Complications during and following cardiac catheterization

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 : 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