Our patient was taken to the cardiac catheterization laboratory. Because she was unstable, it was decided to monitor her hemodynamics following percutaneous coronary intervention. This was accomplished by the placement of a Swan-Ganz catheter.
Swan-Ganz catheter
The Swan-Ganz catheter has an inflatable balloon at its distal end. It allows the catheter to move by normal blood flow from a peripheral vein to the pulmonary artery. Multiple ports allow for intravenous infusion and blood sampling for oxygen determination. A thermistor is used to measure cardiac output by the thermodilution technique. Right heart, pulmonary artery and wedge pressures can be measured. The latter reflects left heart filling pressures. The Swan-Ganz catheter helps to differentiate hypotension due to hypovolemia from pump failure and cardiogenic shock. The data obtained from our patient was consistent with left heart failure due to extensive myocardial ischemia.
Cath began
Our patient's catheterization began two hours after the onset of her pain one hour after the 911 call was received and forty-five minutes after arrival in the emergency department. The optimal goal of a "door-to-balloon" time is less than ninety minutes.
Ventriculogram graphic
To help understand the following left ventriculogram from a normal patient, a diagram of the left heart is shown in the right anterior oblique view. The left atrium, left ventricle and aorta are labeled. The tip of the pigtail catheter is positioned in the left ventricle. The motion of the left ventricle from diastole to systole is also indicated by the arrows.
Ventriculogram RAO view
This is a still-frame of the left ventriculogram from our patient. The tip of the pigtail catheter is in the left ventricle, where contrast material has been injected. In the study in slow motion that follows, note the hypokinesis, or decreased systolic motion, of the anterior wall and apex of the left ventricle as compared to the inferior wall. Note also that mild mitral regurgitation is now present.