Right heart catheterization

A 42-year-old woman suffered an acute anterior myocardial infarction, initially associated with pulmonary edema. After hemodjmamic stabilization she was given lisinopril 10 mg oraUy. Two hours later she developed circulatory failure in conjunction with acute renal insufficiency. Right heart catheterization showed markedly reduced systemic vascular resistance but a normal cardiac index. After the usual causes of cardiogenic shock had been ruled out, repeated fluid challenges and intravenous noradrenaline failed to improve her hemodynamic status. She was therefore given angiotensin II intravenously (5-7.5 pg/minute), which immediately and markedly raised the systematic vascular... 

The literature includes eight case reports of pulmonary hypertension in AL amyloidosis attributed to pulmonary vascular amyloid deposition (Table 2). Autopsies confirmed pulmonary artery amyloid deposits in four out of four cases. The prevalence of restrictive cardiomyopathy and diastolic dysfunction in AL patients predisposes them to secondary forms of pulmonary vascular disease. Direct measurements of pulmonary artery pressures (PAP) were obtained in five cases (3 pulmonary arteriograms, 2 right heart catheterizations) however, only two reports include direct measures of left atrial filling pressures. Echocardio-graphic estimates of elevated right ventricular systolic pressures and normal diastolic function were reported in all cases. 

Abbreviations MM, multiple myeloma RV dil, right ventricular dilatation Cath, right heart catheterization CCB, calcium channel blocker dig, digoxin dx, diagnosis LVH/RVH, left ventricular hypertrophy/right ventricular hypertrophy. 

The cardiac catheterization procednre reqnires vascnlar access, nsually obtained percutaneonsly at brachial or femoral arteries or veins. Left-sided catheterization provides access to the aorta, left ventricle, and left atrinm. Right-sided catheterization enables the right side of the heart, coronary sinus, pulmonary arteries, and pulmonary wedge position to be reached. Left-sided catheterization is used for coronary angiography and ventriculography, whereas rightsided catheterization is nsed for determination of cardiac performance parameters. 

The appropriate use of invasive hemodynamic monitoring tools such as right-sided heart catheterization in patients with hypovolemic shock is controversial. 

Right and left heart catheterizations, quantitative ventilation-perfusion scanning as well as multiplegated acquisition radionuclide ventriculography are also obtained if clinically relevant (Kazerooni et al. 1995). 

Rubidium-82 myocardial perfusion images are used to study patients with myocardial ischemia or infarction. An example of this study is shown in Figure 8. Three patients with known myocardial infarction were imaged with Rb-82. Twenty millicuries of Rb-82 were administered in a 20 ml bolus in 20 sec. Data accumulated from 0-90 seconds post infusion show the blood pool as the radioactivity enters the right side of the heart, flows out to the lungs, and returns to the left side of the heart. Data accumulated from 90-300 seconds reflect uptake of Rb-82 in the myocardium as distributed by blood flow. These results by a non-invasive procedure correlated with the results of catheterized contrast x-ray studies (27,28). 

Blunt chest injury Mechanical artificial heart Atrial septal defect Ventricular septal defect Patent foramen ovale Pulmonary arteriovenous fistula Particularly with right to left shunt Catheterization, angioplasty Primary oxalosis, hydatid cyst... 

Luck JC, Engel TR. Transient right bundle branch block with Swan-Ganz catheterization. Am Heart J 1976 92 263-264. 

Sprung CL, Elser B, Schein RM, et al. Risk of right-bundle branch block and complete heart block during pulmonary artery catheterization. Crit Care Med 1989 17 1-3. 

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