Complications during and following cardiac catheterization
- 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 50%
Valvular heart disease
Severe non-cardiac disease
- 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
- 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
- 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
- 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 50%
Valvular heart disease
Severe non-cardiac disease
- 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 50%
- Valvular heart disease
- Severe non-cardiac disease
- Major Complications
Predictors of Major Coronary Complications of Coronary Angiography
- 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
- Major Complications
Mortality
Myocardial infarction
Cerebrovascular accident
Arrhythmias
Vascular complications
Contrast reaction
Hemodynamic complications
Perforation of heart chamber
- 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
- 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
- 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