introduction to the cardiac catheterization laboratory
TRANSCRIPT
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Introduction to the Cardiac
Catheterization Laboratory
April 16, 2010
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History
65 yo male
Hypertension and hyperlipidemia but no prior cardiac history
Had sharp 7/10 back pain between his scapulae when he awoke. Took 3 ibuprofen, and then went for his regular walk with his wife. He denied any CP at the time, though he was somewhat more dyspneic on exertion than he typically would be.
Later in the day, he experienced back pain while sitting which was now 10/10. This time pain was associated with substernal chest pressure as well as SOB and diaphoresis.
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One Hour Later
Was taken to Central Carolina Hospital in Sanford
Had cardiac arrest while registering
Successfully resuscitated (several teeth dislodged in process) and then given ASA, heparin, and nitro.
Diagnosis – Acute Myocardial Infarction
Transfer to UNC via Air Care
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Coronary Angiography
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Export Thrombus Extraction Catheter
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Thrombus
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History of Cardiac Catheterization
1711 – Hales conducts the first cardiac catheterization of a horse using brass pipes, a glass tube and the trachea of a goose.
1844 - French physiologist Bernard coins the term "cardiac catheterization" and uses catheters to record intracardiac pressures in animals.
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Werner Forssmann performs first cardiac
catheterization in a human - 1927
After these successful preliminary studies, I attempted the
first experiment on a living human, performing the
experiment on myself. … I proceeded with vena puncture in
my left antebrachial vein and introduced the (ureteral)
catheter to its full length of 65 cm. I only perceived some
sensation of warmth similar to the sensation during
intravenous ejection of calcium chloride. There was no pain.
When I pushed on the catheter, I felt a warm sensation
behind the clavicle and near the sternomastoid. There was
also a minor stimulus to cough, probably due to irritation of a
vagus branch.
I checked the catheter position radiologically, after having
climbed stairs from the OR to the radiology department.
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The Rest of the Story
“When Schneider refused to give permission for experiments without prior research, Forssmann suggested that he would do the experiment on himself. Schneider strictly forbade any self-experiment, but Forssmann was set to go ahead with the self-experiment. He quite ingeniously deceived the scrub nurse. To get the instruments for the vena sectio, he made her an accomplice by sharing his dream with her. One day, he had successfully persuaded her to help with the vena sectio, just to see how it worked. She, however, became suspicious and insisted on being the subject. In a moment of inattentiveness, he tied the nurse to the operating table”
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History of Cardiac Catheterization
1940s –Cournand and Richards study usefulness of right heart catheterization as diagnostic procedure
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Nobel Prize in Medicine or Physiology to
Forssmann, Cournand and Richards - 1956
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Procedure Room
Image
Intensifier
X-ray
Tube
C-arm
Hemodynamic
Monitor
Image
Monitor
Power Injector
Crash
Cart
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Hemodynamics
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Hemodynamics
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Left Ventricular Function
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Left Ventriculogram
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Coronary Angiography
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Coronary Artery Disease
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Lower Extremity Angiography
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Renal Angiography
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Aortogram
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IVUS
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Revascularization – Restoration of Blood Flow
1956 – Nobel prize
1959 – First coronary angiography
1964 – First concept of percutaneous revascularization (Charles Dotter)
1967 - Coronary artery bypass graft surgery (Rene Favaloro)
1974 - Percutaneous transluminal peripheral angioplasty (Andreas Gruentzig)
1977 - Percutaneous transluminal coronary angioplasty (Andreas Gruentzig).
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Second Era of Cardiac
Catheterization:
Diagnostics + Treatment
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Coronary Artery Disease
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A. Gruenzig - first balloon angioplasty (1977)
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Balloon Angioplasty
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Intracoronary stents
1985 - Palmaz Stent
1986 - first intracoronary stent
1994 – FDA approval
2003 – First drug eluting stent
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Peripheral Interventions
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Renal Intervention
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Catheter Based Therapeutics
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Stations in The Cardiac Catheterization
Laboratory
Introduction to Angiograms
Diagnostic Catheterization – Equipment and
Technique
Percutaneous Intervention – Equipment and
Technique
Electrophysiology
Tour of the Cardiac Catheterization and
Electrophysiology Laboratory
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A „Typical‟ Patient
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Emergency Angiography