Cardiac catheterization 59

CARDIAC CATHETERIZATION

Cardiac catheterization is an invasive method used to investigate the cardiovascular system.

During this procedure a catheter (thin plastic tube) is inserted into an artery or vein in the arm
or leg. From there it can be advanced into the chambers of the heart or into the coronary
arteries. If the catheter is inserted through a vein, the right chambers of the heart can be
investigated, whereas if the catheter is inserted through an artery the left chambers of the
heart can be explored.

The method is used to:

► measure blood pressure within the heart and major blood vessels,
► measure blood oxygenation (how much oxygen is in the blood),
► measure the pumping ability of the heart muscle,
► inject dye into the heart chambers (angiocardiography) or coronary arteries:
coronary angiography or coronary arteriography;
► catheters with a balloon on the tip are used in the procedure called coronary
angioplasty
► record intracavitary ECG.

When performed on humans, the catheter is introduced through a large artery/vein after
using a puncture needle, whereas during animal experiments the catheter is introduced after
dissection of the region and visualization of the vessel. The catheter then is guided into
position using radioscopy.

MEASUREMENT OF BLOOD PRESSURE

► Method. The external end of the catheter is connected to a blood pressure

transducer. A reference trace is used, which is always the ECG. After recording the
pressure curves maximal (systolic), minimal (diastolic) and median values are read or
calculated (Figure no. 76). The normal values of pressure in different compartments
of the heart are presented in Figure no. 81.

AP VD ECG

AD

Figure no. 76. Pressure curve recording from the pulmonary artery (AP),
then from the right ventricle (VD) and right atrium (AD).

► Importance. Pressures in heart chambers are modified by cardiac malformations,

heart valve diseases or diseases affecting myocardial contractility.
60 Physiology laboratory exercises

ANGIOCARDIOGRAPHY

► Method. Angiocardiography is done by injecting a radio opaque dye into the

different compartments of the heart and recording the images with an X-Ray
machine.

► Importance. This method enables the study of heart and major blood vessel
radiological anatomy, to diagnose cardiac malformations or valvulopathies. The
method also enables the calculation of ventricular volumes (Figure no. 77).

VTD VTS
L
L
h
D
D

V= K x D 2 x L

Figure no. 77. Drawing representing the angiocardiographic imaging of the

left ventricle at the end of diastole (VTD) and systole (VTS). The method
used to calculate ventricular volumes is also presented.

► Normal values obtained with this method are:

– end-diastolic volume (EDV): the volume of blood in a ventricle at the end of
filling (diastole): 70±20 ml/m2
– end-systolic volume (ESV): the volume of blood in the left ventricle at the
end of contraction, or systole: 24±13 ml/m2
– stroke volume (SV): the volume of blood pumped from one ventricle of the
heart with each beat: 45±13 ml/m2
– ejection fraction (EF): the fraction of blood pumped out of a ventricle with
each heart beat: 0.67  0.08

► Coronary angiography is a variant of angiography, when the radio opaque dye is

injected directly into one of the coronary arteries. Thus the status of the coronary arteries can
be appreciated. (Figure no. 78).

MEASUREMENT OF BLOOD OXYGENATION

► Method. Blood samples are collected from different areas in order to determine O2
saturation and hemoglobin. Results are expressed either in ml O2 in 100 ml of blood
or as a percentage of the maximal oxygen saturation of the hemoglobin. Between the
two there is a constant relationship (1 g of hemoglobin can maximally bind 1.34 ml of
oxygen).
Cardiac catheterization 61

OAD OAS

ADA ACD ACx

ADA
ACD

ACx

Figure no. 78. Schematic representation of the angiographic aspects of the

coronary arteries in right anterior oblique incidence (OAD) and left anterior
oblique incidence (OAS); ACD = right coronary artery, ADA = anterior
descending artery, ACx = circumflex artery.

► Normal values of oxygen saturation in different compartments of the heart are

presented in Figure no. 81.

► Importance. Oxygen saturation will be modified in all cardiac congenital

malformations in which there is a communication between the left and the right side
of the heart (i.e. ventricular or atrial septal defect). Based on the magnitude of the
modification of oxygen saturation the output through the septal defect can be
calculated.

► Fick's method allows us to calculate the cardiac output based on the blood
oxygenation (Figure no. 79).

Figure no. 79. Schematic representation of Fick's method to calculate

cardiac output; oxygen concentration in the pulmonary vein (CO2Vp) and in
the pulmonary artery (CO2Ap), oxygen consumption (VO2).

DILUTION CURVES

► Method. For this procedure a special catheter is used with a small thermistor
(temp probe) about 3 centimeters behind the tip. Cold fluid is injected (under 10
Celsius or room temperature) using a opening of the catheter in the right atrium
(typically 10 ml of saline - i.e. 0.9% NaCl). As the cooler fluid passes the tip
62 Physiology laboratory exercises

thermistor, a very brief drop in the blood temperature is recorded. By attaching both
the injector site and the ventricular thermistor to a small computer, the thermodilution
curve can be plotted
► Importance. The dilution of the cold fluid is inversely proportional with the flow of
blood in that territory, thus the cardiac output can be calculated.

INTRA-CAVITARY ELECTROCARDIOGRAM

► Method. The ECG is recorded using the same method (as surface ECG), the
genesis of the waves is exactly the same (Figure no. 80).

► Importance. It is used in diagnosing arrhythmia. The procedure can be used for

therapeutic purposes as well (cardiac stimulation).

Figure no. 80. Schematic representation of a unipolar ECG recording in:

VCS = vena cava superior, VCI = vena cava inferior, AD = right atrium, VD =
right ventricle. a = recording in VCS, b = recording in VCI, c = recording in
superior AD, d = recording in medial AD, e = recording in inferior AD, f =
recording in VD.
Cardiac catheterization 63

Figure no. 81. Maximal, minimal and median pressures measured during
different phases of the heart cycle. The saturation of oxygen of the blood in
different compartments is also presented.
64 Physiology laboratory exercises

INVAZIVE MEASUREMENT OF BLOOD PRESSURE

This method allows us to record the pressure curve as well as to test the in vivo effect of
several mediators (sympathetic and parasympathetic)

The animal used for the experiment is weighed and anesthetized using a mixture of
Ketamine and Xylazine (administered i.m.). The depth of anesthesia is checked regurarly
(corneal reflex and response to pain).

Animals used for demonstration and experimental purpose are healthy.

Nevertheless avoid direct contact with their blood, faeces or secretion. Do not
touch animals except when specifically told by the demonstrator and always
wear gloves. Do not pet the animals, do not feed the animals. Further details
regarding laboratory safety rules as well as ethical considerations of animal
experimentation are provided at the end of this Handbook.

The animal is placed and stretched out in supine position on a dissection board. A midline
incision is made through the skin just above the trachea. Bleeding will be minimal in a midline
cut. The trachea and the carotid arteries are visualized. The jugular vein is also visualized by
dissection. A cannula filled with saline solution (with heparin) is inserted into the carotid
artery on one side and fixated with threads. The cannula is attached to a pressure transducer
that converts the mechanical signal to an electrical signal. This in turn is amplified and
filtered using a BIOPAC system (low-pass filter 66Hz, high-pass filter 38.5Hz, band-stop filter
50Hz, initial amplification 100x).

Figure no. 82. Pressure curve recording in basal conditions.

Recording is started by pressing the "Start" button. On the recording the

pressure wave can be identified with the dicrotic notch. The normal (baseline)
frequency can be measured (in rats normal values are 240-350/min.) as well
as the baseline blood pressure (normal values are 140-160/50-70mmHg).
Then adrenaline (Figure no. 83) and acetylcholine (Figure no. 84) is recorded.
Cardiac catheterization 65

Figure no. 83. The efect of adrenaline on the in vivo rat heart.

Figure no. 84. Efect of acetylcholine.