Intro to Cardio Exam 1

• 1844 - Claud Bernard catheterized the arterial and venous systems in animal experiments
• 1870 - Adolph Fick proposed that through cardiac catheterization, one could estimate the total cardiac output

  • Cardiac Output (CO): The product of the heart rate (HR) and stroke volume (SV)
  • CO = HR x SV, measured in Liters/ Minutes (L/min)
  • Normal range is 4-8 L/min
• 1895 - William Einthoven invented the first electrocardiograph
• 1929 - Werner Forssman successfully inserted a catheter into his own vein that went to his heart and walked down the stairs to radiology to look at catheter placement (Right Heart Cath)
• 1941 - Andre Cournand perfected heart catheterization to examine cardiac and pulmonary diseases
• 1950 - H.A. Zimmerman performed the first Left Heart Cath
• 1953 - Sven Ivar Seldinger developed the "Seldinger Technique" for percutaneous vascular entry
• 1953 - Inge Edler is the discoverer of M-Mode echocardiography
• 1959 - F. Mason Sones accidentally performed the first coronary angiography
• 1962 - Melvin Judkins developed pre-shaped catheters for coronary angiography called "Judkins Catheter"
• 1977 - Andreas Gruntzig performed the first balloon angioplasty of a coronary artery, known as Percutaneous Transluminal Coronary Angioplasty (PTCA)
• 1985 - Ulrich Sigwart performed the first percutaneous stenting procedure
• • 1999 – 1st drug eluting stent deployed in coronary artery
  • 2002 – 1st Transcatheter Aortic Valve Replacement (TAVR) performed
  • 2016 – 1st bioabsorable stent approved by the FDA
• Mode Echocardiography:

  • Produces an image similar to a tracing rather than an actual picture
  • Used for measuring or viewing heart structures
• 2 Dimensional Echo:

  • Used to see the actual motion of the heart structures
• Doppler Echocardiography:

  • Used to measure and assess the flow of the blood through the heart chambers and valves
  • Can detect abnormal blood flow
• Color Doppler Echocardiography:

  • Enhanced form of Doppler Echo with color
  • Used to designate the direction of blood flow
• 3D Echocardiography:

  • Live images allow for a more accurate assessment of heart function
  • Uses measurements taken while the heart is beating
• Transesophageal Echocardiography (TEE):

  • Involves advancing a transducer into the esophagus to get ultrasonic views of the heart from a different angle
  • Commonly used to assess for thrombus in the Left Atrial Appendage
• Stress Echocardiography:

  • Done to assess how well the heart works under stress
  • Triggered by exercise on a treadmill or medicine called dobutamine
• Myocardial Biopsy:

  • A sample is taken to look for disease or damage to the myocardium
  • A bioptime is used to snip a piece of the myocardium
  • After a transplant, the patient will require myocardial biopsy samples taken to test for early organ rejection
• Intravascular Ultrasound (IVUS):

  • Utilizes a mini transducer loaded onto the end of the catheter
  • Sound waves are used to visualize the inside of the coronary artery
  • Allows the provider to measure the size of the vessel and the degree of narrowing
• Percutaneous Coronary Intervention:

  • Used when there's a blockage in an artery
  • A stent (metal scaffolding) is inserted onto a balloon and expanded to keep the artery open
• Atherectomy:

  • Process of removing calcium by grinding it away to make the lesion more compliant
  • Helps when plaque hardens over time and becomes calcified and difficult to stent
• Pacemaker:

  • Small device used to treat certain bradycardia arrhythmias by sending impulses to stimulate contraction
• Implantable Cardiac Defibrillator:

  • Device used to monitor and correct life-threatening arrhythmias by sending shocks to the myocardium
• Implantable Loop Recorder:

  • Heart monitoring device that records electrical activity implanted under the skin
  • Left in for an extended period and transmits data to the physician
• EP Study:

  • Test used to diagnose arrhythmias
  • Multiple catheters with electrodes are placed in various areas of the heart to monitor rhythm and map electrical activity
• Direct Current Cardioversion (DCCV):

  • Used to treat arrhythmias, especially atrial fibrillation
  • Patient is sedated and a shock is delivered externally by the machine
• Peripheral Vascular (PV) Procedures:

  • Similar to coronary arteries, arteries of the extremities can develop atherosclerosis
  • Requires interventions like ballooning, stenting, and atherectomy
• Abdominal Aortic Aneurysm (AAA) Repair:

  • Involves placing a graft similar to a stent with a mesh covering to exclude the aneurysm
• Inferior Vena Cava (ICV) Filter:

  • Placed in the inferior vena cava to prevent blood clots from traveling to the lungs and causing Pulmonary Embolism
• Echocardiogram:

  • Visualizes heart structures by placing a transducer on the patient's chest
• 12 Lead EKG:

  • Analyzes cardiac rhythm and can determine if a patient is having a heart attack
  • Proper placement is crucial for accurate diagnosis of arrhythmias and other conditions
• Holter Monitor:

  • Externally monitors a patient's heart rate and rhythm for up to 30 days
• Stress Testing:

  • Assesses a patient's heart during exercise by walking on a treadmill or medically increasing heart rate
• CVT Roles in the Cath Lab:

  • Scrub: assists the physician by draping patients, setting up equipment, and handling catheters
  • Monitor: observes patient status, vital signs, and documents the procedure
  • Panner: operates the x-ray unit and ensures safety measures are met
  • Flex: assists in various tasks during the procedure
• Cath Lab Focus:

  • Focuses on the plumbing aspect of the heart
• Electrophysiology (EP) Focus:

  • Focuses on the electrical aspect of the heart
• Invasive Cardiac Procedures:

  • Left Heart Cath: An artery is accessed and a catheter is advanced to the heart to visualize the coronary arteries
  • Right Heart Cath: A vein is accessed and pressure measurements from the right side of the heart are obtained