Diagnostic cardiac catheterization findings and implications for anesthesiologists

Cardiac catheterization finding	Implications for the anesthesiologist
Coronary anatomy	Knowledge of the coronary anatomy (right versus left dominance or codominance) and stenotic coronary lesions allows the anesthesiologist to better interpret intraoperative events such as ischemic ST-segment changes detected with ECG monitoring or LV RWMAs detected with TEE monitoring.
Pulmonary artery pressure	The presence and severity of pulmonary hypertension and the resultant degree of RV compromise influence decisions regarding whether a PAC should be inserted to monitor PAP and cardiac output and whether pulmonary vasodilator agents should be prepared, and also influence preparation of specific inotropic agents.
Right atrial pressure and cardiac output	An elevated RAP with reduced cardiac output indicates severe RV dysfunction and increased risk of intraoperative RV failure (eg, due to direct myocardial depressant effects of anesthetic agents; RV ischemia caused by systemic hypotension; or increased RV impedance caused by acute increases in PAP due to pain, hypoxemia, or hypercarbia).
Hemoglobin saturation "step-up"	A hemoglobin saturation "step-up" indicates a left-to-right heart shunt, with possible volume overload of the right heart chambers and associated complications (eg, tricuspid regurgitation, RA enlargement and supraventricular arrhythmias, RV dysfunction, and hepatic and venous congestion). (Refer to UpToDate topics on pathophysiology of left-to-right shunts.)

ECG: electrocardiogram; LV: left ventricular; RWMA: regional wall motion abnormality; TEE: transesophageal echocardiography; PAP: pulmonary artery pressure; RV: right ventricular; PAC: pulmonary artery catheter; RAP: right atrial pressure; RA: right atrial.

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Diagnostic cardiac catheterization findings and implications for anesthesiologists