Complications during and following cardiac catheterization
Editors-In-Chief: Alexandra Almonacid M.D.[1] and Jeffrey J. Popma M.D.[2]
- 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
- Increased Medical Risk
- Major Complications
- Major Complications
- Mortality
- Myocardial infarction
- Cerebrovascular accident
- Arrhythmias
- Vascular complications
- Contrast reaction
- Hemodynamic complications
- Perforation of heart chamber
- Major Complications
- 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