INDICATIONS FOR DIAGNOSTIC CARDIAC CATHETERIZATION IN THE ADULT PATIENT







Coronary Artery Disease

 Symptoms
  • Unstable angina
  • Postinfarction angina
  • Angina refractory to medications
  • Typical chest pain with negative diagnostic testing
  • History of sudden death


 Diagnostic Testing
  • Strongly positive exercise tolerance test
  • Early positive, ischemia in ≥ 5 leads, hypotension, ischemia present for ≥ 6 min of recovery
  • Positive exercise testing after myocardial infarction
  • Strongly positive nuclear myocardial perfusion test
  • Increased lung uptake or ventricular dilation after stress
  • Large single or multiple areas of ischemic myocardium
  • Strongly positive stress echocardiographic study
  • Decrease in overall ejection fraction or ventricular dilation with stress
  • Large single area or multiple or large areas of new wall motion abnormalities

Valvular Disease

 Symptoms
  • Aortic stenosis with syncope, chest pain, or congestive heart failure
  • Aortic insufficiency with progressive heart failure
  • Mitral insufficiency or stenosis with progressive congestive heart failure symptoms
  • Acute orthopnea/pulmonary edema after infarction with suspected acute mitral insufficiency
  • Diagnostic Testing
  • Progressive resting left ventricular dysfunction with regurgitant lesion
  • Decreasing left ventricular function and/or chamber dilation with exercise


 Adult Congenital Heart Disease

 Atrial Septal Defect
  • Age > 50 y with evidence of coronary artery disease
  • Septum primum or sinus venosus defect
Ventricular Septal Defect
  • Catheterization for definition of coronary anatomy
  • Coarctation of the aorta
  • Detection of collaterals
  • Coronary arteriography if increased age and/or risk factors are present

Other
  • Acute myocardial infarction therapy—consider primary percutaneous coronary intervention
  • Mechanical complication after infarction
  • Malignant cardiac arrhythmias
  • Cardiac transplantation
  • Pretransplantation donor evaluation
  • Posttransplantation annual coronary artery graft rejection evaluation
  • Unexplained congestive heart failure
  • Research studies with institutional review board review and patient consent

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