Congestive heart failure cardiac catheterization: Difference between revisions

	Congestive Heart Failure Microchapters
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Revision as of 05:17, 10 February 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Cardiac Catheterization

Coronary Angiography

Coronary angiography is perfomred in patients with heart failure in whom there is a suspicion of underlying atherosclerosis as the basis for the heart failure. Patients who are troponin or CK-MB positive, who have dynamic EKG changes or other signs and symptoms of an acute coronary syndrome who are revascularization candidates should undergo coronary angiography.

Hemodynamic Assessment

Right Heart Catheterization

Right heart catheterization can be useful to assess the following:

Pulmonary capillary wedge pressure
Pulmonary artery pressure to diagnose pulmonary hypertension and response to therapy

Left Heart Catheterization

Left heart catheterization can be useful to assess the following:

The aortic valve gradient, and diagnose aortic stenosis and track its severity
The left ventricular end diastolic pressure (LVEDP)
Simultaneous assessment of the LVEDP and pulmonary capillary wedge pressure allows for the diagnosis and assessment of mitral stenosis.
Dye can be injected to perform a left ventriculogram and assess for regional wall motion abnormalities, aortic insufficiency, and mitral insufficiency.

Class I
"Invasive coronary angiography is recommended in patients with angina despite medical therapy or symptomatic ventricular arrhythmias.(Level of Evidence: B) "
Class IIb
" Invasive coronary angiography may be considered in patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischemia in non-invasive stress tests.(Level of Evidence: B) "

Class IIa
"1. Coronary arteriography is reasonable for patients presenting with heart failure who have chest pain that may or may not be of cardiac origin who have not had evaluation of their coronary anatomy and who have no contraindications to coronary revascularization. (Level of Evidence: C) "
"2. Coronary arteriography is reasonable for patients presenting with heart failure who have known or suspected coronary artery disease but who do not have angina unless the patient is not eligible for revascularization of any kind. (Level of Evidence: C) "

References

Template:WikiDoc Sources

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 * Dye can be injected to perform a [[left ventriculogram]] and assess for regional wall motion abnormalities, [[aortic insufficiency]], and [[mitral insufficiency]].
-==2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
-===Cardiac Catheterization in Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
 {|class="wikitable" style="width:80%"
 |-
-| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
+| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Coronary arteriography]] should be performed in patients presenting with [[heart failure]] who have [[angina]] or significant [[ischemia]] unless the patient is not eligible for [[revascularization]] of any kind.<ref name="pmid6352078">{{cite journal |author=Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, Levine F, Schloss M |title=Results of coronary artery surgery in patients with poor left ventricular function (CASS) |journal=[[Circulation]] |volume=68 |issue=4 |pages=785–95 |year=1983 |month=October |pmid=6352078 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=6352078 |accessdate=2012-04-05}}</ref><ref name="pmid15466654">{{cite journal |author=Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM, Lytle BW, Marlow RA, Nugent WC, Orszulak TA |title=ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery) |journal=[[Circulation]] |volume=110 |issue=14 |pages=e340–437 |year=2004 |month=October |pmid=15466654 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15466654 |accessdate=2012-04-05}}</ref><ref name="pmid11161934">{{cite journal |author=Fox KF, Cowie MR, Wood DA, Coats AJ, Gibbs JS, Underwood SR, Turner RM, Poole-Wilson PA, Davies SW, Sutton GC |title=Coronary artery disease as the cause of incident heart failure in the population |journal=[[European Heart Journal]] |volume=22 |issue=3 |pages=228–36 |year=2001 |month=February |pmid=11161934 |doi=10.1053/euhj.2000.2289 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=11161934 |accessdate=2012-04-05}}</ref><ref name="pmid15219526">{{cite journal |author=Arques S, Ambrosi P, Gelisse R, Roux E, Lambert M, Habib G |title=Prevalence of angiographic coronary artery disease in patients hospitalized for acute diastolic heart failure without clinical and electrocardiographic evidence of myocardial ischemia on admission |journal=[[The American Journal of Cardiology]] |volume=94 |issue=1 |pages=133–5 |year=2004 |month=July |pmid=15219526 |doi=10.1016/j.amjcard.2004.03.046 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914904004606 |accessdate=2012-04-05}}</ref><ref name="pmid16835970">{{cite journal |author=Kurtz CE, Gerber Y, Weston SA, Redfield MM, Jacobsen SJ, Roger VL |title=Use of ejection fraction tests and coronary angiography in patients with heart failure |journal=[[Mayo Clinic Proceedings. Mayo Clinic]] |volume=81 |issue=7 |pages=906–13 |year=2006 |month=July |pmid=16835970 |doi=10.4065/81.7.906 |url=http://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)61483-3 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>[[Invasive coronary angiography]] is recommended in [[patients]] with [[angina]] despite medical therapy or [[symptomatic]] [[ventricular arrhythmias]].([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]]
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki> [[Invasive coronary angiography]] may be considered in [[patients]] with [[HFrEF]] with an intermediate to high pre-test probability of [[CAD]] and the presence of [[ischemia]] in [[non-invasive stress tests]].([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
 |}