INDICATIONS FOR DIAGNOSTIC CARDIAC CATHETERIZATION IN THE ADULT PATIENT
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
- 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
