You could learn more about cardiology courses with Prof. Sameh Allam by clicking on courses’ library link here:

Get the sufficient information about coronary anatomy in the second lecture in Al-Azhar Radial Course - Radial approach vs femoral for cardiac catheterization.

Learning Objectives of this course:
1- Master the essentials of a successful complex PCI by using the radial approach
2- Essential questions on radial approach and the use of the specific radial device(s)
3- Clinical case strategy and radial approach limits
4- Anatomical variations in the Radial artery
5- Master the essential steps of a successful radial procedure.

The left main coronary artery, which is divided into left anterior descending and circumflex branches, and the right main coronary artery are the major arteries of the coronary circulation.
The coronary ostia, which are situated behind the aortic valve leaflets, are where the left and right coronary arteries begin at the base of the aorta.

Elective Cardiac catheterization should be performed when comorbid conditions, such as CHF, diabetes mellitus, or renal insufficiency, are assessed, treated and became stable.
So, everybody and every patient should have a clinical history documented and a physical examination performed.

During Preliminary evaluation, the patient should be asked about:
1- Hypertension
2- Diabetes.
3- Anticoagulant
4- History of allergy to some types of drugs and contrast.
5- Anemia.

Investigations prior to card cath include many steps. The most important is:
All patients:
1- CBC
2- creatinine.
3- 12 lead ECG.
4- Blood sugar.
5- Hepatitis makers.
Some patients will help to:
1- I.N.R for patients on warfarin.
2- Chest x ray (in indicated)

Therapeutics will include:
1- Anti anginal drugs.
2- Oral antiplatelet therapy.
3- Anticoagulant therapy.

For Diabetes mellitus patients, they should be scheduled at the beginning of the list to avoid hypoglycemia. And the treatment with sulphonylurea should be omitted on the morning of the day of the procedure because it increases C.I.N.
Finally. For sure the diabetes mellitus patients should stop taking S.C insulin on the day of the procedure.

Premedication should be in the consideration too, if anxiety is overt Diazepam 5-20 mg orally given 1-1.5 hour before the procedure.
Hydrocortisone 100 mg IV or prednisone 40 mg 1x4 if the patient reports an allergy to contrast dye.

The Pre Procedure Patient Evaluation includes:
1- Procedure Indication
2- Patient Risk factors for severe ischemia:
- Long standing angina
- Multiple prior infarctions
- Markedly positive noninvasive study
3- Potential for severe LV dysfunction:
- Non invasive studies showing low ejection fraction
- History of multiple prior infarctions
- CHF
4- Concomitant Potentially complicating Diseases:
- Diabetes
- Hypertension (particularly uncontrolled or long-standing)
- Renal insufficiency
- Clotting abnormalities or bleeding tendencies
- Cerebral vascular or peripheral vascular disease
- Other significant medical conditions, e.g. anemia, acute or chronic infection, etc.
- Contrast allergy

To learn more about coronary anatomy and procedure preparations, watch this lecture and stay tuned.


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