Sandbox Turky

Is cardiac catheterization an emergency?

Yes

No

Refer to management of acute coronary syndromes

Confirm patient has ANY of the following indications for cardiac catheterization ❑ Canadian cardiovascular society (CCS) class III (i.e. symptoms with everyday living activities) or class IV angina (i.e. inability to perform any activity without angina or angina at rest) despite medical therapy, OR ❑ Angina plus systolic dysfunction, OR ❑ High-risk stress test finding, defined as ANY of following , OR ❑ Resting LVEF < 35% ❑ High-risk treadmill score (≤ 11) ❑ Severe exercise LVEF < 35% ❑ Stress-induced large perfusion defect ❑ Stress-induced multiple perfusion defects ❑ Large, fixed perfusion defect with LV dilation OR increased lung uptake ❑ LV dilation or increased lung uptake ❑ Stress-induced moderate perfusion defect with LV dilation or increased lung uptake ❑ Uncertain diagnosis following non-invasive test and need to confirm diagnosis, OR ❑ Systolic dysfunction with unexplained cause, OR ❑ Survivor of sudden cardiac death, polymorphic VT, or sustained monomorphic VT, OR ❑ Suspected spas m or non-atherosclerotic cause of ischemia

Obtain a detailed history History of present illness ❑ Age ❑ Chest pain or chest discomfort ❑ Onset of symptoms ❑ Sensation of heaviness, tightness, pressure, or squeezing ❑ Duration of each episode ❑ Radiation to the left arm, jaw, neck, right arm, back or epigastrium ❑ Timing of symptoms (morning vs. evening vs. wake patient at night) ❑ Alleviating factors (e.g. medications or rest) ❑ Exacerbating factors ❑ Association of symptoms to food intake ❑ Palpitations ❑ Nausea or vomiting ❑ Sweating ❑ Dyspnea ❑ Orthopnea ❑ Dizziness ❑ Weakness of extremities ❑ Numbness of tingling of extremities ❑ Lightheadedness ❑ Syncope or presyncope ❑ Increased frequency of symptoms ❑ Worsening of symptom severity ❑ Previous episodes ❑ Recent infections ❑ Fever ❑ Weight or appetite changes ❑ Stress ❑ Fatigue Possible triggers of symptoms ❑ Physical exertion ❑ Air pollution or fine particulate matter ❑ Recent infection ❑ Heavy meal intake ❑ Cocaine ❑ Marijuana Cardiovascular Risk Factors ❑ Known CAD (review available catheterizations or CABG reports) ❑ Smoking history ❑ Baseline blood pressure (Duration, antihypertensive therapy, compliance with medications) ❑ History of diabetes mellitus (Duration, DM control, compliance, antidiabetic medications, recent HbA1c, screening for micro- and macrovascular DM complications) ❑ Dyslipidemia ❑ Obesity (BMI > 30 kg/m2) Past Medical History ❑ Congenital heart disease ❑ Left to right shunts ❑ Dextrocardia ❑ Situs inversus ❑ History of renal disease (CrCl < 60 mL/min) ❑ History of bleeding tendency ❑ Known significant anemia (Hct < 30%) ❑ History of heparin-induced thrombocytopenia (HIT) ❑ History of pulmonary disease ❑ History of major surgery in the past month ❑ Anticipated major surgery in the next year Medications ❑ Prescribed drugs ❑ Home oxygen therapy ❑ Over-the-counter drugs ❑ Herbs and supplements ❑ Administration of ANY of the following medications within the last 48 hours prior to catheterization? ❑ Aspirin ❑ Clopidogrel ❑ Metformin ❑ Phosphodiesterase inhibitors (e.g. Tadalafil, sildenafil, or similar drugs) ❑ Warfarin. If yes, what is most recent INR? ❑ Low molecular weight heparin (LMWH). If yes, when was last dose? ❑ Other chronic anticoagualants (e.g. dabigatran, NOACs, fondaparinux) Allergies ❑ List of allergies, including severity and manifestations (pruritus, rash, hives, stridor, or anaphylactic shock) ❑ Known drug allergies ❑ Allergy to aspirin or history of nasal polyps or aspirin desensitization ❑ Allergy to heparin ❑ Other drug allergies ❑ Contrast allergy ❑ Latex allergy ❑ Allergy to Shellfish (controversial association between shellfish allergy and contrast allergy) ❑ Other known environmental and food allergies Family history ❑ Family history of premature cardiovascular diseases Social and Sexual History ❑ Healthcare proxy and available family members for patient care ❑ Barrier to tolerate or adhere to dual antiplatelet therapy (DAPT) or follow-up visits ❑ Pregnancy or possible pregnancy Advanced Directives ❑ DNR status ❑ DNI status

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