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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.

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.

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.

Cardiac cath lab is one of the major revenue generating department of the hospital, so it must be managed properly.

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.

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