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Aim: Acute Myocardial Infarction is one of the commonest medical emergencies encountered by Emergency Medical Professionals. The EMS professional is the first responder in the hospital emergency room. Primary percutaneous coronary intervention (PCI) performed in a timely manner is the preferred method of treatment for ST-elevation myocardial infarction (STEMI). This study aims to assess perception regarding factors causing delay of Door to Balloon Time (DTBT) in Acute Myocardial Infarction management amongst Emergency Medical Professionals. Study Design: Cross Sectional Descriptive Study. Place and Duration of Study: Symbiosis Centre for Health Skills, Pune in May 2021. Materials and Methods: The study was conducted amongst 120 Emergency Medical Professionals in Pune, India. The data was collected during the month of May 2021. Professionals who have completed Post Graduate Diploma in Emergency Medical Services were included in the study. A pre tested and validated questionnaire developed by Jafery et al was utilized to assess the knowledge and perception level among Emergency Medical Professionals. Results and Discussion: The study provided insight into the factors causing delay in DTBT. An overwhelming majority of respondents blamed the shortage of general and specialist staff for the delay in DTBT. Shortage of CCU beds was also reported as the key factor in the hold up by as many as 71% of the respondents. Cardiac Cath lab availability and ECG equipment shortage were considered to be hindrances by nearly half the respondents. Lack of structured protocol and poor information communication was also hampering the achievement of ideal DTBT. Conclusion: Emergency Medical Professionals have adequate knowledge of their role and the barriers that prevent timely clinical care. The study offers avenues for improvement in various clinical and non-clinical areas so as to achieve the desired clinical goals.

This study analyzed the learning curve effect when a new stroke thrombectomy program was initiated in a cardiac cath lab in close cooperation with neurologists and radiologists.Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but this method is not widely available.An endovascular treatment program for acute ischemic strokes was established in the cardiac cath lab of a tertiary university hospital in 2012. The decision to perform catheter-based thrombectomy was made by a neurologist and was based on acute stroke clinical symptoms and computed tomography angiographic findings. Patients with a large vessel occlusion of either anterior or posterior circulation were enrolled. The primary endpoint was the functional neurological outcome (Modified Rankin Scale [mRS] score) of the patient at 3 months. A total of 333 patients were enrolled between October 2012 and December 2019.The clinical (mRS) outcomes did not vary significantly across years 2012 to 2019 (mRS 0 to 2 was achieved in 47.9% of patients). Symptomatic intracerebral hemorrhage occurred in 19 patients (5.7%). Embolization in a new vascular territory occurred in 6 patients (1.8%).When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the treatment of acute stroke in regions where this therapy is not readily available due to the lack of neurointerventionalists.

Objectives To describe, compare and examine self-reported anxiety levels and associated physiological responses of blood pressure, heart rate and respiratory rate of patients undergoing cardiac catheterisation (CATH). Methods Repeated measure design was used to assess a sample of 100 patients who had undergone cardiac catheterisation (CATH) in a major specialised heart institute in Jordan. Results Patients’ anxiety levels differed significantly across the three time periods (baseline, prior to and post CATH). The mean anxiety levels prior to CATH scored with State Anxiety Inventory (M = 52.14, SD = 6.0) was significantly higher than that at baseline (M = 48.35, SD = 5.6) and post CATH (M = 36.27, SD = 9.7). Conclusion Most patients experienced anxiety when scheduled for a CATH. The highest level of anxiety was within two hours prior to the procedure and the lowest was post procedure.

There has been a long history of collaboration at Mayo Clinic between cardiac surgery and the cardiac catheterization laboratory. Before the availability of cardiopulmonary bypass, cardiologists and cardiovascular surgeons investigated hemodynamics of congenital malformations managed surgically including coarctation of the aorta and patent ductus arteriosus. Cardiologists in the catheterization laboratory were critical to the development of open-heart surgery by providing detailed preoperative diagnostic studies. Less well understood are the important contributions of Dr. Earl Wood and his colleagues in the catheterization laboratory to intraoperative and postoperative care of cardiac surgical patients. Much of the development of physiologic monitoring used routinely in current practice can be traced to the innovations of these investigators. The rapid development of percutaneous approaches to many structural heart diseases coupled with the availability of modern noninvasive imaging has changed the relationship of surgeons with the catheterization laboratory, and this chapter gives one surgeon’s overview of this changing landscape.

More than 1 million diagnostic cardiac catheterizations (excluding percutaneous coronary intervention-only procedures) are performed each year in the nearly 2,000 cardiac catheterization laboratories in the United States.1.

This study sought to report outcomes from an efficiency improvement project in a large cardiac cath lab.Operational inefficiencies are common in the cath lab, yet solutions are challenging. A detailed report describing and providing solutions for these inefficiencies may be valuable in guiding improvements in productivity.In this observational study, the authors report metrics of efficiency before and after a cath lab quality improvement program in June 2014. Main outcomes included lab room start times, room turnaround times, laboratory use, and employee satisfaction. Time series analysis was used to assess trend over time. Chi-square testing and analysis of variance were used to assess change before and after the initiative.The principal changes included implementation of a pyramidal nursing schedule, increased use of an electronic scheduling system, and increased utilization of a preparation and recovery area. Comparing before with after the program, start times improved an average of 17 min, and on-time starts improved from 61.8% to 81.7% (p = 0.0024). Turnaround times improved from 20.5 min to 16.4 min (trend p 0.0001), and the proportion of days at full lab utilization improved from 7.7% to 77.3% (p 0.00001). There were no increases in overtime, night, or weekend cases. There was a reduction in full time employees from 36.1 in 2013 to 29.6 in 2016, with an improvement in employee satisfaction.A systematic approach to reducing inefficiencies can improve cath lab start times, turnaround times, and overall productivity. This knowledge may be helpful in assisting other cath labs in similar efficiency improvement initiatives.

BACKGROUND Interventional cardiac catheterization (cath) and electrophysiology (EP) procedures are not routinely performed together. There are several perceived barriers affecting this practice, though there are also advantages for both the patient and practitioner to a combined approach. METHODS This was a single-center retrospective study reviewing combined cath and EP procedures with a preprocedural intention to intervene at Texas Children's Hospital from 2001 to 2014. We excluded procedures in which the intended procedure was purely diagnostic in nature. RESULTS A total of 121 patients requiring 125 procedures were identified, of which 61 patients underwent 62 procedures that met our inclusion criteria. Potential subgroups of interest included adult congenital heart disease patients (26% of cohort), single ventricle anatomy (34%), and heterotaxy (19%) and collectively 58% of procedures involved a patient in one of these groups. The combined nature of the procedure did not preclude a cath or EP intervention in any patient. There were no mortalities. There were three adverse events, affecting 4.8% of procedures. CONCLUSIONS Combined interventional cardiac cath and EP procedures in pediatric patients and those with congenital heart disease can be performed safely in a high-volume center. These combined procedures save patients the risk and inconvenience of multiple procedures, and further investigation into cost savings is warranted.

It is widely recognized that delays in STEMI identification and treatment can negatively affect patient outcomes. Early intervention to achieve reperfusion of the blocked vessel is crucial in minimizing myocardial damage and optimizing patient outcomes. In April 2017, the Southern Alberta STEMI program identified a delay in SHC ED achieving STEMI target times as outlined by the American College of Cardiology and the American Heart Association. Of all walk-in STEMI patients presenting to SHC ED between October 2016 and October 2017 requiring urgent transfer to FMC cardiac cath lab: 24% met the ‘Triage to 1st ECG target’ of ≤ 10 mins 6% met the ‘Door in-Door out target’ of ≤ 30 mins A multi-disciplinary project team was formed to examine barriers to both targets and begin implementing strategies aimed at improving these times.

Cardiac cath lab procedures are developing in numbers, complexities and in demands with good outcomes. The complexicity of procedures and high risk patient factors require efficient cardiac anaesthesiologist's care. They need good infrastructure and anaesthesia facilities. These facilities may be available at Metrocity superspeciality centres, but small units at district levels may not have all these facilities. There are many issues existing which make cardiac anaesthesiologists to prefer to work only in cardiac operation theaters than cath lab. They don't get the job satisfaction in cath lab because of higher stress levels to overcome with the lacunaes in cath lab working. Aim: We hypothesize that cath lab in various centres are run by cardiac anaesthesiologists in majority. To analyze the infrastructure and working conditions of cath lab in perspective of anaesthesiologist, we conducted this survey. Setting and Design: Online survey among IACTA members, through email available through IACTA site. The link was https://www.surveymonkey.com/r/9FKZ3TV . Subjects and Methods: We contacted 500 IACTA members through email addresses available with us. 116 members replied to the online questionnaire done using SurveyMonkey software. Total 12 questions asked and answers analysed. The identity of responders is not disclosed by Survey monkey. Results: Results were analysed in for options in percentage wise by Surveymonkey software.we compiled all responses and categorized the suggestions by responders. Conclusion: Role of anaesthesiologist and anaesthesia facilities should be given important priority in cath lab units. Healthy attitude of governing members of cathlab as well as standard guidelines for recommendation of infrastructure of cath lab, monitoring and patient care is need of the hour!

Introduction: Significant obesity is an increasing co-morbidity in pulmonary hypertension (PH). We note many patients with echo features of pre-capillary PH (PrePH) who were being classified as post-capillary PH (PostPH), due to elevated pulmonary wedge pressure (PWP). We wished to assess the impact of intrathoracic pressure (ITP) measurements on haemodynamics during artificial alterations of ITP in obese patients and on classification. Methods: Obese individuals underwent invasive cardiac cath and intra-oesophageal pressure (IOP) measurements. Haemodynamics were measured during end-expiration, Valsalva and external compression of the abdomen. Fluid challenge was administered in selected patients. Results: 17 patients underwent investigation between Jan ‘13 and Dec ’16. There was a direct 1:1 linear relationship between ITP, as assessed by IOP, and wedge pressure (PWP) (Fig 1A). There was a tight relationship between IOB and PWP during manoeuvres (Valsalva, 1B; external compression, 1C). Following fluid, PWP rose by 4 mmHg. 14/17 patients were classified as PostPH, but following correction for expected ITP (4mmHg), only 3/17 were classified as PostPH (1D). Conclusions: ITP has a 1:1 relationship on PWP. We show that this may frequently result in misclassification of patients as PostPH who have echo features of PrePH and whose PWP does not change significant with fluid challenge.

Cardiac hemodynamic assessment during cardiopulmonary exercise testing (CPET) is proposed to play an important role in the clinical evaluation of individuals with cystic fibrosis (CF). Cardiac catheterization is not practical for routine clinical CPET. Use of oxygen pulse (O2pulse) as a noninvasive estimate of stroke volume (SV) has not been validated in CF. This study tested the hypothesis that peak exercise O2pulse is a valid estimate of SV in CF. Measurements of SV via the acetylene rebreathe technique were acquired at baseline and peak exercise in 17 mild-to-moderate severity adult CF and 25 age-matched healthy adults. We calculated [Formula: see text]. Baseline relationships between SV and O2pulse were significant in CF ( r = .80) and controls ( r = .40), persisting to peak exercise in CF ( r = .63) and controls ( r = .73). The standard error of estimate for O2pulse-predicted SV with respect to measured SV was similar at baseline (14.1 vs 20.1 mL) and peak exercise (18.2 vs 13.9 mL) for CF and controls, respectively. These data suggest that peak exercise O2pulse is a valid estimate of SV in CF. The ability to noninvasively estimate SV via O2pulse during routine clinical CPET can be used to improve test interpretation and advance our understanding of the impact cardiac dysfunction has on exercise intolerance in CF.

Minimally invasive, transcatheter therapeutic interventions for structural heart disease have evolved over the past several decades as appealing alternatives to open-chest surgery. Smaller incisions, shorter hospital stays and quicker recovery are outcomes that are ubiquitous to all approved transcatheter procedures, in comparison to traditional surgery. X-ray fluoroscopy (XRF) is the most commonly used imaging modality to guide transcatheter procedures. XRF offers certain advantages. Interventionalists have close familiarity with XRF systems. These systems are also widely available in centers with cardiac catheterization laboratories. XRF can visualize high X-ray attenuating devices such as radio-opaque catheters and metallic stents. However, XRF has certain disadvantages. For example, soft tissues such as myocardium, and valves are visualized poorly. Chambers and vessels are only transiently visible when filled with boluses of iodinated contrast, which can be nephrotoxic in susceptible individuals. Conventional X-ray also images using the principle of “projection” imaging, making it difficult to judge three dimensional (3D) perspective. Finally, over-reliance on XRF as the sole imaging modality exposes the patient and in-room personnel to the harmful effects of ionizing radiation. Wholly magnetic resonance imaging (MRI) (1-4) and ultrasound guided (US) (5,6) cardiovascular interventions have been tested in animal models and clinical studies as ionizing radiation-free alternatives to XRF. However, wide adoption of these methods has been prevented in large part by the lack of visually conspicuous devices that still maintain high mechanical performance.

Based on a systematic review and meta-analysis of 8 studies, involving 2,559 subjects, both interventional cardiologists (3.21) and cardiac cath lab staff (2.76) had a significantly higher relative risk of posterior lens opacity than the control group. It is essential to provide "best practice" in radiation dose management and lead shielding in the cath lab with the standard "As Low As Reasonably Achievable"! There is a clear need for better data to quantitate the radiation risk and to design innovative strategies to decrease that risk.

Over the last decade, there was a substantial increase in the number of interventional cardiology procedures worldwide, and the corresponding ionizing radiation doses for both the medical staff and patients became a subject of concern. Interventional procedures in cardiology are normally very complex, resulting in long exposure times. Also, these interventions require the operator to work near the patient and, consequently, close to the primary X-ray beam. Moreover, due to the scattered radiation from the patient and the equipment, the medical staff is also exposed to a non-uniform radiation field that can lead to a significant exposure of sensitive body organs and tissues, such as the eye lens, the thyroid and the extremities. In order to better understand the spatial variation of the dose and dose rate distributions during an interventional cardiology procedure, the dose distribution around a C-arm fluoroscopic system, in operation in a cardiac cath lab at Portuguese Hospital, was estimated using both Monte Carlo (MC) simulations and dosimetric measurements. To model and simulate the cardiac cath lab, including the fluoroscopic equipment used to execute interventional procedures, the state-of-the-art MC radiation transport code MCNPX 2.7.0 was used. Subsequently, Thermo-Luminescent Detector (TLD) measurements were performed, in order to validate and support the simulation results obtained for the cath lab model. The preliminary results presented in this study reveal that the cardiac cath lab model was successfully validated, taking into account the good agreement between MC calculations and TLD measurements. The simulated results for the isodose curves related to the C-arm fluoroscopic system are also consistent with the dosimetric information provided by the equipment manufacturer (Siemens). The adequacy of the implemented computational model used to simulate complex procedures and map dose distributions around the operator and the medical staff is discussed, in view of the optimization principle (and the associated ALARA objective), one of the pillars of the international system of radiological protection.

Cardiac arrest is a prominent cause of death for adults in the United States. Postcardiac arrest syndrome can have devastating consequences ranging from mild memory impairment to permanent neurologic deficits. Only 9.5% of out-of-hospital cardiac arrest (OHCA) patients survive to discharge. Since 2002, scientific literature has supported the use of targeted temperature management (TTM) for improved outcomes in comatose OHCA patients. There is limited use of TTM protocols for cardiac arrest survivors in clinical practice, as translation of evidence-based guidelines into clinical practice remains a complicated task. The authors' goal was to utilize the Promoting Action on Research Implementation in Health Services (PARiHS) framework prospectively to develop a TTM program for OHCA survivors in two community hospitals. A collaborative team of providers from an urban hospital and a suburban hospital joined forces to bring evidence into practice with the endpoint of initiating TTM in the emergency, cardiac cath...

The elimination of catheter-related bloodstream infections (CR-BSI) requires meticulous intravenous (IV) catheter care. There are three different types of needlefree connectors and one intraluminal protection device that require different care regimens, including the correct usage of disinfectants, flushing techniques, and clamping sequences. The nurse must be able to identify which connector is in use and select the appropriate care. This care must be followed not only in the inpatient unit by the bedside nurse but also in areas that are providing diagnostic procedures such as the cardiac cath lab. Since bacterial adhesion to the intraluminal catheter wall is the primary building block of a CR-BSI, which may not present until days after initial inoculation, preventing intraluminal fluid pathway contamination is paramount with every access. In addition, many institutions have more than one type of connector available. This complicates the provision of consistent safe care. Split septum, negative mechanical valves, positive pressure mechanical valves, and intraluminal protection devices have specific care and maintenance requirements. This article discusses the different connector types, why each requires special care, how intraluminal fluid pathway contamination can lead to CR-BSI, and how simple nursing care and maintenance practices of connector septum swabbing and catheter flushing by the cardiac cath nurse can help prevent this serious complication.

Cardiac catheterization training for general fellows comes with a steep learning curve. Simulation training outside of the cardiac cath lab in a protected environment provides an alternative arena for general fellows to gain better experience before entering the cardiac cath lab with actual patients

Use of radiation for medical examinations and test is the largest man-made source of radiation exposure. Interventional procedures are only 2% of all radiological procedures, but contribute to about 20% of the total collective dose per head per year. On average, a left ventriculography and coronary angiography corresponds to a radiation exposure for the patient of about 300, a coronary stent to 1,000, a peripheral artery intervention to 1,500 to 2,500, and a cardiac radiofrequency ablation to 900-1,500 chest x-rays. Invasive cardiology procedures increased tenfold in the last ten years and growth in the field has been accompanied by concern for the safety of the staff. Interventional cardiologists have an exposure per-head per year two- to three times higher than that of radiologists, with an annual exposure equivalent to around 250 chest x-rays per head. A reduction of occupational doses by a factor of ten can be achieved simply by and intensive training program. The awareness of radiation effects may be suboptimal in the medical community. It is recommended by professional guidelines and reinforced by the European law that the responsibility of all physicians is to minimize the radiation injury hazard to their patients, to their professional staff and to themselves.

The highly specialized skills of registered nurses (RNs) in the cardiac catheterization laboratory pose unique problems for administrators when dealing with staffing shortages. Faced with a temporary reduction of 25% of the total RN labor and 50% of the procedural RN labor, a cardiac catheterization laboratory in north central Illinois resorted to cross-training RNs through all the phases of care, including preadmission, preprocedural, intraprocedural, and postprocedural care. This creative staffing solution solved the short-term staffing issue and had the added benefit of improving interpositional team knowledge and morale.

Siemens has a logical stepwise approach and employs proven technology. Siemens historically remains focused on efficiently handling image data in the cardiac cath lab as evidenced by: the 1990 introduction of HICOR and timely introduction of ACOM in 1995 together with the extension of the DICOM 3 standard by ACC/NEMA. Today and into the future Siemens is building the strength with the powerful synergy developed between our medical division and computer division (Siemens Nixdorf) to assure even greater success with tomorrow's ACOM.net (Figure 3). Siemens statement: All HICORs can be upgraded with ACOM. All ACOMs can be interfaced to the ACOM net.

Thoughtful clinicians no longer doubt the efficacy of thrombolytic therapy for acute stroke, but its use outside of the Food and Drug Administration–approved indications remains controversial. One of the most difficult decisions for the stroke team arises upon a call to the cardiac cath lab or

The role of thrombolytic therapy has evolved since the discovery of the first lytic agent, streptokinase, in 1931. Since then, there have been several agents developed for specific areas of clot and some that have been forcibly adapted for use outside of their intended scope. Traditional use for thrombolytic therapy included acute MI, PE, and DVT. We have adapted thrombolytic therapy to treat acute occlusions of peripheral bypass grafts, dialysis fistula and grafts, venous access devices, and nonhemorrhagic stroke. Even newer uses are for fibrin sheaths around chest tubes. This presentation reviewed the history of the development of thrombolytic therapy, its uses in the coronaries and peripheral vasculature, the various agents that can be used, and the events of the mid-1990s that changed the practice in IR, NIR, and cardiac cath labs across the nation. This presentation allowed the participants to understand the role of each agent in thrombolytic therapy for each indication. They were able to better understand the roles of streptokinase, urokinase, and alteplase in acute MI, PE, DVT, and stroke. The participants have an understanding of the patient care associated with each clinical indication based on evidence-based medicine. The participants were also able to understand the difference in dosing each medication and the financial cost of each medication when treating clots at standard doses for each agent used. In addition, the participants were aware of the clients who were not having their clot treated adequately.

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females. Key words: Risk factors; Coronary angiography. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9179 Cardiovasc. J. 2011; 3(2): 122-125