Angiogram Examples - Telling Apart between LAD and LCx

[Cardsfellow1234]

Hello all,
I am a second year Cards fellow and in certain views I have realized I have a hard time telling LAD from Cx. I am sorry if this seems too intuitive to some, would love some validation/cross checking to make sure I am interpreting this correctly. I also hear Angiogerams are tested on the boards, but more so for my own practice I want to make sure I have these down straight, I hope this discussion also helps anyone else out there like me who struggles with 3 D spatial thinking
Would appreciate any input !!!!

Example 1. Below I think is an AP view - L = LAD, C =LCx. IS this labelled correct?

Example 2: Below I think is a weird RAO Caudal View

Example 3 Below is an AP View but I am really not sure if I have labelled the LAD and Cx correct here, hence the question marks...lol

Example 4: Think below is again an RAO caudal view

Example 5: I think below is an RAO Cranial View - really not sure if this is labelled correctly

Example 6: Really not sure if below is an RAO cranial or RAO caudal view - I dont see a diaphragmatic shadow clearly which would suggest a cranial angulation

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[alphakingdom]

you clearly do not understand the views or what you are looking at/for. Cranial views should have a diaphragm shadow. The LAD usually goes vertically down on cranial views and LCx goes vertically down on caudal views. The septal perforators and the wrap around apex will give you hints it is the LAD. LCX goes along the AV groove, should see the curve of the main vessel while the OMs are usually larger branches shooting off. Pattern recognition is important. Knowing your views and landmarks is important. I think you should read/look at more pictures and understand it better. You should know LAO vs RAO and caudal vs cranial first before knowing which vessel is what.

 

[Cardsfellow1234]

With due respect, I can always tell RAO vs LAO based on location of the spine/ catheter/ direction of ribs and apex of the heart and if there is diaphragmatic shadow I know its Cranial. But sometimes despite knowing these landmarks, vessels are not always going vertically down . Also sometimes the diaphragmatic shadow is not present or obscured in a cranial view. There was no need to take that condescending tone. Some of the images I posted above do not fall neatly under those categories

 

[aafisahar]

Identifying septal perforators is key if there is ambiguity in your views.

For example, in example 3 and 4, you can see clear septal perforators marking that vessel as the LAD which you labeled as being possible circumflex. Example 5, that vessel looks more like a high diagonal than circumflex, you have the LAD marked correctly.

 

[alphakingdom]

With due respect, I can always tell RAO vs LAO based on location of the spine/ catheter/ direction of ribs and apex of the heart and if there is diaphragmatic shadow I know its Cranial. But sometimes despite knowing these landmarks, vessels are not always going vertically down . Also sometimes the diaphragmatic shadow is not present or obscured in a cranial view. There was no need to take that condescending tone. Some of the images I posted above do not fall neatly under those categories

when you described example 6, i will either assume you mistyped caudal or you didnt see the large diaphragm shadow in the picture really suggesting cranial.