Cardiovascular System Flashcards
(18 cards)
What is angiography?
Angiography is a medical imaging technique used to visualize blood vessels. It involves injecting a contrast dye into the bloodstream and taking X-ray, CT, or MRI images to detect blockages, aneurysms, or other vascular abnormalities. It is commonly used to assess the heart, brain, and other organs and can guide treatments like stent placement or angioplasty.
What are the 2 types of contrast?
Iodinated water soluble
High osmolarity contrast media (HOCM):
Ionic contrast media
Cheaper
High rates of adverse effects 4-12%
Low osmolarity contrast
media (LOCM):
Non-ionic contrast media
Low rates of adverse effect 1-3%
Non iodinated
Barium Sulphate (E-Z Paque)
Gadolinium
What is DSA- digital subtraction angiography?
DSA is a fluoroscopy technique used to clearly visualise the blood vessels in the body
Images are produced using contrast media by subtracting a ‘pre-contrast’ image from later images, once the contrast medium has been introduced into a structure
DSA steps
Step 1: An x-ray (image) is taken of the leg without contrast. This is also called the ‘mask’ image.
Step 2: Contrast is injected and multiple x-rays (images) are taken of the leg.
Step 3: Both images are laid on top of each other.
Step 4: The ‘mask’ image is subtracted from the contrast image to leave contrast only. Bone is removed.
What is the seldinger technique?
The Seldinger technique is a method for safely inserting catheters into blood vessels.
All procdures conducted from the groin.
A needle punctures the vessel, a guidewire is inserted, the needle is removed, and a catheter is placed over the guidewire before it is withdrawn.
It is widely used in angiography and central line placement for accuracy and safety.
Different types of catheters
Cobra
Shepherds hook
Pigtail
All wires and catheters have floppy/ soft tips so as not to damage or rupture any vessels
Thin hollow plastic tube
Bendy
Risks of Interventional procedures
Haemorrhage/ Haematoma- if we don’t close the artery properly we can cause bleeding which starts to clot.
Infection- risk is minimal but still a risk if at the site of the groin where punctured.
Contrast used in every single procedure- monitor to see if any reactions.
Blood clots-Stroke: give drugs
`Heperein for every procedure- blood thinner. Stops blood clotting around the equipment as clots can lead to strokes.
Adverse contrast reactions
Radiation effects
Rupture- cause internal bleeding
Kidney damage
What are the 2 types of adverse contrast reactions
Immediate
Occurs within 20 mins very rare as we use different contrast now. 0.4% of ppl have a contrast reaction and 0.06%
Delayed
Happens an hour to a week after IA or IV. Tend to present as a macropapular rash.
Contrast reactions examples and solutions
Mild:
Nausea, vomiting, headache, mild urticaria (mild rash)
Self-limiting, monitoring patient, antihistamines
Moderate:
Urticaria (rash is spreading, airway starts to close up, unable to speak, short breath, blood pressure begin to drop.
), bronchospasm
Antihistamines, adrenaline if necessary, oxygen
Severe:
Seizure, respiratory/circulatory collapse.
Crash team, keep supine, oxygen.
Radiation protection
Patient
ALARP
High dose procedures
LMP- 10 day rule
Staff
Correct PPE
Dose monitoring badges
Lead screens
AORTIC ANATOMY
Descending- thoracic and abdominal aorta.
Abdominal splits into 2 and then again into iliac arteries.
2 renal arteries supply kidneys.
3 branches of the top of the aorta. Right subclavian- right arm
Left subclavian artery
Left vertebral
Left common carotid
Braciocephalic trunk
Right common carotid
Right vertebral
Circle of Willis
Both the vertebral and carotid arteries allow blood to travel from the aortic arch towards the brain.
Vertebral arteries join to form the basilar artery
Internal carotid arteries bifurcate into the middle cerebral and anterior cerebral arteries
ACAs are joined by the ACOM
Basilar artery is connected to the ICA by the PCOM arteries
What is an aneurysm?
A localised, blood-filled balloon-like bulge in the wall of a blood vessel
Risk of rupture and bleed
Treatment- Embolisation
Coiling
Stenting
Aneurysm- bulgened weakened area of the aorta.
Saccular aneurysm- as it forms a sack
Aneuerym risk of rupturing- leads to bleeding internally, if its inside your brain and ruptures it causes a haemora something stroke
Triple A
Coiling- endovascular procedure- feed into aneurysm and coil tightly around one another, have tiny fibres on them and starts to clot the blood inside and seals the clot.
Stenting- covered stent blood can only go in one way cannot go out the side, blood cant flow into aneurysm.
What is stenosis and its treatment?
Often caused by atherosclerosis
Restricts blood-flow to organs/ limbs
Formed from plaques, lipids cholesterol.
Bad diet, smoking
Can cause ischaemia
Can cause gangrene, ulcers
Treatment
Angioplasty- Infalte balloon so it compresses the plaque on the sides of the wall- re open the artery so blood can flow back through
Stent
What is a stroke and 2 types?
Ischaemic- mpst common type of stroke 85% cases. Blood clot lodges inside one of the cerevra; arteries, so blood can no longer flow past it and no oxygen can get to the brain. Lose 12 million brain cells or every min we lose oxtygen
Mechanical thrombectomy- feed a stent from the groin to where the clot is Let stent sit on top of the clot and leave it around 3 mins. Lose 36 million brain cell in just those 3 mins
Haemorrhagic- bleed on the brain due to arteries.
Common interventions: Vascular
SFA angioplasty
Embolisations (of bleeds)- stretching the vessel anywhere on the leg, blocking bleeds.
EVAR/ TEVAR/ FEVAR
TACE- diagnostic procedure, pathologies in the brain,
PVE
Prostate artery embolisations
Fistuaplasty
IVC filter insertions
Common interventions: Neuro-vascular
Cerebral angiogram
Cerebral aneurysm embolisation
Cerebral AVM embolisation
Spinal angiogram
DSA Myelograms
Mechanical thrombectomy
Common interventions: Non- Vascular
RIG- Gastrostomy
Ureteric stent insertion
Nephrostomy
PTC
