ● To visualize vessel bifurcations, origin of side branches and specific lesion characteristics (length, eccentricity, calcium etc.) GOALS
- 10. ANATOMY 03
- 11. CORONARY ARTERY
- 12. CORONARY ARTERY
- 14. BRANCHES OF RIGHT CORONARY ARTERY
- 16. RCA DISTRIBUTION
- 19. LCA DISTRIBUTION
- 20. DOMINANCE
- 23. 1. Diagnosis of CAD in clinically suspected pts. 2. Providing peri-interventional information for (PCI)percutaneous coronary intervention/ formerly known as (PTCA)percutaneous transluminal coronary angioplasty 3. Coronary anomalies 4. To exclude stenoses before non-coronary cardiac surgery (valve surgery after 40 yrs. of age) 5. Determine patency of coronary artery bypass grafts INDICATIONS
- 24. In patients with non–ST-segment elevation acute coronary syndromes with high-risk features (e.g., ongoing ischemia, heart failure) In patients with acute ST-segment elevation myocardial infarction (STEMI) Percutaneous coronary intervention (PCI) is usually performed in the same procedure, immediately after the diagnostic procedure INDICATIONS
- 25. Coagulopathy Decompensate congestive heart failure Uncontrolled Hypertension (CVA) Cerebrovascular accident GI Hemorrhage Pregnancy Inability for patient cooperation Active infection Renal Failure Contrast medium allergy CONTRAINDICATIONS
- 26. PROCEDURES 05
- 27. Access is easiest from right side of patient due to aortic bend Puncture is generally done via the femoral artery Alternative sites include the radial and brachial arteries of the arm ARTERIAL PUNCTURE
- 29. ACCESS TECHNIQUE
- 30. Most frequently used access site Ease of access, lesser contrast and radiation exposure, freedom to upgrade to bigger size sheaths Need for immobilization, local site complications: main drawback FEMORAL
- 31. No need for immobilization Lower rate of local vascular complications Increasingly being used as primary access site Slightly higher contrast and radiation exposure with beginners Spasm, loops, failure to get access may require switch to femoral route RADIAL
- 46. THANK YOU!
Editor's Notes
- ANGIOGRAMS-The X-ray images created during angiography. ANGIOGRAPHY-a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers.
- Vasa vasorum are small blood vessels that comprise a vascular network supplying the walls of large blood vessels, such as elastic arteries (e.g., the aorta) and large veins (e.g., the venae cavae).
- CRUX CORDIS- OR CRUX OF THE HEART IS A LATIN WORD MEANING CROSS- IS THE AREA ON THE LOWER BACK SIDE OF THE HEART WHERE THE CORONARY SULCUS AND THE POSTERIOR INTERVENTRICULAR SULCUS MEET. CORONARY SULCUS- (THE GROOVE SEPARATING THE ATRIA FROM THE VENTRICLES)
- is a minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the heart muscle
- STEMI is a total or nearly total blockage of a coronary artery that supplies oxygen-rich blood to part of the heart muscle. Lack of blood and oxygen causes that part of the heart to fail. Non-ST-elevation myocardial infarction (NSTEMI) is a type of involving partial blockage of one of the coronary arteries, causing reduced flow of oxygen-rich blood to the heart muscle.
- Heparin injection is an anticoagulant. It is used to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels. This medicine is sometimes called a blood thinner, although it does not actually thin the blood.