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
• Major Complications
  • Predictors of Major Coronary Complications of Coronary Angiography

• • 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

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