RT 255 (rev 2010) Dawn Charman, M.Ed,R.T Reference:

1. CORONARY ANGIOCARDIAC CATH& Ablation ProceduresLecture # 3 ACardiac 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. 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* Cardiac Catheterizationalso known as a heart cath or coronary angiogram

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: • Angio supplies & equipment • Fluoro Imaging (w/ Cine – Digital) • & Ancillary equipment * Type of catheter used will be dependant on the type Of Procedure performed

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.

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. What is this?When is it used inCardiac 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. 2. Most body parts can be 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. • A:Judkins RT B:Judkins LT C: Pigtail 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 used depending on Physician choice and Pt condition • Seldinger Tech is a percutaneous method for the femoral approach

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 tip is inserted through the artery in the groin or arm. • X-ray is used to guide the catheter up into the heart. • One Possible Complication: • Plaque material or blood clots dislodging and floating downstream, leading past the treated 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 Restenosis • Lifestyle Change • 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/health/dci/images/stent_restenosis.gif&imgrefurl=http://www.nhlbi.nih.gov/health/dci/Diseases/stents/stents_all.html&usg=__xDlbsaX9JhuYbpVojLcz19apr-I=&h=513&w=450&sz=59&hl=en&start=20&tbnid=vWwqaG-RNW7M-M:&tbnh=131&tbnw=115&prev=/images%3Fq%3Dabdominal%2Bstents%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. 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 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

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 scanningPerfusion 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://www.heartsite.com/assets/images/cardiac_cath_man.jpg&imgrefurl=http://www.heartsite.com/html/cardiac_cath.html&h=350&w=269&sz=88&tbnid=KtrNOVmZWv3nhM:&tbnh=116&tbnw=89&hl=en&start=57&prev=/images%3Fq%3Dcardiac%2Bc Go toReview of Cardiac Anatomy, Pathology & Circulation - Lect # 3b