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CCTA-Contraindications - PowerPoint PPT Presentation

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RADIOLOGY REPORT. 64 Detector CT P.A.C.S. Stroke Program Update Neuro Interventional Update. LightSpeed VCT 64-Slice CT Scanner. Helps us obtain the information we need to diagnose disease and life-threatening illnesses, including cardiovascular disease, chest pain and stroke.

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  • 64 Detector CT
  • P.A.C.S.
  • Stroke Program Update
  • Neuro Interventional Update

LightSpeed VCT

64-Slice CT Scanner

  • Helps us obtain the information we need to diagnose disease and life-threatening illnesses, including cardiovascular disease, chest pain and stroke.
  • The world’s first volume CT (VCT) system, captures images of a beating heart in five heartbeats, an organ in one second, and performs whole body trauma in ten seconds, more than twice as fast as conventional multi-slice CT scanners.
appropriate ct angio indications
Appropriate CT Angio Indications
  • Chest pain, intermediate pretest probability, and either
    • uninterpretable ECG or unable to exercise
    • No ECG changes and serial enzymes negative
  • Suspected anomalous coronary artery anatomy or other complex congenital heart disease
  • Evaluation of coronaries for etiology of new onset heart failure
  • Evaluation of cardiac mass, tumor or thrombus, or pericardial disease when echo, TEE or MRI technically limited
appropriate ct angio indications continued
Appropriate CT Angio Indications-continued
  • Evaluation of pulmonary vein anatomy prior to RF pulmonary vein isolation
  • Mapping of old bypass grafts prior to re-do CABG
  • Mapping of coronary veins prior to bi-V pacer implantation
  • Evaluation of aortic dissection, thoracic aortic aneurysm, or pulmonary embolus
uncertain ct angio indications
Uncertain CT Angio Indications
  • Chest pain, intermediate pretest probability of CAD, able to exercise with interpretable ECG
  • Chest pain, low or high pretest probability of CAD, no ECG changes and enzymes negative
  • Chest pain, post coronary stent or CABG procedures
  • Triple rule out (ECG and enzymes negative)
  • Detection of CAD in asymptomatic patients at moderate or high risk (Framingham)
uncertain ct angio indications continued
Uncertain CT Angio Indications-continued
  • Preoperative assessment before intermediate or high-risk noncardiac surgery (intermediate risk patient)
  • Evaluation of LV function (technically limited echocardiogram)
  • Evaluaiton of native or prosthetic cardiac valves (technically limited echo, TEE or MRI)
inappropriate ct angio indications
Inappropriate CT Angio Indications
  • Chest pain and
    • High pretest probability of CAD
    • ST elevation or positive enzymes
    • Ischemia on stress testing
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ccta contraindications
  • Atrial fibrillation (permanent or AF at the time of the study)
  • Bigeminy, trigeminy, high degree heart block
  • Severe asthma
  • Creatinine > 1.8 (eGFR < 60)
  • Failed steroid prep for contrast allergy
  • Morbid obesity (BMI > 40)
ordering physician
Ordering Physician
  • Cardiologist
  • CT surgeon
interpreting physician
Interpreting Physician
  • ACC/AJR credentialed physician
  • Interpreting physician also responsible for supervision of the study
cardiology participation
Cardiology Participation
  • Ordering Physician +/- review with radiologist
  • Interpreting Physician ( pending CPT codes )
patient preparation
Patient Preparation
  • Prior to procedure patient receives preparation packet
  • Packet includes cardiac, medical history forms, and a brief description of what to expect when having CCTA
  • Instructed to take meds in am as usual, including (especially) beta-blocker
patient preparation1
Patient Preparation
  • No caffeine for 12 hrs prior to exam
  • Metoprolol 100mg po one hour prior to study
  • Second dose of Metoprolol 50 mg if HR > 71
  • Nitro spray 1/150 gr. sl.

NTG contraindications

- allergy

- Viagra,Cialis,Levitra

target heart rate
Target Heart Rate
  • Ideal rate is < 70bpm
  • Can be done up to 80 bpm if they have a regular rhythm ( images not as good )