Coronary air embolism: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The introduction of an air bubble in the coronary microcirculation can be explained by Laplace's law and may result in development of an air lock. Laplace’s law relates the pressure difference over a blood–air interface to the surface tension and the radius of the blood–air interface. The predominant mechanism is the air diffusion into the blood and surrounding tissues, leading to bubble shrinking, in wich, the severity of the cardiac impairment is related to the volume of air injected into the coronary arteries, the baseline cardiac function, and subsequent vascular responses such as vasospasm or distal air-lock. However, the size and volume of the bubbles have the most important roles in blood flow speed restoration. Furthermore, this diffusion is significantly enhanced by an increase in the mean arterial pressure and the partial pressure of oxygen in the arterial system.<ref name="Van Blankenstein-1993">{{Cite journal | last1 = Van Blankenstein | first1 = JH. | last2 = Slager | first2 = CJ. | last3 = Schuurbiers | first3 = JC. | last4 = Strikwerda | first4 = S. | last5 = Verdouw | first5 = PD. | title = Heart function after injection of small air bubbles in coronary artery of pigs. | journal = J Appl Physiol (1985) | volume = 75 | issue = 3 | pages = 1201-7 | month = Sep | year = 1993 | doi = | PMID = 8226530 }}</ref> Both conditions and also vasoconstriction may cause a division of bubbles more proximal in the vascular bed leading to more rapid dispersion of bubbles which develop a deleterious effect on the microvasculature decreasing the capillary bed space and so leading to a decrease in distal coronary blood flow.<ref name="Dib-2006">{{Cite journal | last1 = Dib | first1 = J. | last2 = Boyle | first2 = AJ. | last3 = Chan | first3 = M. | last4 = Resar | first4 = JR. | title = Coronary air embolism: a case report and review of the literature. | journal = Catheter Cardiovasc Interv | volume = 68 | issue = 6 | pages = 897-900 | month = Dec | year = 2006 | doi = 10.1002/ccd.20880 | PMID = 17086533 }}</ref> | |||
==Causes== | ==Causes== | ||
Revision as of 14:50, 22 November 2013
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Coronary Angiography | |
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General Principles | |
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Anatomy & Projection Angles | |
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Normal Anatomy | |
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Anatomic Variants | |
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Projection Angles | |
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Epicardial Flow & Myocardial Perfusion | |
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Epicardial Flow | |
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Myocardial Perfusion | |
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Lesion Complexity | |
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ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis | |
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Lesion Morphology | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]
Synonyms and keywords: Coronary artery air embolism; coronary air embolization
Overview
Coronary air embolism is a complication of coronary angiograpghy, in which there is an iatrogenic introduction of gas bubbles into the blood stream, that can be associated with high morbidity and even mortality. In this case, the signs and symptoms result from the cessation of the blood flow within the arterial segment, caused by even a small amount of bubbles, which lead to tissue ischemia from oxygen starvation and may cause cellular damage and irreversible injury. The most dangerous consequences occur in brain and heart due to their vulnerability to short periods of ischemia.[1]
Definition
The coronary air embolism is a result from the iatrogenic introduction of gas bubbles into the blood stream, an uncommon complication in the cardiac catheterization.[1]
Pathophysiology
The introduction of an air bubble in the coronary microcirculation can be explained by Laplace's law and may result in development of an air lock. Laplace’s law relates the pressure difference over a blood–air interface to the surface tension and the radius of the blood–air interface. The predominant mechanism is the air diffusion into the blood and surrounding tissues, leading to bubble shrinking, in wich, the severity of the cardiac impairment is related to the volume of air injected into the coronary arteries, the baseline cardiac function, and subsequent vascular responses such as vasospasm or distal air-lock. However, the size and volume of the bubbles have the most important roles in blood flow speed restoration. Furthermore, this diffusion is significantly enhanced by an increase in the mean arterial pressure and the partial pressure of oxygen in the arterial system.[2] Both conditions and also vasoconstriction may cause a division of bubbles more proximal in the vascular bed leading to more rapid dispersion of bubbles which develop a deleterious effect on the microvasculature decreasing the capillary bed space and so leading to a decrease in distal coronary blood flow.[1]
Causes
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History
Symptoms
Treatment
Clinical Significance
Example
 (Left Anterior Descending Artery; RAO Caudal) |
References
- ↑ 1.0 1.1 1.2 Dib, J.; Boyle, AJ.; Chan, M.; Resar, JR. (2006). "Coronary air embolism: a case report and review of the literature". Catheter Cardiovasc Interv. 68 (6): 897–900. doi:10.1002/ccd.20880. PMID 17086533. Unknown parameter
|month=ignored (help) - ↑ Van Blankenstein, JH.; Slager, CJ.; Schuurbiers, JC.; Strikwerda, S.; Verdouw, PD. (1993). "Heart function after injection of small air bubbles in coronary artery of pigs". J Appl Physiol (1985). 75 (3): 1201–7. PMID 8226530. Unknown parameter
|month=ignored (help)