GLOSSARY OF TERMS AND ACRONYM EXPANSIONS FOR PERFUSION TECHNOLOGY, OPEN HEART SURGERY AND CARDIOLOGY

The following list of perfusion technology terms is offered as a service to the community by the Cardiovascular Perfusion Education Program & Life Support Departments of the Medical University of South Carolina. If you do not find the term or acronym that you are looking for, or perhaps you disagree with a definition or have coined a new term or acronym, please contact Jeffrey R. Acsell CCP with your request to include a term or abbreviation in this glossary, or for further information on a term, leave your e-mail address and you will be contacted.

Select the beginning alphabet character to search:

ABCDEFGHIJKLMNOPQRSTUVWXYZ Other Glossary Links [ ]: Symbol for concentration, usually expressed as moles per liter (M/l). [H+] = Hydrogen ion concentration

A
a-: away from, opposite AAA (triple A): abdominal aortic aneurysm AACP: American Academy of Cardiovascular Perfusion A-aDO2: alveolar arterial oxygen gradient ABCP: American Board of Cardiovascular Perfusion; the national body regulating and managing certification (CCP) of perfusion technologists abd.: abdomen ABG: arterial blood gas, a collection of pO2, pCO2, pH, BE and HB SaO2 measurements from an arterial blood sample ABO blood group system: the most important of several systems for classifying human blood used in transfusion therapy ACE: angiotensin-converting enzyme

acid: A substance which can donate H+. Large amounts are produced in the body as a by product of metabolism and to aid digestion. H2CO3 is a volatile acid that can be removed from the body as CO2 by the lungs. Nonvolatile acids such as lactic acid are produced in small amounts by metabolism and are removed by the kidneys. (the lungs excrete approximately 13,000 mEq of H2CO3 in the form of CO2 per day, the kidneys eliminate 50 - 100 mEq of nonvolatile acids per day) Excess acids are harmful to the body because they increase the [H+] which interferes with the bodys normal cellular and chemical function. acid-base balance: the maintanence of a normal level of acid and base in the blood and plasma acidemia: abnormally high level of acid in the blood, low pH (< 7.35) acidosis: a pathologic condition resulting from accumulation of acid in, or loss of base from the body ACLS: Advanced Cardiac Life Support ACT: activated clotting time ACTH: adrenocorticotropic hormone acute myocardial infarction: an acute process of myocardial ischemia with sufficient severity and duration to result in permanent myocardial damage ADP: adenosine diphosphate adventitia: the outside coat of a tissue or structure (see t. adventitia) AF bypass: aortofemoral bypass affinity: the force of attraction holding two elements together, such as hemoglobin affinity for oxygen A Fib: atrial fibrillation A Flt: atrial flutter agglutination: the process of blood cells clumping together as result of antibody interactions AI: aorticinsufficiency: aortic valvular incompetence: failure of the aortic valve to close during diastole causing back flow into the left ventricle AICD: automatic internal cardioverter/defibrillator AIDS : acquired immune deficiency syndrome; a serious, fatal condition in which the immune system is broken down by the HIV virus and does not respond normally to infections AIVR:

accelerated idioventricular rhythm A-line: arterial line alkalemia: an arterial blood pH above normal (> 7.45) due to abnormally high base to acid ratio in the blood alkalosis: a pathologic condition resulting from accumulation of base in, or loss of acid from the body allograft: tissue graft from animal of the same species, not same genotype alpha stat: ventilation scheme where the total CO2 remains constant as temperature falls and the non-temperature corrected ABG appears normal. So called because it keeps the alpha imidazole moiety of histadine in the alpha charge state. This promotes respiratory alkalosis (about 0.01465 pH units per oC rise; Rosenthal Correction Factor) in the CPB blood. ALT: see SGPT alveoli: the small, sac-like structural unit of the lung where oxygen is exchanged for carbon dioxide AMP: adenosine monophosphate AmSECT: American Society of Extra-Corporeal Technology; the largest professional organization representing perfusion technologists anaphylactic shock: a severe hypersensitivity reaction to the injection or ingestion of a substance to which the organism has been previously exposed ancrod: anticoagulant derived from Malayan pit viper venom, depletes fibrinogen aneurysm: the abnormal dilation or out-pouching of a blood vessel or ventricle anginapectoris: a clinical syndrome typically characterized by a deep, poorly localized chest or arm discomfort that is reproducibly associated with physical exertion or emotional stress and relieved promptly by rest or sublingual NTG. angiographically significant CAD: CAD is typically judged "significant" at coronary angiography if there is at least a 70 percent diameter stenosis of one or more major epicardial coronary segments or at least a 50 percent diameter stenosis of the left main coronary artery antegrade: with the normal direction of flow anti-: against, or opposed to antibody : a complex molecule produced by specialized cells in response to the presence of an antigen

anticoagulant: any agent that inhibits coagulation , see; heparin, ancrod, hirudin antigen: any substance percieved as foreign by the body that induces antibody production anxiolytic therapy: treatment to counteract or diminish anxiety A&Ox3: alert and oriented to person place and time aorta: the large single artery arising from the left ventricle carrying blood to the systemic circulation aortic: of or pertaining to the aorta aortic atresia : small or undeveloped aortic valve aortic valve: the semilunar valve separating the left ventricle from the aorta that prevents backflow of blood into the ventricle aortotomy : a surgical incision into the aorta apheresis: the separation or removal of a blood component or chemical to treat a disease or condition aPPT: activated partial thromboplastin time AR: aortic regurgitation, aortic insufficiency (AI) ARDS: adult respiratory distress syndrome; a disease process where the patient's lung fail to remove sufficient carbon dioxide and provide sufficient oxygen during ventilation ARF: acute renal failure arrhythmia: irregularity or loss of rhythm of the heartbeat ART: arterial arteriole: a small artery branching off of an artery giving rise to the capillary network arteriosclerosis: the process thickening and loss of elasticity in the walls of arteries artery: a blood vessel that carries blood away from the heart; arteries usually carry oxygenated blood AS: aortic valvular stenosis:narrowing of the normal aortic valve area causing a pressure drop across the aortic valve during ventricular systole ASA: aspirin

ASD: atrial septal defect, ASCVP: Australasian Society of Cardiovascular Perfusionists, represents all perfusionists in Australia and New Zealand ASPVD: atherosclerotic peripheral vascular disease AST: see SGOT ASV: autogenous saphenous vein ATIII: antithrombin III, an albumin cofactor that normally binds free thrombin in the blood, heparin catalyzes the anti-thrombin action of ATIII 1000 times normal atherosclerosis: a form of arteriosclerosis in which atheromas containing cholesterol, lipoid material and lipophages are formed within the intima and inner media of large and medium-sized arteries ATN: acute tubular necrosis:ischemic damage to the tubule cells of the kidney causing renal failure ATP: adenosine triphosphate atrial: of or referring to the atrium or atria atrialization: appearing or becoming atrial like atrium: a chamber affording entrance to another structure or organ; r. atrium the upper right cardiac chamber that receives blood from the venae cavae and delivers blood to the right ventricle l. atrium the upper left cardiac chamber that receives blood from the pulmonary veins and delivers blood to the left ventricle (pleural form is atria) ATS: autotransfusion system; an extracorporeal circuit designed to collect a patient's shed blood during a surgical procedure and reinfuse the blood back to the patient; blood may be collected by pre-donation, intraoperative salvage or post operative wound drainage autograft: tissue graft from self autologous: referring to self, or tissue coming from the self autoregulation: the ability of an organ system to dilate or constrict the arteriols that enter it in order to control the blood flow to the organ to meet it's metabolic needs AV: 1. atrioventricular; 2. aortic valve; 3. arterio venous AVA:

aortic valve area AVB: atrio-ventricular block AV canal: atrioventricular canal AV node: atrioventricular node AVG: aortic valve gradient AVR: aortic valve replacement; open heart surgery to replace a diseased aortic valve with a prosthetic, artificial valve

B
base: a substance capable of accepting or binding a hydrogen ion (H+) in a chemical reaction; The bicarbonate ion [HCO3-] is the most important base in the body. base excess (BE): a measurement of the total acid base ratio; the difference between the actual blood buffer concentration and the normal blood buffer concentration, reflects mainly the [HCO3-] in the plasma compaired with the expected [HCO3-]. BB: blood buffer , the sum of all of the plasma and RBC blood buffer systems: bicarbonate, hemoglobin, phosphate and proteins that serve to prevent changes in the pH of the blood BBB: bundle branch block beta blocker (beta-adrenergic blocking agent): a drug that blocks the effect of catecholamines, producing a decrease in heart rate and oxygen demand in the myocardium bicarbonate [HCO3-]: the most common base found in the plasma and RBC BiVAD: bi-ventricular assist device; the use of two blood propulsion devices or ECCs to assist the failing right and left ventricles blood volume: the amount of blood circulating throughout the body in the vascular system Blood Gas (ABG): Laboratory test that usually includes the pH, pO2, pCO2, Total CO2, HCO3-, BE, Hb Saturation, HCT, and possibly the K+, Ca++, and Glucose. Normal Adult Values: Source HWD ZWD arterial 7.35-7.45 7.38-7.42 venous arterial 35-48(mmHg) 38-42(mmHg)

pH pCO2

MUSC Lab 7.350-7.450 7.320-7.420 35-45(mmHg)

pO2

venous arterial venous

[HCO3 [K+] serum + [Na ] serum [Cl ] serum

41-51(mmHg) 80-100(mmHg) 25-40(mmHg) 23-28(mEq/L) 22-26(mEq/L) 22-26(mEq/L) 3.4-5.3(mEq/L) 136-146(mEq/L) 95-105(mEq/L)

Horace W. Davenport, The ABC of Acid-Base Chemistry (sixth edition) The University of Chicago Press 1974 Zagelbaum, Welch, Doyle. Basic Arterial Blood Gas Interpretation. Little Brown and Company 1988

BLS: basic life support BMR: basal metabolic rate bohr effect: the influence of carbon dioxide on the affinity of hemoglobin to bind with oxygen, increasing the carbon dioxide level decreases the affinity of hemoglobin for oxygen BPG: bypass graft BPM: beats per minute bronchioles / bronchi: the tubes or airways for the lungs that lead from the trachea to the alveoli BSA: body surface area (usually in square meters) BSBE: breath sounds bilateral and equal BTBV: beat to beat variability BT Shunt : Blalock-Taussig Shunt . BQ: blood flow buffer: a chemical system that prevents change in concentration of another chemical substance; a substance which acts in a solution to resist any change in pH of the solution when acid or base is added; the combination strong acid and a week conjugate base. Percentage of Buffers in Whole Blood Hemoglobin & Oxyhemoglobin 35%

Phosphate Plasma Proteins Total non-bicarbonate Plasma Bicarbonate RBC Bicarbonate Total bicarbonate -

5% 7% 47% 35% 18% 53% TOTAL BUFFER 100%

BUN: blood urea nitrogen bundle branch block: An ECG change characterized by an intraventricular conduction delay affecting the left ventricular wall and septum. Acute occurrences most commonly result from myocardial ischemia. BVH: biventricular hypertrophy

C
CABG: coronary artery bypass graft CABRI: coronary artery bypass revascularization investigation CAD: coronary artery disease calcium channel blocker: drug that blocks entry of calcium into cells and inhibits the contractility of smooth muscle, resulting in dilation of blood vessels and reduction in blood pressure cannula(e): tubes or catheters placed in the great vessels or cardiac chambers to allow decompression or selective propulsion of blood flow to the structure or vessel capillaries: the smallest blood vessels in the body that connect arterioles and venules (CO2)carbon dioxide: a colorless, odorless nonflammable produced in respiration, and given off by the tissue to the blood carbonic acid(H2CO3): an weak acid resulting from the reaction of H20 and CO2 to form H2CO3 which dissociates into H+ and HCO3carbonic anhydrase : an enzyme found primarily in the kidney and red blood cells that accelerates the reversible reaction of H20 and CO2 to form H2CO3cardiac: of or referring to the heart cardiac mortality:

death due to cardiac cause cardiac catheterization: passage of a catheter into the heart through a blood vessel leading to the heart for the purpose of measuring intracardiac pressure abnormalities, obtaining cardiac blood samples, and/or imaging cardiac structures by injection of radioopaque dye cardiac output: the volume of blood displaced by the left ventricle over one minute cardiac index: cardiac output normalized to body surface area or body weight cardiogenic shock: failure to maintain blood supply to the tissues because of inadequate cardiac output, such as may be caused in myocardial infarction cardiomegaly: hypertrophy of the heart cardiomyopathy: a general diagnostic term designating primary myocardial disease cardioplegia: 1. interruption of myocardial contraction, as by use of chemical compounds or cold in cardiac surgery 2. a solution infused into the heart to interrupt myocardial contraction cardiopulmonary: pertaining to the heart and lungs cardiopulmonary bypass : use of an extracorporeal circuit to circulate blood around the heart and lungs cardiopulmonary resuscitation: an emergency measure to maintain a person's breathing and heartbeat when they have stopped as a result of myocardial infarction, trauma, or other disorder. cardiotomy: 1. surgical opening in the heart 2. component of extracorporeal circuit serving as a reservoir for blood carotid: referring to the large arteries in the neck carrying blood to the brain and scalp catecholamine : any of a group of sympathomimetic amines (including dopamine, epinephrine, and norepinephrine) cath: catheterization CAVH: continuous arterio-venous hemofiltration CBC: complete blood count CCP: Certified Cardiovascular Perfusionist; the professional credential for the certified perfusion technologist CCSC: Canadian Cardiovascular Society Classification CCU: coronary care unit

cerebral: referring to the cerebellium or brain CHD: congenital heart disease CHF: congestive heart failure cholesterol : chol, a monatomic alcohol found in animal fats and oils, bile, blood , brain tissue, milk, egg yolk, myelin sheaths of nerves, liver, kidneys and adrenal glands, increased blood levels of which are a risk factor for the development of coronary artery disease chronic obstructive pulmonary disease (COPD): group of conditions in which the patient has an expiratory airflow obstruction such as chronic bronchitis or emphysema CI: 1. cardiac index, 2. confidence interval circ art: circumflex artery CK: creatinine kinase clot: see thrombus CMV: cytomegalovirus CO: cardiac output c/o: complaining of coag: coagulation coar/Ao: coarctation of the aorta colloidal osmotic pressure (COP) : the osmotic force due to the presence of proteins or other large molecular weight substances co-morbidity: concomitant but unrelated pathologic or disease process,usually used to indicate coexistence of two or more disease processes. compensation: the process where one acid base imbalance offsets another imbalance in an effort to bring the pH back within normal limits. Ex. metabolic acidosis with a [HCO3-] less than 22 mEq/L causes tachypnea causing a pCO2 less than 35 mmHg (respiratory alkalosis) congestive heart failure : failure of the heart to maintain adequate circulation of blood. COP: colloidal osmotic pressure COPD: chronic obstructive pulmonary disease

cor: heart coronary : encircling in the manner of a crown; especially to the arteries of the heart,and by extension, to pathologic involvement of them coronary sinus: the opening into the right atrium to which the veins of the left coronary circulation drain coronary artery bypass graft : vein or artery grafted surgically to permit blood to travel from the aorta to a branch of the coronary artery at a point past an obstruction. coronary artery disease (CAD): Although a number of disease processes other than atherosclerosis can involve coronary arteries, in this guideline the term CAD refers to the atherosclerotic narrowing of the major epicardial coronary arteries. coronary thrombus: blood clot that obstructs a blood vessel of the heart coronary stenosis: narrowing or constriction of any arteries, orifices or chambers leading into or from the heart C/P: cardiopulmonary CPB: cardiopulmonary bypass CPK: creatine phosphokinase CPR: cardiopulmonary resuscitation Cr: creatinine Cr cl: creatinine clearance CRF: chronic renal failure CRI: chronic renal insufficiency cross-matching: the mixing of a donor's blood with a potential recepient's blood to test for compatibility cryoprecipitate: the thin white layer obtained from freezing and thawing blood CTICU: cardiothoracic intensive care unit CVP: central venous pressure cx: circumflex artery CXR: chest x-ray

D
D1 or D2: diagonal branch of the LAD artery D5W: dextrose 5% in water DBP: diastolic blood pressure D/C: discontinue / discharge Defib: defibrillate DHCA: deep hypothermic circulatory arrest dialysis : the process of separating crystalloids and colloids in solution by the difference in their rates of diffusion through a semipermeable membrane, used to remove metabolites and toxins from body fluids diastole : referring to the period of time during relaxation of the ventricle(s) DILV: double inlet left ventricle DIC: disseminated intravascular coagulapathy; an abnormal process that occurs when clot formation and clot lysis occurs simultaneously in the microcirculation diffusion : the spontaneous mixing of the molecules of two or more substances from an area of high concentration to low, resulting from random thermal motion: it's rate is proportional to the concentrations of the substances and increases with the temperature DKS: Damus-Kaye-Stansel DM: diabetes mellitus DORV: double outlet right ventricle DOLV: double outlet left ventricle DOE: dyspnea on exertion DVT: deep venous thrombosis dx: diagnosis dyspnea : shortness of breath, difficulty breathing

EAST: Emory Angioplasty Study Trial ECA: external carotid artery ECC: extra-corporeal circulation (or circuit); the propulsion of blood outside the body to perform an artificial organ function ECCO2R: extra-corporeal carbon dioxide removal; the agressive removal of carbon dioxide from a portion of the venous blood before it enters the right atrium to provide support to a patient in respiratory failure ECD: endocardial cushion defect ECG : electrocardiogram ECHO: echocardiogram echocardiography: the process of reflecting ultrasound doppler signals off the heart and surrounding anatomical structures to visualize cardiac activity and structure, and acilitate diagnosis ECMO: extracorporeal membrane oxygenation; the process of propelling blood outside the body (often in neonates, or newborns) to perform artificial ventilation of the blood with a blood oxygenator that allows for diffusion of oxygen and carbon dioxide across a continuous membrane material separating gas and blood ECT: Extracorporeal Circulation Technology; the study of maintaining blood flow outside the body to perform artificial organ(s) functions -ectomy: to surgically excise EEG: electroencephalogram EF: ejection fraction; the percent of the left ventricular volume that is ejected in one cardiac contraction; stroke volume divided by ventricular end-diastolic volume ejection fraction (EF): the percent of the left ventricular volume that is ejected in one cardiac contraction; stroke volume divided by ventricular end-diastolic volume EKG: electrocardiogram embolus: a small solid particle or gas bubble that is carried in the blood flow stream; (plural is emboli) EMT: 1. emergency medical transport; 2. emergency medical technitian

endothelium : the monocellular lining of blood vessels, heart and lymphatic system erthrocyte : a mature red blood cell that contains molecular hemoglobin erythropoiesis: the process by which the bone marrow produces red blood cells and other cellular elements ET: endotrachial tube exercise tolerance testing: stress test, a diagnostic test in which the patient exercises on a treadmill, bicycle, or other equipment while heart activity is monitored by an ECG. extracorporeal: outside the body extravascular: outside the vascular system, or fluid that is contained in the interstitial space

F
FFP: fresh frozen plasma; the non-cellular component of donor blood that is removed and frozen for later transfusion to treat hypocoagulable states FTT: failure to thrive fibrin : the insoluble protein formed in the blood to produce clot by the action of thrombin on fibrinogen fibrinogen : the protein produced in the liver, present in the blood that is the precursor to fibrin in the clotting process fistula: a duct or other passage formed surgically or by the imperfect closing of a wound or abscess and leading either to the body surface or to another holow organ AV fistula - a fistula connecting an artery and vein bypassing the capillary bed, often surgically placed in patients undergoing renal dialysis FiO2: fraction of inspired oxygen, the percent concentration of oxygen in the gas entering the lungs, ventilator or a blood oxygenator

G
GEA : gastroepiploic artery GI: gastrointestinal GME:

gaseous microemboli; a small embolus of gas that is carried in the blood flow stream great vessels: the large arteries and veins arising from the heart and pericardium GTT: glucose tolerance test

H
H+: hydrogen ion, also known as a proton haldane effect: the influence of oxygen on the affinity of hemoglobin to bind with carbon dioxide, increasing the oxygen level decreases the affinity of hemoglobin for carbon dioxide [HCO2-]: bicarbonate ion concentration in mEq/L. The bicarbonate ion is the most important base in the body. The amount of HCO2- in the blood is expressed in mEq/L and is regulated by the kidneys. The kidneys regulate the [HCO2-] by increasing or decreasing the resorption of HCO2- in the renal tubule. The HCO2- is the metabolic component of the acid-base balance. The normal [HCO2-] is maintained between 22 - 26 mEq/L with a mean of 24 mEq/L hct: hematocrit HCTZ: hydrochlorothiazide, (type of diuretic) hematocrit : the percent of the blood which is cellular elements, normally 35 - 43 % hemo-: referring to blood hemoconcentration: the process of removing fluid and electrolytes from the blood to increase the concentration of hemoglobin and red blood cells hemodialysis: the separation of waste products from the blood by osmosis across a semipermeable membrane hemodilution: the decrease in the concentration of hemoglobin and red blood cells in the blood hemodynamic instability: i nstability of the blood pressure. hemoglobin : the red pigmented complex protein found in the red blood cells that functions to carry oxygen and carbon dioxide hemolysis : the freeing of hemoglobin from the inside of the red blood cell by normal breakdown or mechanical destruction hemostasis : the cessation of bleeding through normal coagulation or by surgical procedure

Henderson - Hasselbach equation: pH = pK + log [HCO2-]/[CO2d][H2CO3] pH = pK + log [HCO2-]/(0.03 * pCO2) (The carbon dioxide solubility coefficient 0.03 converts pCO2 in mmHg to mm/L, the pK is 6.10 at 37oC). Relates the ratio of the metabolic component to the respiratory component. heparin : a negatively charged polysaccharide normally found in lung or gut mucosa that naturally prolongs the time it takes blood to clot by catalyzing antithrombin III hepatic : pertaining to the liver hepatitis: inflammation of the liver usually caused by a virus transmitted by contact or blood transfusion hepatomegaly: enlargement of the liver heterograft: see xenograft heterologous: referring to a different species, or tissue coming from a different species heterothermic: cold blooded; poikilothermic; animals whose body temperature changes with the environment Hgb: hemoglobin hirudin : coagulation inhibitor isolated from leeches, inhibits thrombin without requiring ATIII HIV: human immunodeficency virus; a retrovirus that converts RNA to DNA and inserts it in the host cell, and is responsible for the fatal disease AIDS HLHS : hyperplastic left heart syndrome; congenital defect characterized by atretic underdeveloped or absent left ventricle HMD: hyaline membrane disease H/O: history of homeostasis: the maintanence of a normal state of balance in a physiologic system homeothermic: warm blooded; animals whose body temperature are maintained within a narrow range by its metabolic processes homograft: see allograft homologous: referring to the same species, or tissue coming from the same species HR: heart rate

HTN: hypertension Hx: history hydrogen ions (H+) ion produced when hydrogen looses an electron, a proton, the ions released when an acid is placed in solution such as in water or plasma hyper: above normal hypercapnea : a measurement of an abnormally high CO2 level in the blood, pCO2 > 45 mmHg hypercholesterolemia : excessive cholesterol in the blood. hyperlipidemia: excessive quantity of fat (cholesterol and triglycerides) in the blood. hyperthermia: temperature above normal hypertrophiccardiomyopathy: disease of the myocardium produced by the enlargement of the cells of the myocardium; often the result of increased oxygen demand in ischemic heart disease. hypertrophy : enlargement or overgrowth of an organ or part due to increase in seze of its constituent cells. hypervolemia : blood volume increase above normal hypo: below normal hypoperfusion : decreased blood flow to an organ or tissue such as in shock hypotension : decrease of systolic and diastolic blood pressure below normal. hypothermia : temperature below normal hypovolemia: decreased blood volume below normal hypoxemia: reduction of oxygen level in the blood below normal hypoxia : reduction of oxygen level in tissues below normal

I
IABP: intra-aortic balloon pump ICA: internal carotid artery ICS:

intercostal space ICU: intensive care unit IDDM: insulin dependent diabetes mellitus immune system: the system of blood cells and chemicals that protects the body from invasion by foreign organisms; the system that produces antibodies in response to antigens in situ: in place, but isolated in a living organism intima: an innermost structure (see tunica intima) in vitro: in the laboratory or in the test tube outside a living organism in vivo: within a living organism interstitial: between cells; the space in the tissues between cells outside the vascular system intra-aortic balloon pump : Use of a balloon attached to a catheter inserted through the femoral artery into the descending thoracic aorta for producing alternating inflation and deflation during diastole and systole, respectively. intra-coronary stenting: use of a prosthetic metal device to provide and maintain an enlarged coronary lumen at the site of an obstructive atherosclerotic plaque. I&O (I/O): intake and output ischemia: the need for oxygen exceeds the supply of oxygen leading to tissue cellular damage and possible death or necrosis ischemic heart disease: a form of heart disease whose primary manifestations result from myocardial ischemia due to atherosclerotic CAD. isthmus: a narrow connection between two larger bodies or parts IV: intravenous IVC: inferior vena cava IVCD: interventricular conduction defect

J
JVD: jugular venous distention

K
Konno: Surgical procedure to treat patients with congenital aortic stenosis.

L
KVO: keep vein open

L
LA LA: left atrium LAD: left anterior descending coronary artery LBBB: left bundle branch block LDH: lactate dehydrogenase left ventricular function: function of the main pumping chamber of the heart (left ventricle) that receives blood from the left atrium and pumps it out into the general circulation through the aortic valve. left main (LM) disease: stenosis of the left main (LM) coronary artery. LIMA : left internal mammary artery LLL: left lower lobe LM: left main coronary artery. LV: left ventricle LVH: left ventricualr hypertrophy lysis: destruction or decomposition, as of a cell or other substance

M
MAP: mean arterial pressure MB: cardiac muscle

mec: meconium media: middle,(see tunica media) mediastinum : The mass of tissues and organs separating the sternum in front and the vertebral column behind, containing the heart and its large vessels, trachea, esophagus, thymus, lymph nodes, and other structures and tissues metabolic: refers to the process of the chemical reactions at the tissue level metabolic acidosis: abnormal physiological process characterized by the primary gain of strong acid or primary loss of bicarbonate from the extracellular fluid. Reflected by a low [HCO3-] and low pH. (HCO3- less than 22 mEq/L) Treat by increasing perfusion of tissues and give NaHCO3. metabolic alkalosis: mbnormal physiological process characterized by primary gain of strong base or loss of strong acid. Reflected by a high [HCO3-] and high pH. (HCO3greater than 26 mEq/L) Normally no need to treat. MI: 1. mitral insufficiency; back flow or regurgitation of flow through the mitral valve during ventricular systole 2. myocardial infarction MICU: medical intensive care unit milliequivalent: one thousandths of an equivalent: An equivalent is the amount of a substance (mg or mM) that can enter into a reaction with one mole of hydrogen ions, or replace one mole of H+ in the reaction (gram molecular weight/valence). mitral : referring to the bicuspid valve separating the left atrium and ventricle to prevent back flow into the atrium during ventricular systole mitral regurgitation : abnormal systolic back flow of blood from the left ventricle into the left atrium, resulting from imperfect closure of the mitral valve mitral stenosis : mitral valvular stenosis;narrowing of the normal area of the mitral valve causing a pressure drop across the valve during left ventricular filling modified ultrafiltration : hemoconcentration of patients blood, post bypass prior to decannulation, using the extracorporeal circuit for blood access mole: the gram molecular weight of any substance, which always contains 6.023 X 1023 molecules of that substance. The number of molecules of a substance in one gram molecular weight of the substance. one mole of hydrogen ions, or replace the H+ in the reaction (gram molecular weight/valence). MR: mitral regurgitation MS:

1.mitral stenosis 2. multiple sclerosis MUF: modified ultrafiltration MUGA: multiple gated acquisition test; a radionuclide test of myocardial performance multivessel disease: disease in two or more of the coronary arteries MV : mitral valve MVR: mitral valve repair, or replacement; open heart surgery to repair or replace a diseased mitral valve with a prosthesis or artificial heart valve myocardial ischemia: condition in which oxygen delivery to and waste removal from the myocardium falls below normal levels with oxygen demand exceeding supply. myocardial infarction (Ml): damage to the heart muscle caused by occlusion of one or more of the coronary arteries. myocardium : the muscular wall of the heart located between the inner endocardial layer and the outer epicardial layer.

N
necrosis : death of individual cells or groups of cells, or of localized areas of tissue NHLBI: National Heart, Lung, and Blood Institute NIDDM: non-insulin dependent diabetes mellitus nitrate: a drug whose metabolites produce a relaxation of vascular smooth muscle, causing dilation of the veins, reducing preload and myocardial oxygen demand. nitrogen: chemical element at. no. 7, symbol N, molecular N2. It forms about 78% of the atmosphere and 78% of dissolved gas in the blood N/G: naso gastric NICU: neonatal intensive care unit NKA: no known allergies NKDA: no known drug allergies non-Q-wave myocardial infarction: myocardial infarction that is not associated with the evolution of new Q waves on the ECG.

npo: nothing by mouth NSR: normal sinus rhythm NTGNTG: nitroglycerin

O
OHDC: oxyhemoblobin disassociation curve obtuse marginal: branches of the circumflex coronary artery OM1 OM2: obtuse marginal osmosis: the passage of pure solvent from a solution of lesser to one of greater solute concentration, when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent osmotic pressure : the negative pressure created by a dissolved non-diffusable substance across a membrane permeable to solvent but not to the solute ostia: opening -otomy: to make a surgical opening into oxygen : chemical element at. no 8, symbol O, molecular O2; an odorless, colorless gas that is essential to all plants and animals for respiration oxygenator : an artificial device that functions like the lung to exchange oxygen and carbon dioxide with the blood

P
P50: hemoglobin P50, the partial pressure of oxygen where hemoglobin is 50% saturated with oxygen, normally about 27 mmHg PA: pulmonary artery PAC: premature atrial contraction PaO2 : the partial pressure exerted by O2 dissolved in arterial (a) plasma and RBC water,(in the venous blood - PvO2) PFO: patent foramen ovale

PaCO2 : the partial pressure exerted by CO2 dissolved in arterial (a) plasma and RBC water, (in the venous blood - PvCO2) palliative: to relieve the symptoms of without fixing or repairing the underlying condition partial pressure : the pressure exerted by a gas dissolved in plasma and RBC water, for example pO2 is the partial pressure exerted by dissolved oxygen pCO2 : The partial pressure (tension) exerted by CO2 in mmHg. The respiratory component. Carbon dioxide (CO2) is produced by metabolism and carried by the blood to the lungs where it diffuses into the alveoli and is eliminated by exhaled breath. The amount of CO2 dissolved in the blood is measured by the partial pressure it exerts and is reported in mmHg. When CO2 dissolves in H2O it combines to form H2CO2 (carbonic acid) the most important acid in the body. The [H2CO2] is directly proportional to the CO2 dissolved in the blood (paCO2) and the paCO2 is a measurement of the ventilation status of the patient. Therefor the paCO2 is known as the respiratory component of the acidbase balance. As with pH, the body maintains the pCO2 within strict limits. The normal pCO2 is 35 - 45 mmHg with a mean of 40 mmHg. PCWP: pulmonary capillary wedge pressure PDA: 1. patent ductus arteriosus 2. posterior descending artery PE: 1. pulmonary embolus 2. pulmonary edema 3. peripheral edema percutaneous transluminal coronary angioplasty (PTCA): percutaneous transluminal coronary angioplasty; compression of an athromatous lesion by inflating an intracoronary balloon catheter to dilate the vessel PERLA: pupils equal and reactive to light and accommodation perfusion : 1. flowing over or through; 2. blood flow through the organs and tissues of the body; 3. the profession of the study and implementation of blood flow through an extracorporeal circuit for life support perfusion scan: a test to determine the status of blood flow to an organ. perfusion balloon angioplasty: a variation of PTCA in which a catheter is inserted in the artery that permits blood flow during balloon inflation. perfusionist : see perfusion technologist perfusion technologist:

perfusionist; the health professional educated to operate the heart lung machine and other life support devices peri-: surrounding, around pericardium : the tough non-elastic membrane surrounding the heart that attached to the great vessels and other anatomical structures in the mediastinum pericarditis : inflamation of the pericardium pH : the inverse log of the hydrogen ion activity; a measure of the alkalinity or acidity of the blood or solution on a 14 point scale with 1 being acidic and 14 being alkaline. The body normally maintains the [H+] and therefor the pH within very strict limits. Normal pH is 7.35 - 7.45 with a mean of 7.40. PH2 O: water vapor pressure, the partial pressure exerted by the presence of water vapor phagocyte : a white blood cell that engulfs and distroys foreign organisms and debris in the blood pharmacologic stress test: a test of heart function during intentional drug-induced stress. pH stat : ventilation scheme where the total CO2 increases as the temperature falls and the temperature corrected ABG appears normal. So called because the temperature-corrected, actual blood pH equals 7.40 during all temperatures of CPB PI: pulmonary insufficiency PICU: pediatric intensive care unit PJC: premature junctional contractions pK: a constant that describes the rate or degree to which a chemical reaction goes to completion, depending on temperature and pH plasma free hemoglobin: hemoglobin released from dying or damaged red blood cells plasma : the acellular, colorless liquid portion of the blood plasmin : the substance found in the blood that digests fibrin resulting in clot dissolution plasminogen : the precursor to plasmin that is activated by tissue plasminogen activator (TPA) platelet : thrombocyte; PND: paroxysmal nocturnal dyspnea pO2:

partial pressure of oxygen; Oxygen is used by the body as a metabolic substrate to produce energy. A constant supply of oxygen is needed to maintain living tissue. 21% of the air we breath is oxygen and at sea level it exerts a pO2 of ~159 mmHg. The air is taken into lungs with each inhalation and moved into the alveoli where the pO2 is ~100 mmHg. The O2 diffuses into the blood and dissolves in the plasma where it exerts a pO2 of ~95 mmHg. In normal arterial blood with a pO2 of ~95 mmHg the blood is ~98% saturated with oxygen. The oxygen is carried to the tissue by the blood and by the time the venous blood returns to the lungs it has a pO2 of ~40 mmHg and is ~75% saturated. The paO2 is assessed on the ABG to provide a measure of the arterial oxygenation. poikilothermic: cold blooded; heterothermic; animals whose body temperature changes with the environment polycythemia : a serious condition characterized by too many red blood cells in the circulation pooled platelets: platelets collected from multiple donors and mixed together for use in transfusion post-Ml angina: angina occurring from 1 to 60 days after an acute MI. PR interval: ECG PR segment, interval of time between the P wave and the R wave on the ECG prime (pump): 1. to fill the extracorporeal circuit with fluid; 2. the fluid that is required to initially fill and debubble the extracorporeal circuit before connection to the patient's vascular system prinzmetal's angina: variant angina, a clinical syndrome of rest pain and reversible ST-segment elevation without subsequent enzyme evidence of acute MI. In some patients, the cause of this syndrome appears to be coronary vasospasm alone often at the site of an insignificant coronary plaque, but a majority of patients with variant angina have angiographically significant CAD. PS: pulmonary valvular stenosis; PT: prothrombin time, protime PTCA: percutaneous transluminal coronary angioplasty; PTT: partial thromboplastin time pulmonary : referring to the lung or the bicuspid valve separating the right ventricle and the pulmonary artery to prevent back flow into the ventricular during diastole pulmonary edema: condition, usually acute, but sometimes chronic, where fluid builds up in the lungs. This often occurs as a response to left ventricular failure in ischemic heart disease, hypertension, or aortic valve disease. pulmonary atresia :

small or undeveloped pulmonary valve pulmonary insufficiency : pulmonary valvular incompetence; back flow or regurgitation of flow through the pulmonary valve during ventricular diastole pulmonary stenosis : pulmonary valvular stenosis; narrowing of the normal area of the pulmonary valve causing a pressure drop across the valve during left ventricular systole pump: 1. the blood propulsion device included in the extracorporeal circuit to replace the left ventriclar function 2. slang for the heart pumptech: 1. slang for the technologist that is a perfusionist 2. a technician that is responsible for operating heart lung machine durring surgery 3. a member of the 'pump team' PV : pulmonary valve PVC: premature ventricular contraction PVD: peripheral vascular disease PVR: 1. pulmonary vascular resistance; resistance to the flow of blood through the pulmonary vascular beds 2. peripheral vascular resistance; resistance to the flow of blood through the peripheral vascular beds 3. pulmonary valve repair, or replacement; open heart surgery to repair or replace a diseased pulmonary valve with a prosthesis or artificial heart valve valve

Q
QIP: quality improvement process

R
RA: right atrium radionuclide test: A diagnostic test in which a radioactive substance is injected into the bloodstream and the emitted radioactivity is detected by a scanner; used to visualize the heart and vessels. RBBB: right bundle branch block RBC : red blood cell; erythrocyte

RCA: right coronary artery renal: referring to the kidney(s) renal failure: failure of the kidney to cleanse the blood causing the build up of waste products in the blood respiration : the chemical processes that occur at the tissue cellular level converting oxygen and water to heat, ATP and carbon dioxide respiratory acidosis: an abnormal physiological process in which there is a primary reduction in alveolar ventilation relative to the rate of CO2 production. Reflected by a high pCO2 and low pH. (pCO2 greater than 45 mmHg) Treat by increasing ventilation. respiratory alkalosis: an abnormal pyhsiological process in which there is a primary increase in the rate of alveolar ventilation relative to the rate of CO2 production. Reflected by a low pCO2 and high pH. (pCO2 less than 35 mmHg) Treat by decreasing ventilation. re-stenosis: the recurrence of a stenosis retrograde: against the normal direction of flow revascularization : restoration, to the extent possible, of normal blood flow to the myocardium by surgical or percutaneous means or with removal or reduction of an obstruction as occurs when CABG or PTCA is performed RH: relative humidity Rh: rhesus monkey factor RHD: rheumatic heart disease RIMA: right internal mammary artery RISC: Research Group on Instability in Coronary Artery Disease Risk: high, intermediate, and low risk in this guideline refer to the probability of future adverse cardiac events, particularly death or MI. RITA: Randomized Intervention Treatment of Angina RM: Right Main Coronary Artery RRR: regular rate and rhythm RV: right ventricle RVH:

right ventricular hypertrophy Rx: therapy or treatment

S
SA node: sinoatrial node SBP: systolic blood pressure SCOPA: South Carolina Organ Procurement Agency sed. rate: erythrocyte sedimentation rate SEM: systolic ejection murmur SGOT : serum glutamic oxaloacetic transaminase (AST) SGPT : serum glutamic pyruvic transaminase shock : acute peripheral circulatory failure due to derangement of circulatory control or loss of circulating fluid, marked by hypotension, coldness of skin, usually tachycardia, and often anxiety; decreased cardiac output; sinus node : bundle of excitatory tissue found in the right atrium that functions as the pacemaker of the heart Sinus of Valsalva : the portion of the aortic root just distal to the aortic valve containing the coronary ostia sO2: percent saturation of hemoglobin with oxygen, in the arterial blood - SaO2, in the venous blood - SvO2 solubility: the ability of a gas to dissolve into plasma and RBC water S tach: sinus tachycardia stenosis : a narrowing or blockage of a coronary artery STICU: surgical trauma intensive care unit sublingual: beneath the tongue. supraventricular arrhythmia: an irregular heart beat that originates in the atria or AV node. SV: a device placed in an vessel to keep it open, coronary stent SV: stroke volume

SVCSVC: superior vena cava SVG: saphenous vein graft SVO2: mixed venous oxygen saturation SVR: systemic vascular resistance ([MAP-CVP]/CO) SV tach: supraventricular tachycardia systole : referring to the period of time during contraction of the ventricle(s)

T
TAPVR: total anomalous pulmonary venous return TEE: transesphogeal echocardiography, a doppler echocardiographic transducer is inserted in the esophogus to visualize the lungs, heart and great vessels technician: a person highly skilled in a certain field or process technologist: a person who applies scientific knowledge in a specialized field or process temperature correction: The mathematical process to correct for the physical changes that pH, pO2, pCO2 go through when a blood sample is warmed or cooled in vitro during analysis. tetralogy of fallot (TOF): congenital heart condition characterized by; 1. over riding aorta, 2. VSD, 3. RV outflow tract obstruction and, 3. PDA, if ASD is present the condition is called a "pentology of fallot" TGA: transposition of the great arteries thebesian veins: the small veins terminating into the right sided chambers of the heart draining the right coronary circulation of the heart thrombocytopenia: abnormal decrease in number of the blood platelets. thrombocyte : platelet; the small, disc shaped enucleated body found in the blood that initiates the coagulation process thrombolytic therapy: Pharmacologic treatment with a class of drugs that can break up fibrin blood clots. thrombus : blood clot, blood that has gone from a liquid state to a gel to stop bleeding tricuspid atresia : small or undeveloped tricuspid valve

TI: tricuspid insufficiency TM: thrombolysis in myocardial infarction TIA: transient ischemic attack TOF: tetralogy of Fallot total CO2 content: consists of HCO3-, H2CO3, and dissolved CO2 (pCO2). (Since CO2 and H2CO3 are interchangable) total CO2 = dissolved CO2 gas + HCO3-. or total CO2 = HCO3- + (0.03 * pCO2). (The CO2 solubility coefficient, 0.03, converts pCO2 in mm/L to meq/L) In normal plasma, more than 95% of the total CO2 is contributed by HCO3-, the other 5% by dissolved CO2 and H2CO3. TPA: tissue plasminogen activator; a substance that converts plasminogen to plasmin to dissolve clot TR: tricuspid regurgitation trans-: across or through transcutaneous : through the skin transfusion : the injection of whole blood or blood products into the blood stream transvenous pacemaker: cardiac pacemaker using a pacing electrode or wire passed through a vein into the chambers of the heart that stimulates and maintains a normal heart rate; may be permanent or temporary triage: screening and classification of sick, wounded, or injured persons to determine priority of need and proper place of treatment tricuspid valve: the valve between the right atrium and the right ventricle TS: tricuspid stenosis; stenosis of the tricuspid valve tunica: in anatomy, a general term for a membrane or other structure covering or lining a body part or organ t. adventitia the outer coat of various tubular structures including blood vessels t. intima the innermost coat of a blood vessel t. media the middle coat of a blood vessel TV : tricuspid valve

U
UAC:

umbilical artery catheter UO: urine output ultrafiltration: the separation of fluid and electrolytes from the blood by seiving across a porous membrane unstable angina: angina or chest pain that occurs at rest, new onset of pain with exertion, or pain that has accelerated (more frequent, longer in duration, or lower in threshold).

V
VA: Veterans Administration VAD: ventricular assist device; a blood propulsion devices or ECCs to assist the failing right or left ventricles valvuloplasty : surgical repair of a cardiac valve valvulotomy : to make an incision into a diseased and stenosed cardiac valve to increase the valve area variant angina: prinzmetal's angina, a clinical syndrome of rest pain and reversible STsegment elevation without subsequent enzyme evidence of acute MI. In some patients, the cause of this syndrome appears to be coronary vasospasm alone often at the site of an insignificant coronary plaque, but a majority of patients with variant angina have angiographically significant CAD. vasa vasorum: the small blood vessels providing nutrient blood flow to large arteries and veins vascular : pertaining to blood vessels or indicative of a copious blood supply vasoconstrict: the arterioles decrease in diameter restricting blood flow to an organ or portion of the body vasodilate: the arterioles increase in diameter allowing more blood flow vein : a blood vessel that carries blood toward the heart; veins usually carry deoxygenated blood vena cava (e): the large vein(s) collecting the venous return from the head, neck and shoulders (superior vena cava) and the legs and gut (inferior vena cava) draining into the right atrium of the heart ventilation : the movement of gas in and out of the lungs to facilitate blood oxygenation and carbon dioxide removal

ventricle : a small cavity or chamber, as in the brain or heart right v. the lower chamber of the right side of the heart, which pumps venous bloood through the pulmonary trunk and arteries to the capillaries of the lung left v. the lower chamber of the left side of the heart, which pumps oxygenated blood out through the aorta to all the tissues of the body ventriculography: a procedure for visualization of ventricles of the heart by x-ray after injection of a radio opaque contrast dye. V fib: ventricular fibrillation Von Willebrand Disease : coagulation disorder caused by lack of or non functional Von Willebrand Factor VSD: ventricular septal defect V tach: ventricular tachycardia VWF: Von Willebrand Factor

W
WBC: white blood cell(s), leukocyte(s); neutrophils, basophils, esonophils, monocytes, and lymphocytes WNL: within normal limits

X
XC: cross clamp xenograft : tissue taken from another species, treated and implanted

Y
Y Connector: bifurcation junction resembling alphabet "Y" used for dividing or merging the flow through two pieces of tubing

Z Other Glossary Links

Case Report - Stenting With Intravenous Abciximab Infusion from Journal of Invasive Cardiology

Case Report
A 67-year-old female patient complained of exertional precordial chest pain with radiation to the left shoulder occurring over a two-month period. The pain was aggravated by minor activities, such as household chores or walking, and relieved by rest. The frequency and severity of the chest pain had been increasing during the past 2 months with the last episode of chest pain lasting for 1 hour on the morning of admission. The patient was admitted to our hospital under the impression of unstable angina. She had a 20-year medical history of hypertension. Diabetes mellitus had been diagnosed 5 years ago. The patient had been on antihypertensives and oral hypoglycemic medications for 2 months. Her echocardiogram (ECG) on admission revealed a symmetrical T-wave inversion in the precordial leads from V1 to V5 (Figure 1). Since the value of CK-MB and Troponin-T were slightly elevated up to 7.38 ng/ml and 1.83 ng/ml, respectively (normal values: 0-5 ng/ml and 0-0.1 ng/ml, respectively), acute non-Q wave anterior myocardial infarction was diagnosed. Figure 1. (click image to zoom) Echocardiogram on admission revealed symmetrical T-wave inversion in the precordial leads from V1 to V5.

On the third day of admission, coronary angiography revealed two-vessel disease with 73% luminal narrowing of the proximal left anterior descending coronary artery (LAD) (Figure 2) and 50% luminal narrowing of the mid-right coronary artery (RCA). It was decided to perform PTCA with stenting of the proximal LAD lesion. Following predilatation with a 3.5 x 20 mm Omnipass balloon (Cordis Corporation, Warren, New Jersey), the 3.5 x 16 mm NIR stent (Boston Scientific/Scimed Inc., Maple Grove, Minnesota) could not be passed into the lesion. Angiography showed acute thrombus formation at the left main coronary artery (Figure 3) and the patient developed severe sudden chest pain with ST-segment elevation in leads Ia, aVF, V5 and V6, which degenerated into ventricular fibrillation (Figures 4A and 4B). The patient was immediately defibrillated and an intra-aortic balloon pump was inserted thereafter. After defibrillation, follow-up angiography revealed that the thrombus embolized into the proximal LAD and the proximal left circumflex artery (LCX) (Figure 4C). Abciximab infusion was started while a coronary stent (4.0 x 17 mm MAC) was successfully deployed at the left main coronary artery. Follow-up angiography showed residual stenosis at the proximal LAD and thrombotic occlusion of the distal intermediate branch. Another MAC stent (3.5 x 17 mm) was successfully deployed in the proximal LAD. After deployment of the two stents, vital signs were stable and the patient was transferred to the Coronary Care Unit with no complaints of chest pain. The activated clotting time during the procedure was 230 seconds. We performed coronary angiography using Xenetics (Guerbet S.A., France), a non-ionic contrast agent. After the procedure, the CK-MB was elevated to 393 mg/dL.

Figure 2. (click image to zoom) Coronary angiography revealed diffuse irregular 73% luminal narrowing of the proximal left anterior descending coronary artery. Figure 3. (click image to zoom) After predilation with a 3.5 x 20 mm Omnipass balloon catheter, the stent was still unable to be passed into the lesion. Follow-up angiography revealed a large thrombus formation in the left main coronary artery.

Figure 4. (click image to zoom)(A) The patient developed sudden severe chest pain with ST elevation at leads II, aVF, V5 and V6, (B) which degenerated into ventricular fibrillation. (C) Coronary angiography revealed that the thrombus embolized into the proximal left anterior descending coronary artery and proximal left circumflex artery. One day after the procedure, follow-up coronary angiography revealed patent stents in the left main and proximal LAD with a remaining thrombotic occlusion of the distal intermediate branch (Figure 5A) and ECG revealed a right bundle branch block with precordial T-wave inversion (Figure 5B). The patient was discharged 7 days after PTCA without chest pain and dyspnea. Follow-up ECG 3 months after discharge revealed that the precordial T-wave inversions were normalized (Figure 6).

Figure 5. (click image to zoom)(A) One day after percutaneous transluminal coronary angioplasty with stenting, a follow-up coronary angiography revealed the patent stents of the left main coronary artery and proximal left anterior descending coronary artery with remaining thrombotic occlusion of the distal intermediate branch; (B) an echocardiogram revealed a right bundle branch block with precordial T-wave inversion. Figure 6. (click image to zoom) A follow-up echocardiogram performed three months after discharge revealed that the precordial T-wave inversion was normalized.

Complete Summary GUIDELINE TITLE

Diagnostic coronary angiography.

BIBLIOGRAPHIC SOURCE(S)
Finnish Medical Society Duodecim. Diagnostic coronary angiography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2006 Jan 25 [Various]. [18 references]

GUIDELINE STATUS
This is the current release of the guideline. This guideline updates a previous version: Finnish Medical Society Duodecim. Coronary angiography and indications for CABG or angioplasty. In: EBM Guidelines. Evidence-Based Medicine [CD-ROM]. Helsinki, Finland: Duodecim Medical Publications Ltd.; 2004 Sep 14 [Various]

COMPLETE SUMMARY CONTENT

SCOPE METHODOLOGY - including Rating Scheme and Cost Analysis RECOMMENDATIONS EVIDENCE SUPPORTING THE RECOMMENDATIONS BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS IMPLEMENTATION OF THE GUIDELINE INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES IDENTIFYING INFORMATION AND AVAILABILITY DISCLAIMER

SCOPE

DISEASE/CONDITION(S)
Coronary heart disease, with or without angina pectoris

GUIDELINE CATEGORY
Diagnosis Management

CLINICAL SPECIALTY
Cardiology Family Practice Internal Medicine

INTENDED USERS
Health Care Providers Physicians

GUIDELINE OBJECTIVE(S)
Evidence-Based Medicine Guidelines collects, summarizes, and updates the core clinical knowledge essential in general practice. The guidelines also describe the scientific evidence underlying the given recommendations.

TARGET POPULATION
Patients with angina pectoris Patients without angina pectoris in whom angiography may be indicated or considered

INTERVENTIONS AND PRACTICES CONSIDERED

Coronary angiography

MAJOR OUTCOMES CONSIDERED

Not stated Top^

METHODOLOGY

METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources) Hand-searches of Published Literature (Secondary Sources) Searches of Electronic Databases

DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The evidence reviewed was collected from the Cochrane database of systematic reviews and the database of abstracts of reviews of effectiveness (DARE). In addition, the Cochrane Library and medical journals were searched specifically for original publications.

NUMBER OF SOURCE DOCUMENTS

Not stated

METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Levels of Evidence A. Strong research-based evidence. Multiple relevant, high-quality scientific studies with homogenic results. B. Moderate research-based evidence. At least one relevant, high-quality study or multiple adequate studies. C. Limited research-based evidence. At least one adequate scientific study. D. No research-based evidence. Expert panel evaluation of other information.

METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses Systematic Review

DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

COST ANALYSIS
A formal cost analysis was not performed and published cost analyses were not reviewed.

METHOD OF GUIDELINE VALIDATION

Peer Review

DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated Top^

RECOMMENDATIONS

MAJOR RECOMMENDATIONS
Aims To determine the extent of anatomic coronary artery obstruction when coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) is considered. To evaluate difficult diagnostic problems in patients with unstable angina, survival of sudden death, atypical chest pain.

Indications in Patients with Angina Pectoris (AP) Severe stable AP resistant to medication Occlusion of left anterior descending artery (LAD) or a 3-vessel disease is suspected on the basis of an exercise tolerance test (also when the symptoms are mild) Ischaemic ST (>2 mm) with minimal load and low heart rate Deficient rise in blood pressure (BP) during exercise test AP after acute myocardial infarction Pain at rest or when walking while the patient is still in the hospital AP and severe heart failure (myocardial stunning) ST-depression outside the infarction area during exercise Unstable AP resistant to medication AP following PTCA In cases of rapidly recurring AP after CABG, if PTCA may be considered.

Indications in Patients without AP

Angiography may be indicated or considered: In patients accepted for heart surgery (e.g., valve prosthesis) In survivors of ventricular fibrillation without myocardial infarction (MI) When the exercise electrocardiogram (ECG) changes are clearly pathological In acute pulmonary oedema without evident cause When ECG after a T-wave infarction (non-Q-wave infarction) shows long lasting and wide T inversions in anterior wall leads When MI is diagnosed with biochemical markers while ECG is normal

As a diagnostic method in special situations (e.g., when symptoms are atypical, or when left bundle branch block [LBBB] and left ventricular hypertrophy [LVH] disturb the interpretation of the exercise test)

CLINICAL ALGORITHM(S)
None provided Top^

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

Concise summaries of scientific evidence attached to the individual guidelines are the unique feature of the Evidence-Based Medicine Guidelines. The evidence summaries allow the clinician to judge how well-founded the treatment recommendations are. The type of supporting evidence is identified and graded for select recommendations (see the "Major Recommendations" field). Top^

BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

POTENTIAL BENEFITS
Appropriate use of coronary angiography to diagnosis the extent of coronary artery obstruction before coronary bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA)

POTENTIAL HARMS
Not stated Top^

IMPLEMENTATION OF THE GUIDELINE

DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided. Top^

INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

IOM CARE NEED

Getting Better

IOM DOMAIN
Effectiveness Top^

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)
Finnish Medical Society Duodecim. Diagnostic coronary angiography. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2006 Jan 25 [Various]. [18 references]

ADAPTATION
Not applicable: The guideline was not adapted from another source.

DATE RELEASED
2001 Apr 30 (revised 2006 Jan 25)

GUIDELINE DEVELOPER(S)
Finnish Medical Society Duodecim - Professional Association

SOURCE(S) OF FUNDING
Finnish Medical Society Duodecim

GUIDELINE COMMITTEE
Editorial Team of EBM Guidelines

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Primary Authors: Editors

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS
This is the current release of the guideline. This guideline updates a previous version: Finnish Medical Society Duodecim. Coronary angiography and indications for CABG or angioplasty. In: EBM Guidelines. Evidence-Based Medicine [CD-ROM]. Helsinki, Finland: Duodecim Medical Publications Ltd.; 2004 Sep 14 [Various]

GUIDELINE AVAILABILITY
This guideline is included in "EBM Guidelines. Evidence-Based Medicine" available from Duodecim Medical Publications, Ltd, PO Box 713, 00101 Helsinki, Finland; email: info@ebm-guidelines.com; Web site: www.ebm-guidelines.com.

AVAILABILITY OF COMPANION DOCUMENTS

None available

PATIENT RESOURCES
None available

NGC STATUS
This summary was completed by ECRI on August 28, 2001. The information was verified by the guideline developer as of October 26, 2001. This summary was updated by ECRI on December 9, 2002. This summary was verified by the developer on April 2, 2003. This summary was updated by ECRI on February 21, 2005, and March 15, 2006.

COPYRIGHT STATEMENT
This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Top^

DISCLAIMER

NGC DISCLAIMER
The National Guideline Clearinghouse (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities. Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx. NGC, AHRQ, and its contractor ECRI make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. Readers with questions regarding guideline content are directed to contact the guideline developer.

Definition of Coronary angiography

Coronary angiography: The most accurate method (the "gold standard") for evaluating and defining coronary artery disease (CAD). Coronary angiography is used to identify the exact location and severity of CAD. During coronary angiography, a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery in the groin or the arm. Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with x-ray images) is injected into each coronary artery. The images that are produced are called the angiogram. Angiographic images accurately reveal the extent and severity of all coronary arterial blockages. Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not terribly uncomfortable. The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm is sutured, "sealed," or treated with manual compression to prevent bleeding. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of an experienced physician, this risk is quite small (well below one per cent). In patients for whom the test is appropriate, the therapeutic information learned from the coronary angiogram is far more valuable than the relatively small risk of the procedure. For patients with severe angina or myocardial infarction, or those who have markedly abnormal noninvasive tests for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty, coronary stenting, atherectomy ("roto-rooter"), or coronary bypass surgery.

The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions.

Glossary
Here are definitions of medical terms related to heart attack. Adrenaline: One of the chemical messengers in the body that causes the heart to beat faster. Angina: Term for choking pain (Latin, throat pain or choking). When coupled with the word 'pectoris' (Latin, of the chest), angina refers to a painful, constricting sensation in the chest. Angina is caused by coronary artery disease, which reduces the supply of blood to the heart muscle. Angioplasty: The reconstruction of damaged blood vessels. Coronary angioplasty is an operation to enlarge a narrowed coronary artery. Aorta: Great artery that arises from the left ventricle (pumping chamber) of the heart and is the starting point of the body's arterial system. Arrhythmia: Disturbance of the heart's normal rhythm. Arteries: Blood vessels that carry blood away from the heart and around the body. Arteriography: Procedure used to make an x-ray picture (arteriogram) of an artery or arterial system after injecting a contrasting dye into the blood stream (see coronary angiography). Atheroma: Bulging yellow mass or "plaque" that forms within the walls lining the arteries. Atheromas (Italian, porridge) contain a mix of fatty and fibrous scar tissue and, when deposited on the inner wall of an artery, reduce its inner diameter. Atherosclerosis: Gradual build-up and hardening of atheromas within the arterial walls. Atria: The two upper chambers of the heart (the left atrium and the right atrium), which take in blood flow from the veins. Atrial fibrillation: A condition in which the heartbeat is irregular and often unusually rapid. Atrial flutter: A condition in which the upper chambers of the heart contract rapidly, but the heart rhythm is regular. Balloon angioplasty: Widening of an artery performed by passing a catheter with a tiny balloon attached to the end of a catheter, up an artery to the site of the blockage. The baloon is inflated against the arterial wall widening the

sessel as the blockage is flattened. (also known as percutaneous transluminal coronary angioplasty [PTCA]). Bradycardia: A slow heart rate (less than about 50 beats per minute). Cardiac catheterization: Insertion of a catheter (fine tube) into an artery in the forearm or groin and snaking it through the blood vessels until it reaches the coronary arteries. This procedure is used during coronary angiography. See also coronary angiography. Coronary angiography: Procedure used to make an x-ray picture (angiogram) of the heart's blood vessels after injecting a contrasting dye into the blood stream. Coronary angioplasty: See angioplasty Coronary artery: Artery that delivers blood to the heart. The three major coronary arteries are the left anterior descending artery, left circumflex artery, and the right coronary artery. Coronary artery disease (CAD): Narrowing of the arteries that supply the heart (also known as coronary heart disease [CHD] and ischemic heart disease [IHD]). The coronary arteries become blocked by atheromas that form within the walls lining the arteries. Echocardiography: A noninvasive test that uses sound waves to produce images of the heart on a monitor. Electrocardiography (ECG): Procedure used to measure the electrical activity of the heart muscle. It provides information about how the heart functions. The record produced by ECG is known as an electrocardiogram. Exercise tolerance (stress) test: Procedure used to measure the heart's response to exercise (also known as a stress test). During exercise tolerance testing, the individual is asked to ride a stationary bicycle or walk on a treadmill while a physician takes an electrocardiogram. See also electrocardiogram. Fibrillation: Rapid, uncoordinated contraction (squeezing) of the heart muscle. Heart block: A condition in which the impulses from the heart's upper chambers are delayed or blocked from reaching the lower chambers. Lipids: Group of fatty substances that are stored in the body and can be measured in the blood; they include high-density lipoproteins (HDL; "good cholesterol"), low-density lipoproteins (LDL; "bad cholesterol"), and triglycerides, among other compounds.

Myocardial infarction (MI): Death of tissue in the heart muscle; a "heart attack." Myocardial ischemia: Insufficient blood in the heart muscle. Pacemaker: An electrical device that delivers electrical impulses to produce a heartbeat of desired frequency. Implantable pacemakers are the mainstay of treatment for bradycardia, and are also useful for some tachycardias. Palpitations: Awareness of the heart beating; the heartbeat may feel fast, slow, forceful, or irregular. Pericarditis: Inflammation of outer covering of the heart. Percutaneous transluminal coronary angioplasty (PTCA): See balloon angioplasty. Pneumothorax: The presence of air or gas in space that holds the lungs. Plaque: See atheroma. Prinzmetal's angina: See variant angina pectoris. Stress test: See exercise tolerance test. SVTs (supraventricular tachycardias): Fast heartbeats that originate above the ventricles (in the atria, AV node, or both). Tachycardia: The term used to describe a rapid heartbeat of greater than 100 beats per minute. Variant angina pectoris: Angina caused by spasm (sudden contraction [squeezing response]) of the smooth muscle within the coronary arteries (also known as "Prinzmetal's angina," or angina inversa). Variant angina occurs almost exclusively when a person is at rest or asleep, often between the hours of midnight and 8 am. Veins: The blood vessels that carry blood back to the heart. Ventricles: The two lower chambers of the heart (the left ventricle and the right ventricle), which pump blood out of the heart and into the arteries. Ventricular tachyarrhythmias: Fast heartbeats that originate in the ventricles.

Glossary of abbreviations used in symposium on acute coronary syndromes

TERMS

ACEI ACS ARB CABG CAD CK-MB ECG GPIIb/IIIa LMWH MI NQMI NSTE NSTE-ACS NSTEMI OR PCI QWMI STE-ACS STEMI UFH UMTG

Angiotensin-converting enzyme inhibitor Acute coronary syndromes Angiotensin II receptor blocker Coronary artery bypass graft Coronary artery disease Creatine kinase-MB Electrocardiogram Glycoprotein IIb/IIIa Low-molecular-weight heparin Myocardial infarction Non-Q-wave myocardial infarction Non-ST-segment elevation Non-ST-segment elevation-acute coronary syndromes Non-ST-segment elevation myocardial infarction Odds ratio Percutaneous coronary intervention Q-wave myocardial infarction ST-segment elevation-acute coronary syndromes ST-segment elevation myocardial infarction Unfractionated heparin Unmasked treatment group

STUDY NAMES ATACS Antithrombotic Therapy in Acute Coronary Syndromes CAPTURE c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina CREDO Clopidogrel for the Reduction of Events During Observation CURE Clopidogrel in Unstable Angina to Prevent Recurrent Events ESSENCE Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events FRISC Fragmin and Fast Revascularisation During Instability in Coronary Artery Disease GUSTO Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries ISAR-COOL Intracoronary Stenting With Antithrombotic Regimen Cooling-Off MATE Medicine Versus Angiography in Thrombolytic Exclusion MIRACL Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering PROVE ITPravastatin or Atorvastatin Evaluation and Infection TherapyTIMI Thrombolysis in Myocardial Infarction PURSUIT Platelet Glycoprotein IIb/IIIa in Unstable Angina Receptor Suppression Using Integrilin Therapy RITA Randomized Intervention Trial of Unstable Angina TACTICSTreat Angina With Aggrastat and Determine Cost of Therapy With an TIMI Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction TIMI Thrombolysis in Myocardial Infarction VANQWISH Veterans Affairs Non-Q-wave Infarction Strategies in Hospital

VINO

Value of First Day Coronary Angiography/Angioplasty in Evolving Non-ST-segment Elevation Myocardial Infarction