DIAGNOSTIC CARDIAC CATH
DATE:
PT NAME:
SSN:
INDICATIONS
Age
Gender
TYPE OF PROCEDURE
Left Heart Cath
Right and Left Heart Cath
Coronary Angiography
Pacer Temp
Cardioversion
Other
PROCEDURAL COMMENTS:
DIAGNOSTIC CATH RESULTS:
PA Pressure %
RA Pressure %
PV Pressure %
PCW Pressure %
LV Function
Wall Motion
EF %
Left Ventricular pressure (EDP) %
|
Not Assessed |
Normal |
Luminal Irregularities |
Mild CAD |
Moderate CAD |
Severe CAD |
Sub-total Occlusion |
ARTERIES |
TEST | TEST | TEST |
TEST |
TEST |
TEST |
TEST |
Left Main |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
LAD |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
Circumflex |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
RCA |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
RAMUS |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
|
|
|
|
|
|
|
|
BYPASS GRAFTS |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
Left Main |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
LAD |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
Circumflex |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
RCA |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
RAMUS |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
TEST |
VALVE FINDINGS
|
|
Not Assessed |
Mild |
Moderate |
Severe |
AORTA |
Stenosis |
TEST |
TEST |
TEST |
TEST |
|
Inefficiency |
TEST |
TEST |
TEST |
TEST |
MITRAL |
Stenosis |
TEST |
TEST |
TEST |
TEST |
|
Inefficiency |
TEST |
TEST |
TEST |
TEST |
DIAGNOSIS:
RECOMMENDED THERAPY BASED ON FINDINGS:
Medication Therapy (Prescription?)
Percutaneous Intervention
Surgical Consult
Follow-up Office visit (Time Frame?)