Coronary Physiology In The Cardiac Cath Lab

Over the past decade there has been an explosion of data validating the importance of assessing coronary physiology at the time of coronary angiography. This has led to the development of numerous new techniques and metrics for performing these assessments and has also resulted in the inclusion of these indices into practice guidelines. Coronary Physiology in the Cardiac Cath Lab provides the foundational knowledge required to understand the concepts behind a variety of coronary physiologic assessments performed and required to apply them effectively when evaluating cardiac patients. Written to bring a practical and evidence-based approach, this book is a valuable resource for interventional and general cardiologists, cardiology researchers, physicians, cardiac catheterization laboratory staff and anyone interested in understanding the theory and current practice surrounding assessing coronary physiology in the cardiac cath lab.

" ... written specifically by and for nurses and technicians! Topics include ECG interpretation, intracardiac pressure measurement, radiography, intracoronary Doppler, intravascular ultrasound, duties of technical staff, angiography and cardiac catheterization, PTCA, stents, atherectomy, laser, nursing care, valvuloplasty and balloon pericardiotomy, electrophysiology, cardiac pacing, endomyocardial biopsy, foreign body retrieval, pediatric interventional cardiology, cardiac pharmacology, and cath lab emergencies."--Publisher.

Cardiologists must answer three important questions when evaluating and treating patients with a coronary artery stenosis. As a physiologist: "What is the effect of this stenosis on coronary blood flow and myocardial function?"; as a clinician: " Is this lesion responsible for the patient's symptoms?"; and finally as an interventionalist: "Will revascularization of this artery improve the patient?" Fundamentally, the answer to these questions can be given to a large extent by measuring coronary pressure. That is the rationale of writing this book. 1. 1 Historical overview. Andreas Gruentzig and most interventional cardiologists in the early days of PTCA, had the intuitive feeling that pressure measurements could help to establish the severity of a coronary stenosis and to monitor the progress and result of a coronary intervention. At that time, measuring coronary pressure by the balloon catheter was part of a standard procedure. A residual transstenotic gradient of less than 15 mmHg was generally considered as a good result. Later, however, it turned out that measuring these (resting) gradients with balloon catheters was inaccurate an only had a limited prognostic value. Moreover, because there was no consistent theory to correlate pressure measurements to blood flow, the interest in measuring coronary pressures faded and disappeared almost completely with the introduction of new balloon catheters not intended for pressure measurement.

​Since the introduction of coronary angiography, a key technique in understanding coronary artery disease, a number of paradigms regarding its study and interpretation have taken place. Following an emphasis on improved angiographic and subsequent intracoronary imaging techniques, functional assessment of coronary circulation has demonstrated to have major implications for diagnosis and treatment of coronary artery disease. Fractional flow reserve, a pressure derived index of stenosis severity, constitutes the best example of the current importance of physiological assessment in clinical practice. However, the acceptance of FFR by cardiologists contrasts with important voids in knowledge on the basic principles of coronary physiology and of other available techniques that, as an alternative to FFR, allow a more comprehensive assessment of coronary circulation. This is particularly noticeable in the assessment of microcirculation, an unavoidable compartment of coronary circulation that is frequently affected in acute coronary syndromes of in the presence of cardiovascular risk factors or non-coronary heart disease. A deeper understanding of the relationship between epicardial vessel and microcirculatory involvement has started with the advent of newer imaging techniques like invasive optical coherence tomography, and non-invasive CT and NMR techniques. This book aims to be an indispensable tool for clinicians and researches in the field of coronary artery disease. It provides a balanced, comprehensive review of anatomy, physiology and available techniques, discusses both the diagnosis of epicardial vessel and microcirculatory disease, the impact of different diseases at different levels of coronary circulation, and the best way to address a separate or combined assessment of different levels of coronary circulation. ​

This new edition of Hemodynamic Rounds provides an expanded series of case studies demonstrating the importance of hemodynamic measurements in understanding cardiac pathology. As with its popular predecessor, Hemodynamic Rounds, Second Edition provides numerous brief case examples incorporating different hemodynamic tracings and considers for each the factors responsible for producing those waveforms. The text is organized into chapters on specific areas of the heart, common cardiac anomalies, and hemodynamic situations resulting from different therapeutic procedures, and includes both normal and abnormal pressure waveforms. The new sections include: * Mitral stenosis and pulsus alterations * Low-gradient aortic valve stenosis * Pitfalls of right heart hemodynamics * Pulmonary balloon valvuloplasty * Coronary hemodynamics for angioplasty and stenting after myocardial infarction * Hemodynamic evaluation of stenotic bioprosthetic mitral valves Hemodynamic Rounds, Second Edition will be an invaluable resource for invasive cardiologists, cardiology residents, cardiac nurses, and catheterization technicians. Also by the same author . . . INTERVENTIONAL PHYSIOLOGY ROUNDS Case Studies in Coronary Pressure and Flow for Clinical Practice This book is intended to help cardiologists enhance their understanding of interventional coronary physiology, including the basic principles of flow and pressure measurements; coronary hemodynamics in normal and diseased states; and changes in blood flow following interventional procedures ranging from angioplasty and stent placement to atherectomy and coronary thrombolysis.

This practical, pocket-sized handbook shows readers how to perform common therapeutic interventions. An easy-to-read outline format makes this complex subject easier to understand. An international team of specialists reviews traditional procedures as well as more specialized interventions, including laser angioplasty, atherectomy and stent implantation, discussing techniques, cautionary highpoints and outcomes. The 2nd Edition also offers coverage of peripheral vascular disease.

Updated for its Second Edition, Introductory Guide to Cardiac Catheterization is an easy-to-follow "how-to" guide to diagnostic and therapeutic cardiac catheterization. This pocket-sized, concise manual presents practical pointers, tips, ACC/AHA guidelines, and highlighted clinical pearls and includes troubleshooting sections that provide solutions to frequently encountered problems. Numerous illustrations demonstrate the complex procedures now being performed via the catheter. This edition has a section on complications in each chapter, a new chapter on peripheral angiography, and a new question-and-answer review chapter. Other highlights include new safety precautions and updates on novel closure devices.

Research centering on blood flow in the heart continues to hold an important position, especially since a better understanding of the subject may help reduce the incidence of coronary arterial disease and heart attacks. This book summarizes recent advances in the field; it is the product of fruitful cooperation among international scientists who met in Japan in May, 1990 to discuss the regulation of coronary blood flow.