Coronary artery angiography
Risk factors for coronary artery disease
Obesity
Smoking
High cholesterol
Hypertension
Diabetes
+ve FHx (race/genetics)
Indications for CA angiography
STEMI
trop rise (NSTEMI)
Chest pain
Dyspnoea
+ve stress test
+ve CT/CA
Sustained ventricular arrhythmias (VT/VF/TdP)
Complications
Stroke
Death
Tamponade
Coronary dissection
Emergency CABG
Allergies
Bleeding – groin typical
Kidney damage (contrast)
Radiation burn
Induction of arrhythmia
Procedure
Step by step
Puncture/Needle to skin at site of interest
-
Radial artery
-
Femoral artery (groin shot 1st)
Sheath inserted
Radial artery or iliac artery may be visualised with contrast
Diagnostic wires may be used to assist guidance to Aorta
Diagnostic catheter inserted into ascending Aorta (pressure)
Shots of the RCA and LCA taken at different angles
Critical points
Needle to Skin/sheath pull and pressing on groin
-
Vagal reactions -> ↓BP, ↓HR, AV block
LCA/RCA coronary injections
-
Pressure changes during engagement of arteries. Injecting into a vessel w damped pressure may result in VF
-
ST/T wave changes during injections. If changes persist, notify Dr
Equipment
Sheaths
-
5F grey
-
6F green
-
7F orange
-
8F blue
Diagnostic catheters
-
Tig
-
JL 3.5/4/4.5/5 (FL)
-
JR 3.5/4/4.5/5 (FR)
-
AL (Amplatz)
-
AR 3.5/4/4.5/5
-
MPA (multipurpose)
-
LCB
-
RCB
-
IM
Diagnostic catheters
-
Tig
-
JL 3.5/4/4.5/5 (FL)
-
JR 3.5/4/4.5/5 (FR)
-
AL (Amplatz)
-
AR 3.5/4/4.5/5
-
MPA (multipurpose)
Graft studies
Vessels used as grafts
-
Internal mammary
-
Free LIMA/RIMA
-
Radial artery
-
Saphenous vein
