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472 11 — Optimization of Clinical Outcomes and Quality
https://t.me/med1917
consideration of approach to PCI or CABG. The criteria can be used
to facilitate discussions with patients and/or referring physicians about
the need for revascularization. Payers and hospital systems may use
AUC criteria in the design of protocols or preauthorization procedures
or retrospectively for quality reports. The AUC document states, “It is
hoped that payers would use these criteria to ensure that their members
receive necessary, beneficial, and cost-effective cardiovascular care,
rather than for other purposes.”
Conclusion
The cardiac catheterization laboratory is a highly specialized and
sophisticated unit. QA is the key to success in this environment. Risks
are inherent in this with any invasive procedure but can be safely
managed by having strong leadership; a culture of safety, sound policies, and procedures; compliance with those policies and procedures;
and well-trained, dedicated professionals.
Suggested Readings
Bashore TM, Balter S, Barac A, et al: 2012 American College of Cardiology Foundation/
Society for Cardiovascular Angiography and Interventions expert consen sus document on cardiac catheterization laborator y standards update: A repor t of the American College of Cardiology Foundation Task Force on Expert Consensus documents
developed in collaboration with the Society of Thoracic Surgeons and Societ y for
Vascular Medicine. J Am Coll C ardiol 59(24):2221–2305, 2012.
Hendel RC, Patel MR, Allen JM, et al: Appropriate use of cardiovascular technology 2013
ACCF appropriate use criteria methodolog y update: A report of the American College
of Cardiology Foundation Appropriate Use Criteria Task Force. J Am Coll Cardiol
61(12):1305–1317, 2013.
Klein LW, Uretsky BF, Chambers CE , et al: Qualit y as sessment and improvement in inter-
ventional cardiology: a position statement of the Society of Cardiovascular Angiography and Interventions, part I: standards for quality assessment and improvement
in inter ventional cardiology. Catheter Cardiovasc Inter v 77:927–935, 2011.
Levine GN, Bates ER, Blankenship JC, et al: 2011 ACCF/AHA/SCAI guideline for percutane-
ous coronary intervention: A report of the Amer ican College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society
for Cardiova scular Angiography and Interventions. J Am Coll Cardiol 58:44–122, 2011.
Patel MR, Dehmer GJ, Hirshfeld JW, et al: ACCF/SCAI/STS/AATS/AHA/ASNC/HF SA/SCCT
2012 Appropriate use criteria for coronary revascularization focused update: a report
of the American College of Cardiology Foundation Appropriate Use Criteria Task
Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American A ssociation for Thoracic Surgery, American Heart Association, Amer ican Society of Nuclear Cardiology, and Society of Cardiova scular
Computed Tomography. J Am Coll Cardiol 59(9):857–881, 2012.
Sandborn TA, Tcheng JE, Anderson HV, et al: ACC/AHA/SCAI 2014 health policy state-
ment on structured reporting for the cardiac catheterization laboratory: a report of
the American College of Cardiology Clinical Quality Committee. J Am Coll Cardiol
63(23):2591–2623, 2014.
To view Video 11-1, please activate your book on
www.ExpertConsult.Inkling.com using the pincode
on the inside front cover.
https://t.me/med1917
For more information see Video 11-1.
11 — Optimization of Clinical Outcomes and Quality
472.e1
APPENDIX
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A
Invasive Cardiovascular
Examination and
Procedures
Table A -1
Catheter Size Specifications
French Size Inches Millimeters Centimeter s
1.0 0.013 0.33 0.03
2.0 0.026 0.67 0.07
3.0 0.039 1.00 0.10
4.0 0.053 1.33 0.13
5.0 0.066 1.67 0.17
6.0 0.079 2.00 0.20
7.0 0.092 2.33 0.23
8.0 0.105 2.67 0.27
9.0 0.118 3.00 0.30
10.0 0.131 3.33 0.34
11.0 0.144 3.67 0.37
12.0 0.158 4.00 0.40
Note: 1.0 F = 0.33 mm; 2.0 F = 0.67 mm; 3.0 F = 1.00 mm.
e1
Heart Diagrams
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APPENDIX
B
Previous
Previous
CABG:
PTCA:
Yes
Yes
No
No
1. Stable Angina:
CHC I II III IV
2. Unstable Angina:
2. Acute MI:
Aorta
Anterior
basal
LA
LV score =
P
o
s
a
s
l
t
D
a
-
b
%
Proximal RCA
%
Med RCA
%
Distal RCA
%
RPDA
%
RPLA
%
1st RPLA
%
2nd RPLA
%
3rd RPLA
%
Inf. Septal
%
AC Marginal
%
LMCA
%
Proximal LAD
%
Med LAD
%
Distal LAD
%
1st Diag.
%
1st Diag. Br.
%
2nd Diag.
%
2nd Diag. Br.
%
1st Septal
%
Proximal Circumflex
%
Distal Circumflex
%
1st Ob. Marginal
%
1st Ob. Marginal Br.
%
2nd Ob. Marginal
%
2nd Ob. Marginal Br.
%
3rd Ob. Marginal
%
LAV
%
1st LPL
%
2nd LPL
%
3rd LPL
%
LPDA
%
Ramus
%
Ramus Br.
%
3rd Diag.
Ant. Lat.
Apical
i
a
p
h
r
a
g
m
Dominant Posterior wall blood supply:
This is a preliminary estimate
from the TV screen.
A final film analysis will follow.
Main
Circumflex
Aorta
Septal
Ant. Desc.
Right Left Balanced
Diag.
Post. Lat.
Post. Desc.
1st OM
2nd OM
Figure B-1 Di agram of h eart and its branches which can be used for the
patient and family to indicate location of stenoses and st ate of the LV wall
motion. AC, acute circumflex; Ant., anterior; Br., branch; CABG, coronary
artery bypass graf t; CHC, Canadian heart class; Desc., descending; Diag.,
diagonal branch; Inf., inferior; LA, left atrium; LAD, left anterior descending;
Lat., lateral; LMCA, left main coronar y artery; LPDA, left posterior descending
artery; LPL, left posterior lateral; LV, left ventricle; MI, myocardial infarction;
Ob., obtuse; OM, obtuse marginal; Post., posterior; PTCA, percutaneous
transluminal coronary angioplasty; RCA, righ t coronary arte r y; RPDA , right
poster ior descending artery; RPLA, right posterior lateral a r tery.
e3
e4 Appendix B — Heart Diagrams
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Name:
_____________________________
Age:
_________
WT:
_________
HT:
_________
BSA:
_________
TD:
CO = ______ L/min
CI = ______ L/min/m
2
Fick:
CO = ______ L/min
CI = ______ L/min/m
2
RA
PA
Date:
Cath #:
LA
_________
_________
Ao
SVR = ______ dynes/sec/cm
PVR = ______ dynes/sec/cm
–5
–5
RV
LV
TPG = ______ mm Hg
Figure B-2 Ao, Aorta; BSA, body surface area; CI, cardiac index; CO,
cardiac output; HT, height; LA, lef t atrium; LV, left ventricle; PA, pulmon ary
artery; PVR, pulse-volume recording; RA , right atrium; RV, right ventricle;
SVR, systemic vascular resistance; TD, thermodilution; TPG, tra nspulmonar y
gradient; WT, weight.
APPENDIX
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Functional Anatomy of
the Heart
C
Figure C-1 Blood flow through the heart and peripheral circulatory system.
AA, Aor tic arch; IVC, inferior vena cava; LA , left atrium; LV, left ventricle;
RA, right atrium; RV, right ventricle; SVC, superior vena cava.
e5
e6 Appendix C —
https://t.me/med1917
Figure C-2 Anterior view of the hear t and major vessels. A, Aortic;
IVC, inferior vena cava; M, mitral; P, pu lmonic; SVC, su perior vena cava;
T, tricuspid.
Functional Anatomy of the Heart
Figure C-3 Posterior view of the heart and major vessels. SVC , Superior
vena cava.
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Appendix C —
Functional Anatomy of the Heart e7
Figure C- 4
Santa more WP, Corin WJ: New concepts regarding constriction within a
stenosis Influence of intraluminal pressure changes. Trends Cardiovasc Med
2:189–196, 1992.)
Marginal artery
Distribution and configurat ion of coronary stenoses. (From
Left coronary artery
Circumflex branch of
left coronary artery
Right coronary
artery
Posterior interventricular
branch of right coronary artery
Figure C- 5 Corona r y anatomy. (From Langley LL, et al: Dynamic anatomy
and physiolog y, ed 5, New York, 1980, McGraw-Hill.)
Anterior interventricular
branch of left coronary artery
e8 Appendix C —
https://t.me/med1917
Functional Anatomy of the Heart
Damaged
endothelium
Fatty
streak
Fibrous
plaque
Complicated
lesion
Figure C-6 Evolution of an atherosclerotic coronary plaque. (From Lewis
SM, Collier IC: Medical-surgical nursing: assessment and management of
clinical problems, St Louis, 1996, Mosby.)
Adventitia
Media
Intima
Lipoproteins
Lipid filled smooth
muscle cell
Elastic fibers
and collagen
Lipids
Dead tissue
Thrombus
Hemorrhage
Lipids
Calcification
Tables of Units,
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Calculations, and
Conversions
APPENDIX
D
RA
LA
RV
LV
Table D -1
Guidelines for Location of Catheter Tip for Zero Leveling
Fraction of Anteroposterior
Distance (From Back
to Front) Catheter Tip Location within the Chest
0.75
0.70 Anterior wall of the left ventricle
0.65 Middle of the left ventricle and right atrium
0.60 Posterior wall of the left ventricle
0.55 Mitral valv e, supe rior vena cava, pulmonar y
0.50
0.5
0.75
0.6
Right ventr icle and apex of the left ventricle
trunk
Left atrium
Figure D-1 Computed tomo-
graphy of chest demonstrating position of heart
chambers. LA, Left atrium;
LV, left ventricle; RA, right
atrium; RV, right ventricle.
(From Brown LK , Kahl FR,
Link KM, et al: Anatomic
landmarks for use when measuring intracardiac pressure
with fluid-filled catheters. Am
J Cardiol 86:121, 20 00.)
e9
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