Congestive heart failure cardiac catheterization

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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.

2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT)

Cardiac Catheterization in Patients Presenting With Heart Failure (DO NOT EDIT)

Class I

"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. (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) "

Vote on and Suggest Revisions to the Current Guidelines

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

• 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

References

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