When Should You Discharge a PCI Patient From the Hospital?

One of my recent interventional fellows, now a new staff interventionalist at a nearby hospital, wants to know when to discharge uncomplicated patients after percutaneous coronary intervention (PCI). He mentions that the guidelines are not specific on this point. With radial PCI, our fear of femoral bleeding problems is gone. Why keep patients overnight? How long should we keep patients after uncomplicated PCI?



‘Conversations in Cardiology’: What to do with dual anti-platelet therapy in a young pregnant patient with an LAD stent?

Evolving clinical conundrums in modern cardiology require insights from many sources. In this spirit, I’d like to present another ‘conversation in cardiology’ about a real dilemma involving a woman, a stent, and dual anti-platelet therapy. My colleagues generously contributed their thoughtful opinions to assist the treating physician in his decision-making. The conversation addresses the pros and cons, and puts the issue into perspective for a best clinical decision. Let’s see what happened



Evaluation of Coronary Artery Bypass Graft Lesions in the Cath Lab

Many of our patients undergoing cardiac catheterization have had bypass graft surgery (CABG). Some patients have had surgery over a decade or more ago; others within the last several years. Rarely do patients need to come to the cath lab within six months of their surgery, but it has occurred. I thought it would be worthwhile to discuss what we should think about when assessing the patient with coronary artery bypass graft conduits (saphenous venous grafts [SVG], in-situ internal thoracic [mammary] or free radial artery grafts).



Angiographic Projections Made Simple: An Easy Guide to Understanding Oblique Views

Every year, we get a new group of cardiology fellows-in-training who are unfamiliar with angiograms and the angulations needed to best display the coronary arteries. Almost as frequently are the visitors to the cath lab or new trainees in the cath lab who are in need of an orientation to the angiogram, and its specific angulations and abnormalities.



Conversations in Cardiology – A First in Internet Dialog for Medical Education: Managing a Thrombus in the Left Main Coronary Artery

Recent advances in the way we transmit important clinical educational materials now include email, “cloud” internet data repositories, iPhone and iPad instant access, and similar internet applications. Over the last 2 years, I and my colleagues have formed an interested and active group of cardiac cath lab experts to whom several critical questions are posed, circulated for discussion, and feedback provided to one another via a “list serve” internet email. 



Do You Know Your Radiation Dose During Your Cath?

I recently learned that I could see my real-time x-ray dose while doing a case. My x-ray system (Philips, Bothell, Wash.) has a display (see Figures) on the left side of the monitors that shows my table height, source-to-image distance (SID), and flat detector (FD) distance, and below it shows the fluoroscopy settings (low, normal), fluoro time, K mGy/min, patient dose area product (DAP) (I think) and air kerma (AK) in mGy. It was also interesting that by raising and lowering the tube, table, or fluoro setting, the operator can change dosage and know, in real time, in which direction.



My Big 4 at ACC: EVEREST II, Partner Cohort A, RIVAL, and PROTECT II

The American College of Cardiology’s Annual Scientific Session is the time to hear about the most important advances in cardiology. These presentations are often summarized in the media and later published in the scientific journals. I thought I would take this editor’s page to give you my top 4 studies that reflect some of the biggest advances influencing the cath lab in the immediate future. 



Establishing a “Quality” Program for PCI in Your Lab


Why do we talk so much and so often about quality?

It’s simple. We want the best for our patients. We want good care from top-rated physicians doing their work in top-rated facilities, with the most experienced and skilled cath lab staff, and with the best outcomes possible. I want my stenting performed in the best place and by the best physician, and likely, so do you. But how do we know what is the best place or even an acceptable place (or physician)? We have all read the papers about unnecessary procedures, including stents, performed in some places that were possibly not the best. Differences in “quality” are the top of the list of complaints about medical care.



Is Radial Artery Catheterization a Tempest in a Teapot?

Several timely articles in leading newspapers across the country are spotlighting the recent surge in radial artery cardiac catheterization. For example, Suzanne Hoholik wrote the article “Some surgeons inserting stents through the wrist” for the Columbus Dispatch (Sunday, January 30, 2011), and Ron Winslow wrote the article “Wrist May Be Route To Safer Heart Treatment” in the Wall Street Journal (February 8, 2011), providing the lay audience with the reasons why the radial approach in the United States is growing.



Contrast Anaphylactoid Reaction: Is There a Preventative Treatment?


Several weeks ago, Dr. Chris White from the Ochsner Clinic commented, “I need some help. I have a vasculopathic patient who was admitted with resting moderately severe angina. He had CABG [coronary artery bypass graft] surgery several years ago, and has had multiple coronary procedures over the following years. Although the first cath procedure he ever had was uneventful, every procedure since then has been complicated by honest-to-goodness, airway-obstructing, hypotensive, life-threatening contrast reactions.