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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Diagnosis of CAD is based on medical history, physical examination, and routine blood tests. Other diagnostic tests include ECG, echocardiogram, an exercise stress test, a nuclear stress test, cardiac catheterization, and cardiac CT scan. Electrocardiogram can reveal evidence of a previous heart attack or even one that is currently happening. Echocardiogram allows for examination of all parts of the heart wall, revealing signs of CAD. An exercise stress test involves walking on a treadmill or riding a stationary bicycle as an ECG is being performed, and sometimes an echocardiogram is done as well. For some patients, a medication is used to stimulate the heart instead of exercise. A nuclear stress test is similar to an exercise stress test, but provides images as well as ECG recordings, measuring blood flow to the heart muscle during stress and at rest via specialized cameras. In cardiac catheterization, a catheter is inserted into a groin, neck, or arm artery or vein and carefully pushed to the heart, guided by the use of various imaging techniques. Dye may be injected to improve imaging of the blood vessels and any blockages. A cardiac CT helps visualize calcium deposits in the arteries that can narrow them, indicating likely CAD. Also, in a CT coronary angiogram, a contrast dye is injected intravenously to produce detailed images of the coronary arteries (see Figure 9.1).
The Cardiovascular System and its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Cardiac catheterization is a specialized technique whereby a flexible catheter is passed along veins or arteries into the heart to explore structures, measure pressures and blood-gasses, and inject radiopaque dyes for angiography. Relying on fluoroscopy with an image intensifier and a television system, catheterization allows the physician to use radiopaque catheters and dyes to measure septal defects, locate and quantify partial occlusions, isolate the sources of arrhythmias, and determine vascular function. Invasive and requiring specialized training, cardiac catheterization is usually reserved for problems that cannot be resolved without it.
Red Cells with High Oxygen Affinity Hemoglobins
Published in Ronald L. Nagel, Genetically Abnormal Red Cells, 2019
The most pressing need to diagnose these high-affinity hemoglobins is to avoid unnecessary invasive diagnostic procedures and inappropriate and many time dangerous therapeutic interventions. Many of these patients have undergone unnecessary risk by undergoing cardiac catheterization. Others have suffered several courses of 32P treatment based on the confusion of these patients with Policythemia vera. As a rule of thumb it is reasonable to state that any Policythemia vera patient about to undergo a serious therapeutic intervention should be checked with a whole blood oxygen equilibrium measurement.
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
Cardiac catheterization is performed in select cases, such as when the results of noninvasive tests are equivocal. Catheterization is also useful to determine the significance of intramyocardial coronaries such as intraseptal coronaries or vessels with myocardial bridges. Cardiac catheterization with selective coronary angiograms, fractional flow reserve, and intravascular ultrasound (IVUS) can be performed to help with risk stratification. Small children undergo general anesthesia, while older children can tolerate moderate sedation for the procedure. First, an aortic root angiogram is performed, which helps in selection of appropriate catheters to engage the coronary arteries. Coronary angiograms are performed using 4 Fr coronary catheters in angled projections. Generally, Judkins right coronary catheters are used for coronary arteries arising from the right sinus and vice-versa. If standard-curve catheters are not successful in engaging coronary arteries, the catheters can be shaped by hand or with heat to provide specific curves especially for small children.
Utility of Glucose Testing and Treatment of Hypoglycemia in Patients with Out-of-Hospital Cardiac Arrest
Published in Prehospital Emergency Care, 2022
Tiffany M. Abramson, Nichole Bosson, Angelica Loza-Gomez, Marc Eckstein, Marianne Gausche-Hill
In LAC, EMS is provided by 30 fire-based provider agencies with approximately 4,200 paramedics. Prehospital management throughout LAC is standardized via approved field treatment protocols. EMS providers transport patients resuscitated from OHCA to one of 36 designated cardiac arrest receiving centers. All cardiac arrest receiving centers are capable of providing immediate cardiac catheterization 24 hours per day, 7 days per week with cardiovascular surgeons available. In addition, all centers are required to collect data on outcomes, have comprehensive quality improvement programs including internal policies for percutaneous coronary intervention (PCI), fibrinolysis, and targeted temperature management (TTM). At the time of this study, patients who did not obtain return of spontaneous circulation (ROSC) were either pronounced in the field or transported to the most accessible receiving hospital under the guidance of online medical direction.
Update on shunt closure in neonates and infants
Published in Expert Review of Cardiovascular Therapy, 2021
Karim A. Diab, Younes Boujemline, Ziyad M. Hijazi
Transcatheter PDA closure can be done via either the anterograde (venous) or retrograde (arterial) approach, with the former being preferred in very small infants in order to decrease the risk of vascular complications. The detailed protocol for the procedure has been previously reported [87]. Figure 3 illustrates the closure of a large PDA in a premature newborn with a weight of 9900 g. In brief, cardiac catheterization is performed under general anesthesia. An anteroposterior and lateral angiogram in the descending aorta is performed to evaluate the size, position and shape of the ductus and classify it as type A-E according to Krichenko et al.’s angiographic classification [88]. Recently, there has been more realization that the ductus in premature infants can be larger and longer PDAs which fits into what was termed a type F PDA, which helps with selecting the type of device for closure [89]. After delineating the anatomy and landmarks of the PDA, the appropriate device is chosen and deployed. After deploying the device, a descending aortogram is performed to confirm the position and stability of the device followed by a repeat aortogram 10 min after the release to assess the degree of residual shunt.