View source for Complications during and following cardiac catheterization

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{{WikiDoc Cardiology Network Infobox}}
Editors-In-Chief: Alexandra Almonacid M.D.[mailto:aalmonacid@partners.org] and Jeffrey J. Popma M.D.[mailto:jpopma@partners.org] 



*'''Patients at Increased Risk for Complications after Coronary Arteriography'''
**Increased Medical Risk
***Age >70 years
***Complex congenital heart disease
***Morbid obesity
***General debility or cachexia
***Uncontrolled glucose intolerance	
***Arterial oxygen desaturation
***Severe chronic obstructive lung disease
***Renal insufficiency with creatinine greater than 1.5mg/dl
**Increased Cardiac Risk
***Three-vessel coronary artery disease
***Left main coronary artery disease
***Functional class IV
***Significant mitral or aortic valve disease or mechanical prosthesis
***Ejection fraction less than 35%	
***High-risk exercise treadmill testing (hypotension or severe ischemia)
***Pulmonary hypertension
***Pulmonary artery wedge pressure greater than 25mmHg
**Increased vascular Risk
***Anticoagulation or bleeding diathesis
***Uncontrolled systemic hypertension
***Severe peripheral vascular disease	
***Recent stroke
***Severe aortic insufficiency
**Risk of Death
***Death rates: 0.08 – 0.14%
***Age : < 1 years and > 60 years
***Class IV CHF 10 x higher than I or II
***Left main 10 x higher than single vessel patients
***Screening shots, minimize the views 
***LV dysfunction <30% 10x risk compared to >50%
***Valvular heart disease
***Severe non-cardiac disease
*'''Major Complications'''
**[[Predictors of Major Coronary Complications of Coronary Angiography]]
[[Image:Predictors Major Complications_cardiac cath.jpg|frame|center|Predictors of Major Complications. Adapted from ACC/AHA guidelines for coronary angiography Scanlon et al:. JACC 33:1756, 1999]]

**Major Complications	
***Mortality
***Myocardial infarction	
***Cerebrovascular accident	
***Arrhythmias	
***Vascular complications	
***Contrast reaction	
***Hemodynamic complications	
***Perforation of heart chamber
*'''Minor Complications'''
**Uncommon (< 2 %).  
**Air embolus (0.1%)
**Ventricular arrhythmias associated can be treated with lidocaine and direct-current cardioversion.  
**Cholesterol embolization
**Nerve pain
**Lactic acidosis may develop in diabetic patients taking metformin
*'''Tips for Cardiac Catheterization'''
**Be careful with the vascular puncture method
**Always advance catheters over a guidewire around the aortic arch – keep the guidewire in place in the aorta during catheter exchanges
**Flush catheters fully with saline to avoid bubbles within the manifold or the contrast line
**Watch the arterial pressure at all time – never inject if the catheter has a damped pressure
**Make certain the catheters are co-axial 
**Make certain to demonstrate evaluate each segment of each coronary artery



[[Category:Cardiology]]
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