INDIKASI CABG PDF

To develope and intergrate the two necessitates a realistic training experience. Patients safety will always be a number one priority. Educational Purpose A. Understand the indications, limitations, complications and medical and surgical implications of the findings at cardiac catheterization and angiography, as well as a general understanding of related interventional procedures.

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To develope and intergrate the two necessitates a realistic training experience. Patients safety will always be a number one priority. Educational Purpose A. Understand the indications, limitations, complications and medical and surgical implications of the findings at cardiac catheterization and angiography, as well as a general understanding of related interventional procedures.

Understand the pathophysiology of cardiovascular disease and the ability to interpret hemodynamic and angiographic data and to use these data to select cases for surgical and catheterization-based therapeutic procedures. Obtain a basic understanding of radiation physics, radiation safety, fluoroscopy and radiologic anatomy.

Understand the fundamental principles of shunt detection, cardiac output determination and pressure waveform recording and analysis. Educational Purpose E. Learn to perform pulmonary artery catheterization with flow-directed catheters by the percutaneous subclavian, femoral and internal jugular approach. Learn the proper techniques of diagnostic left heart catheterization and angiography by percutaneous brachial and femoral approaches.

Learn to perform insertion and operation of temporary right ventricular pacemakers. Learn to perform and interpret the results of therapeutic pericardiocentesis. Learn intra-aortic balloon counterpulsation indications, insertion, and management. GOALS They will have the knowledge and skills necessary to safely and competently perform these procedures.

They will be versed in the indications, contra-indications and clinical judgment that is associated with the catheterizations procedures. Pressure and saturation of each chambers and vessels were usually taken to obtain the diagnosis.

Angiography is frequently being done to visualize the anatomical structure of the heart and vessels. It may also be used to assess the cardiac function and regurgitation severity. Indications of Cardiac Catheterization To confirm the presence of clinically suspected condition. To define the anatomical and physiological severity of the diseases. To determine the presence of associated condition or complication. As a routine pre op assessment esp. Age and cardiac catheterization Patient age has a great influence on feasibility, risk and clinical impact of cardiac catheterization Feasibility is mostly influenced by patient size because of vascular approach and catheter manipulation Risks change according to patient size, clinical stability, anatomic complexity.

Need of neonatal catheterization in simple heart malformations is exceptional, unless an interventional procedure can be anticipated i. Neonates Patients requiring diagnostic cardiac catheterization in neonatal age are often complex, critically ill and candidates to interventional procedures A further risk is rapresented by low weight SGA and prematurity.

Indications : Unstable angina or Chest pain [uncontrolled with medications or after a heart attack] Heart attack Before a bypass surgery Abnormal treadmill test results Determine the extent of coronary artery disease Disease of the heart valve causing symtpoms syncope, shortness of breath To monitor rejection in heart transplant patients Syncope or loss of consiousness in patients with aortic valve disease.

Contraindications cardiac catheterization Absolut: The refusal of mentally competent patients to consent the prosedure Incomplete equipment and cath facility. Risks cardiac catheterization Common risks of cardiac catheterization are: Bruising Infection Rare risks include: Heart attack Stroke Damage to the artery where the catheter was inserted Irregular heart rhythms arrhythmias Allergic reactions to the dye or medication Tearing the tissue of your heart or artery Kidney damage Excessive bleeding Infection Blood clots mayo clinic.

Kern, The Cardiac Catheterization Handbook. Catheterization: Temporary pain Minor infections Nausea and vomiting Bleeding Reaction to medications or dye Allergic skin reaction to tape, dressing, or latex Abnormal heartbeats Bruising or scarring at the catheter entry site. Pyrogen reactions. Vascular Complications decreased coronary artery dissection Chest ;70; Indication for cardiac catheterization Indication 1.

Suspected or known coronary artery disease a. New-onset angina b. Unstable angina c. Evaluation before a major surgical procedure d. Silent ischemia e. Positive exercise tolerance test f. Atapycal chest pain 2. Myocardial infarction a. Unstable angina postinfarction b. Failed thrombosis c. Schock d. Mechanical complications ventricular septal defect, rupture of wall or papilary muscle.

Procedures LV. COR LV. Sudden cardiovascular death 4. Valvular heart disease 5. Congenital heart disease before anticipated corrective surgery 6. Aortic dissction 7. Pericardial constriction or tamponade 8. Cardiomyopathy 9. Initial and follow up assesment for heart transplant. Absolute contraindications Inadequate equipment or catheterization facility Relative Contraindications Acute gastrointestinal bleeding or anemia Anticoagulation or known, uncontrolled bleeding diathesis Electrolyte imbalance Infection and fever Medication intoxication e.

Complication of cardiac catheterization Major Cerebrovascular accident Death Myocardial infarction Ventricular tchycardia, fibrilation, or serious arrhytmia Other Aortic dissection Cardiac perforation, tamponade Congestive heart failure Contrast reaction anaphylaxis, nephrotoxicity Heart block, asystole Hemorrhage local, retroperitoneal, pelvic Infection Protamine reaction Supraventicular tachyarrhythmia, atrial fibrilation Thrombosis, embolus, air embolus Vascular injury, pseudoaneurysm Vasovagal reaction.

Conditions requiring special Condition Management preparations 1. Defer procedure a. Fresh frozen plasma c. Hold heparin d. Protamin for heparin. Diabetes a. NPH Insulin protamin reaction b. Renal function prone to contrastinduced renal failure c. Metformin usage. Conditions requiring special Condition Management preparations 4. Defer procedure, replenish or correct electrolytes 5. Defer procedure, administer antiarrhytmics 6. Defer procedure. Patient and clinical characteristics associated with increased mortality from Left ventricular dysfunction cardiac catheterization.

Modified from Grossman W: complication of cardiac catheterization: incidence, causes and prevention. Modified from Johnson LW, et al: Cathet cardiovasc diagn , Cerebrovascular accident 0. Treatment Introcoronary nitroglycerin rule out spasm Consider intracoronary Thrombectomy or aspiration, Coronary angioplasty, or emergency Aortocoronary bypass. Complications and precautions Dissestion 0. Do not manipulate catheter in coronary ostium, monitoring pressure of catheter tip.

Do not inject with damped pressure. Use nonionic or low-osmolar contrast media agents. No further coronary injections If ischemia produced, stent or emergency aortocoronary bypass.

If dissection associated with thrombus but no ischemia, use heparin controvential and consider coronary stenting. Elevate patients trunk 30 to 45 degrees Oxygen, morphine 2 to 5 mg IV , nitrates to g IC , furosemide 20 to mg IV ; nitroprusside for afterload reduction; inotropic support with dopamine or dobutamine Intraaortic ballon pumping. Complications and precautions Cardiogenic schock Careful patient selection: 1 left main coronary artery stenosis, 2 aoric stenosis at high risk, and 3 acute infarction Prophylactic IABP for high-risk left main coronary artery angiography; minimize number of injections; treat hypotension Stop procedure if hypotension persist Athopine, adequate volume expansion, Aramine [Metaraminol] intraaortic injection of 0.

Complications and precautions Ventricular tachycardia, asystole or fibrilations 0. Complications and precautions Hematoma in femoral artery 0. Retroperitoneal bleeding Avoid high above inguinal ligament femoral artery puncture Watch for hypotension, low abdominal or flank pain within hous of procedure Low hematrocrit, tachycardia if not receiving -blockers.

Evacuation rarely required Surgical cosult for enlarging hematoma, compartment syndrome, or cool extrimity. Contrast agent nephrotoxicity Hydration and inonic contrast agents Contrast agent reaction vasovagal reaction. Prompt pericardiocentesis with catheter drainage Cardiovascular surgery consultation Surgical exploration and closure for persistant bleeding. Lois, , Mosby. Premixing regimen used in the preparation of norepinephrine levophed for bolus therapy for blood support 1.

Administer bolus doeses of 5g 0. Blood pressure usually responds within 3 to 5 minutes. Learn more about Scribd Membership Home. Much more than documents. Discover everything Scribd has to offer, including books and audiobooks from major publishers.

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Skip to main content Skip to main navigation menu Skip to site footer. Komplikasi tersebut dapat timbul sebagai akibat dari karakteristik peralatan yang digunakan atau karakteristik dari intervensi itu sendiri. Komplikasi PCI secara tradisional dikelompokkan berdasarkan indikasi tindakan, tahapan tindakan dan penggunaan instrumen tertentu. Perkembangan peralatan, penggunaan stent dan terapi antiplatelet yang agresif telah menurunkan insidensi komplikasi mayor PCI selama tahun terakhir. Salah satunya turunnya angka coronary bypass surgery CABG dari 1,5 persen di tahun menjadi 0,14 persen tahun dan dari 2,9 persen di tahun menjadi 0,3 persen di periode tahun References 1. Risks and complications of coronary angiography: a comprehensive review.

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