Interventional Cardiology / PVD Flashcards Preview

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Flashcards in Interventional Cardiology / PVD Deck (9):
1

General Interventional Cardiology Principles

  • Non-invasive testing
  • Coronary angiogram
  • Cath lab
  • Mainstays of treatment for CADConditions improved w/ interventional cardiology (angoiplasy, stenting)

  • Non-invasive testing
    • Most diagnostic tests
    • Assess ventricular function, valvular disease, & coronary anatomy
  • Coronary angiogram
    • Invasive gold standard for identifying stenosis due to CAD
    • Provides the most reliable anatomical info for determining treatment
    • Performed by directly injecting radio-opaque contrast material into coronary arteries & imginag them w/ fluoroscopy
  • Cath lab
    • Measures hemodynamic &  anatomical details
    • Diagnoses valvular, pericardial, & myocardial disease states
    • Delivers targeted therapeutic interventions
  • Mainstays of treatment for CAD
    • Medical therapy
    • Percutaneous coronary intervention (angioplasy / stent replacement)
    • Coronary artery bypass graft surgery
  • Conditions improved w/ interventional cardiology (angoiplasy, stenting)
    • Angina pectoris (symptomatic CAD)
    • Valvular heart disease
    • Congenital heart disease
    • Extra-cardiac vascular disease

2

Access Sites for Cardiac Procedures

  • Most commonly used site for arterial access
  • Other access sites
  • How access is gained

  • Most commonly used site for arterial access
    • Common femoral artery in the inguinal region
  • Other access sites
    • Used to improve comfort, safety, &/or efficacy
    • Brachial & radial arteries: when needed based on aorto-iliac anatomy
    • Internal jugular or common femoral veins: when need venous access
  • How access is gained
    • Seldinger technique: percutaneous approach
    • Needle is placed through the skin & subcutaneous tissue until it enters the vessel lumen

3

Intracoronary Devices & Equipment: CAD

  • Access gained into a vascular structure
  • Intravascular sheath placed to allow equipment to be delivered w/o bleeding
  • Catheters
    • Long hollow tubes inserted into the body through the sheath
    • Placed in various vascular structures
  • Contrast dye is injected to obtain digital images
  • Wires may be threaded into the vessel & placed in distal portions
    • Balloon catheters can be inserted to dilate blood vessels (angioplasty)
    • Followed by stent placement to...
      • Open narrowed blood vessels
      • Treat aneurysmal segments

4

Structural Heart Disease

  • Structural heart disease
  • Structural heart diseases that can be treated by interventional procedures

  • Structural heart disease
    • Non-coronary CV disease processes & related interventions
  • Structural heart diseases that can be treated by interventional procedures
    • Hypertrophic cardiomyopathy
    • Valvular heart disease
    • Patent foramen ovale
    • Atrial septal defect
    • Ventricular septal defect
    • Left atrial appendage
    • Left ventricular aneurysm
    • Patent ductus arteriosus
    • Paravalvular leak

5

Treatment of Symptomatic Severe Aortic Stenosis

  • Surgical valve replacement
    • In ideal candidates
  • Transcatheter aortic valve implantation (TAVI) or replacement (TAVR)
    • In patients who aren't ideal candidates due to advanced age or co-morbidities
    • Less invasive treatment for aortic valve replacement
    • Two major bioprosthetic valves available

6

Treatment of Symptomatic Severe Mitral Regurgitation

  • Poor prognosis
  • Surgical therapy
    • Primary means
  • Endovascular intervention
    • Edge-to-edge repair techniuqe of leaflets w/ a MitraClip device
    • Also treats ASDs, VSDs, & patent foramen ovales
      • Occlusion devices interrupt the communication b/n chambers of the heart which eliminates blood shunting

7

Treatment of Atrial Fibrillation

  • AFib
    • Can be associated w/ thrombus formation in the LA appendage --> stroke risk
  • Medications: warfarin or aspirin
    • Standard treatment for stroke prevention
  • Non-FDA-approved devices
    • In patients who rae at high risk for stoke & can't tolerage anticoagulation or medical therapy

8

Structural Heart Disease

  • Congenital anomlaies
  • Acquired heart disease

  • Congenital anomalies
    • Atrial septum
    • Ventricular septum
    • Pulmonic valve
  • Acquired heart disease
    • LAA (Watchman)
    • Mitral vavle (Mitraclip)
    • Aortic valve (TAVR)
    • Paravalvular leaks
    • Ventricular support

9

Calcific Aortic Stenosis

  • General
  • Dianosis
    • Murmur
    • Disease progression
    • Echo
    • Cardiac cath
  • Treatment

  • General
    • Mainly solid Ca2+ deposits within valve cusps
    • Similar risk factors for CAD
    • High coincidence of CAD & AS
    • 6th, 7th, & 8th decades of life
  • Diagnosis
    • Murmur
      • Crescendo-decrescendo SEM radiating to the neck
      • Mild: murmur peaks early
      • Progressive: murmur becomes louder & peaks progressively later in systole (+/- thrill)
    • Disease progression
      • Murmur intensity lessens as SV decreases
      • Carotid upstrokes are diminished in volume & rate or rise is delayed
    • Echo
      • Establishes the diagnosis
      • LV function / hypertrophy
      • Extent of Ca2+
      • Transvalvular pressure gradient
      • Aortic valve area (dimension / velocity)
    • Cardiac cath
      • Gold standard
      • Gradient & CO needed to calculate valve area
      • Simultaneous pressure measurement in LV & aorta
  • Treatment
    • Surgical aortic valve replacement
      • Large mortality benefit in patients w/ symptomatic, severe AS