1. Cardiac Catheterization
Xin Yang MB Bchir, MA(Cantab), MRCP(Lond)
2008
Zoll Firm Lecture Series

2. Purposes of Right Heart Cath
Hemodynamic assessment to record pressure in the cardiac chambers and the vessels.
Determination of cardiac function and evaluation of shunts.
Oxygen delivery and utilization.
Guide inotrope and vasopressor therapy
2008
Zoll Firm Lecture Series

3. RHC: Swan-Ganz Catheter
2008
Zoll Firm Lecture Series

4. Zoll Firm Lecture Series
Access
Seldinger technique to gain access through RIJ, L subclavian or femoral vein.
Place Cordis sheath.
Don’t forget the Swan-dom.
2008
Zoll Firm Lecture Series

5. Zoll Firm Lecture Series
Positioning of PAC
2008
Zoll Firm Lecture Series

6. Zoll Firm Lecture Series
Positioning of PAC
2008
Zoll Firm Lecture Series

7. Zoll Firm Lecture Series
PAC Tracings
Cardiac cycle:
A: atrial systole
B: Isovolumetric contraction
C: Rapid ejection
D: Reduced ejection
E: Isovolumetric relaxation
F: Rapid ventricular filling
G: Reduced ventricular filling
2008
Zoll Firm Lecture Series

8. Zoll Firm Lecture Series
PAC Tracing
2008
Zoll Firm Lecture Series

9. Zoll Firm Lecture Series
RA Tracing
A fib, canon a wave, TR,
2008
Zoll Firm Lecture Series

10. Zoll Firm Lecture Series
Hemodynamics
Parameter N Value Route Significance
CVP < 6 Cordis RV preload
RAP (m) < 8 Prox port RV preload
PAP (S/D) 15/30-4/12 Dist port RV afterload
PCWP (m) <10 Dist port LV preload
SVO2 >75% Dist port Cardiac output
2008
Zoll Firm Lecture Series

11. Zoll Firm Lecture Series
Hemodynamics
Cardiac output: Assumed O2 consumption
A-V O2 difference
125 x BSA
A-V O2 difference x Hgb x 13.6
Cardiac index : Cardiac output / BSA
(Nl values are: 2.4 – 4.2 l/min/m2)
2008
Zoll Firm Lecture Series

12. Zoll Firm Lecture Series
Hemodynamics
SVR: (MAP-CVP) / CO x 80
PVR: (MPA-MPCW) / CO x 80
Qp/Qs: (SaO2-MvO2) / (PvO2-PaO2)
2008
Zoll Firm Lecture Series

13. Zoll Firm Lecture Series
Clinical Scenarios
Shock
PCWP CO
SVR
MVO2
Hypo-volemia ↓ ↑
Cardiogenic
Distributive
2008
Zoll Firm Lecture Series

14. Zoll Firm Lecture Series
PAC Complications
Bleeding
Pneumothorax
Sustained ventricular arrythmia
Right bundle branch block
Infection
Cardiac / Pulmonary artery perforation
Pulmonary artery infarction
Thromboembolism
2008
Zoll Firm Lecture Series

15. Purpose of Left Heart Cath
Angiography to evaluate the presence of vascular obstruction, contractile function of cardiac chambers, and regurgitation or shunting of blood.
Interventional procedures.
2008
Zoll Firm Lecture Series

16. Pre-procedural Preparations
Labs: CBC, Chem7, coagulation.
NPO after midnight.
IV rehydration (follow pre-cath order set).
Discontinue appropriate medications (metformin, coumadin).
Informed consent.
2008
Zoll Firm Lecture Series

17. Zoll Firm Lecture Series
Cath Lab
2008
Zoll Firm Lecture Series

18. Post LHC Complications
Bleeding:
Hemostasis with manual compression (no sand bags or water bags).
IV fluid.
Check vitals / labs / type & screen.
Unstable, Stat page vascular surgery & cards fellow.
If stable, page cards fellow, consider USS/CT abdo.
2008
Zoll Firm Lecture Series

19. Post LHC Complications
Pseudoaneurysm.
USS.
Thrombin injection if > 2cm.
If AV fistulae is present, get vascular surg consult.
Vagal reaction.
Fluid.
atropine.
is a leakage of arterial blood from an artery into the surrounding tissue with a persistent communication between the originating artery and the resultant adjacent cavity.
2008
Zoll Firm Lecture Series

20. Post LHC Complications
Thromboembolism:
Stroke: stat consult neuro, consider stat NCCT of head and thrombolysis.
Cholesterol emboli: skin/renal/GI involvement, treat underlying risk factors.
Acute limb ischemia: page Duane/Lawrence.
2008
Zoll Firm Lecture Series

21. Post LHC Complications
Recurrent ischemia:
12 lead EKG.
Anti-anginal therapy.
Page on call fellow if concerning EKG changes, persistent symptoms or any concern.
2008
Zoll Firm Lecture Series

22. Post LHC Complications
Dissection:
Bilateral pulses and BP.
CBC, coag and type and cross.
Stat portable CXR
CT chest.
Echo
Call on call fellow.
2008
Zoll Firm Lecture Series