AN EMERGENCY ANGIOCARDIOGRAPHY SERVICE.

Abstract

“Healing is a matter of time, but it is often a matter of opportunity.”—Hippocrates In the past decade, new angiographic technics have assumed an important and prominent place in the field of diagnostic roentgenology. These methods of examination are the responsibility of the radiologist. They challenge his willingness and competence to provide highly sophisticated vascular studies with minimum hazard to the patient. In addition, they also offer an unparalleled opportunity of increasing the stature of the radiologist as a clinician. The need for angiographic examinations in acute clinical emergencies has placed a new demand on Radiology Departments. It is now necessary to have a trained angiographic team constantly available and capable of providing emergency services. Advanced and more aggressive surgical technics, improved anesthesia, and other means of supportive therapy have made the availability of diagnostic arteriographic procedures imperative. Modern surgeons are being trained in the fields of cardiovascular surgery. The urologist must also be prepared to handle various renal vascular emergencies and the neurosurgeon cerebrovascular catastrophies such as ruptured intracranial aneurysms. The radiographic studies of the cardiovascular system which should be available as emergency procedures fall into three broad categories: those dealing with the heart, great vessels, and lungs; those concerned with cerebrovascular hemorrhage; and those having to do with visceral and peripheral arterial emergencies. Intravenous angiocardiography is a simple yet accurate method of making the diagnosis of pericardial effusion which may present with or without tamponade. Massive pulmonary emboli can be detected with ease by the intravenous method; today this problem is being pursued vigorously in centers where open-heart surgical teams are available. Infants with cyanotic heart disease who are critically ill with severe dyspnea, anoxia, and convulsions are candidates for emergency systemic-pulmonary shunt procedures or valvulotomy where severe pulmonic stenosis exists. Precise anatomic details regarding the status of the pulmonary artery or valve is essential prior to surgery and can often be secured by intravenous or selective right-heart catheter angiocardiography. The differential diagnosis of rapidly expanding thoracic aneurysms as opposed to dissecting aneurysms, and the latter as opposed to myocardial infarction often poses a dilemma. Definitive diagnosis may mean the difference between life and death. Emergency examinations in the unresponsive or incoherent patient with cerebral disease have long been an area of co-operative effort between the neurologist, neurosurgeon, and radiologist. Precise diagnosis is mandatory. The differential diagnosis of central nervous system lesions and their specific etiology determines the treatment as well as the prognosis.