The Essentials of Coronary Angiography:

What you Need to Know

Morton J. Kern, MD, MSCAI, FACC, FAHAChief of Medicine, VA Long Beach

Professor of Medicine, UCI

020120 UCI Essentials

Cardiac Cath Lab Procedures

Diagnostic Studies

Coronary Angiography

Ventriculography

Hemodynamics

Shunt Detection

Ao and Periph. Angio

Pulmonary Angio

Coronary Hemodynamics

Endomyocardial Biopsy

Therapeutic Interventions

PCI—Balloon, Stents, Roto

Thombolysis

Coil Embolization

Pericardiocentsis, Window

Cardiomems Monitor

Structural Heart Intervention

Valves

Shunts

HCM

PVD

UCI Cardiac Cath Lab

Nomenclature for Angulations

Radial Cardiac Cath in Biplane at UCI

Concordant Angulation for Biplane Angiography

Radiographics 21:1033-1045, 2001

Better Imaging with better set up.

(also less radiation exposure)

Better Imaging with better set up. Also less panning

Better Imaging with better set up. “The best panning is no panning”

APAP

LAOLAORAO RAO

A B

C D

AP

Heart Shape

LAD RCA

LAD

CFX

CFXLM

LAD CFX

LM

LAD

CFX

LM

LAO, cranial

LAO, caudal

LCA, LAO LM

CFX

LAD

Diagonals

CFX AV continuation

Marginal branches

Septal perforators

LCA – LAO Cranial

LCA – LAO Caudal

RCALAD

CFX

LM

CFXLAD

LAD

CFX

LM

RAO, caudalRAO, cranial

LCA, RAOLM

LAD

CFX

Septals

Marginals

Diagonals

CFX continuation

LCA – RAO Cranial

LCA – RAO Caudal

Conus branchSA node branch

AV nodal branchPL branch

RV marginal branchPDA

RCA, LAO

PDA

LAO, cranialRAO

RCA – LAO

RCA, RAO

SA node branchConus branchRV marginal branch

AV nodal branch

PDAPL branch

RCA - RAO

AP LAO

RAO

Changes in Cardiac Silhouette of LV

1

3

2

1

2

3

4

54

Nomenclature of Cardiac LV Silhouette

SVG Angiography

Angiographic Problems

• Clot

• Dissection

• Aneurysm

• Fistula

Angiographic Problems

• Spasm

• Overlap

• Inadequate opacification

• CTO

• Anomalous origin

– Separate LAD/CFX orgin

– Short LM

IC NTG

Change angulations

Change coaxial seating

Check perfusion territories

Check perfusion territories

Looks for keys to anomalous course

53yo M with Unstable Angina and multiple CAD risk factors

Remember when ever you say,

“Gee, that’s a long left main….”

You should follow it with,

“I wonder if there is anomalous CFX?”

Anomalous Circumflex from RCA

Nonatherosclerotic Coronary Heart Disease, p 1243

Ischemia is not always predicable from the angiographic imaging.