The Diagnostic Procedure

05/25/23 22:42
 Indications for a
Diagnostic Angiogram

• Suspected or known Coronary Artery Disease

(CAD)
• Myocardial Infarction (MI)
• Sudden cardiovascular failure
• Valvular disease
• Congenital Heart Disease (CHD)
• Aortic dissection
 Possible complications* of a
Diagnostic Angiogram
• Death
• MI / Heart Attack
• Stroke
• Arrhythmia’s
• Vascular Injury
• Infection

* Cardiac Catheterization has a < 2% complication

rate associated with either a Diagnostic or
Interventional Procedure
Goals of a Diagnostic Angiogram

• Create a roadmap of the patients coronary

vasculature
• Full visualization of the coronary arteries and
all their branches
• Assess Left Ventricular function
• Determine stenosis site & significance along
with an ability to treat
 Causes of a Heart Attack

• Smoking
• Family History
• Diabetes
• Gender
• Obesity
• Lack of exercise
• Poor diet / high cholesterol level
 Pre-testing

• Full patient history & physical examination

• Lab work-up / blood tests
• EKG
• Echocardiogram
• Chest X-ray
• Exercise treadmill / Stress test
The Diagnostic Procedure, “What
brought you here*?”

• Failed EKG or Stress testing

• Heart Attack
• Significant family history & now your
experiencing chest pain or discomfort
• Shortness of breath
• Inability to exert yourself

* The combination of any or all of the above

Dx Procedure

• Pt is brought to the
Cath Lab
• Placed on various
monitors, i.e.; EKG &
blood pressure
• Prepped & draped
• Given medicine to
lessen anxiety
Monitoring of the patient

• Continuous watch
over all patients vital
signs
• Baseline EKG, blood
pressure and
condition established
• Oxygen saturation
levels maintained
Gaining arterial access

• Palpate for femoral

pulse
• Local anesthetic
• Small incision
• Perc needle inserted
(18 ga)
• Wire placed
• Needle withdrawn
• Sheath inserted
• Wire & dilator
removed
Seldinger Technique

• Needle inserted at a
45 angle with the
bevel “up”
• Needle passed
through anterior wall
of vessel
• Watch for blood
return
• Wire inserted, needle
removed
Catheter insertion

• Catheter pre-flushed
& pre-loaded with
.035 Core wire
• Dx catheter and Core
wire inserted
through sheath &
passed into pt’s
arterial system
• Catheter brought
over the arch & wire
removed
Coronary Injections / Diagnostic
Angiograms

• Catheter connected
to manifold
• Initial arterial
pressures taken
• Catheter engaged
with vessel
• Test injection
• Angiograms
completed
Diagnostic Angiograms

• Multiple views are

taken of Left & Right
systems
• Coronary Artery
Disease identified
• Assessment of disease
location & significance
Routine views taken

LCA
– RAO
– RAO Cranial
– LAO
– LAO Cranial
– LAO Caudal
– Lateral
RCA
– LAO
– RAO
LV Gram
– RAO
Left Ventriculogram

• Used to asses the

function of the left
ventricle
• Pigtail catheter used
• Angiogram taken
• Left ventricle and
aortic pressures
taken
 End of procedure

• Patients status assessed

– Does patient have CAD or not?
• All catheters withdrawn / removed
• Sheaths may be left in place for PTCA if
disease is found
• Sheaths may be removed & vascular sealing /
hemostasis achieved
• Patient discharged or admitted
 What happens next?

If disease has not been found

• The patient may be brought to a step down

patient care area and watched for a few hours
• The sheath(s) may be removed
• The patient can be discharged & will most likely
be followed-up by a Cardiologist for a period of
time
 What happens next?

If disease is found

• An immediate Interventional Procedure may

be performed
• A Interventional Procedure may be scheduled
to be completed within the next day or so
• A consult with a Cardiovascular Surgeon may
be needed
The Diagnostic Procedure

The End