Catheterization cardiac

Although the use of barbiturates and miscellaneous sedatives and hypnotics for sedation has largely been replaced by the antianxiety drugs (see Chap. 30), they occasionally may be used to provide sedation before certain types of procedures such as cardiac catheterization or the administration of a local or general anesthesia Sedative doses usually given during daytime hours, may be used to treat anxiety and apprehension. Fhtients with chronic disease may require sedation, not only to reduce anxiety, but also as an adjunct in the treatment of their disease... 

Sutton AG, Finn P, Grech ED, et al Early and late reactions after the use of iopamidol 340, ioxaglate 320, and iodixanol 320 in cardiac catheterization. 

Barrett B, Parfrey P, Foley R, et al. An economic analysis of strategies for the use of contrast media for diagnostic cardiac catheterization. Med Decis Making 1994 14 325-35. 

Cardiac catheterization and coronary angiography are used in patients with suspected CAD to document the presence and severity of disease as well as for prognostic purposes. Interventional catheterization is used for thrombolytic therapy in patients with acute MI and for managing patients with significant CAD to relieve obstruction through percutaneous transluminal coronary angioplasty, atherectomy, laser treatment, or stent placement. 

Benzodiazepines have a wide array of clinical uses. In addition to relieving anxiety, they can be used to treat epilepsy, alcohol withdrawal, insomnia, agitation, and perhaps impulsivity. They can also be used as muscle relaxants or to produce conscious sedation during certain medical procedures such as cardiac catheterization and colonoscopy. 

Phenytoin, like lidocaine, is more effective in the treatment of ventricular than supraventricular arrhythmias. It is particularly effective in treating ventricular arrhythmias associated with digitalis toxicity, acute myocardial infarction, open-heart surgery, anesthesia, cardiac catheterization, cardioversion, and angiographic studies. 

Minor to major bleeding complications may occur, most commonly at arterial access site for cardiac catheterization. 

Most major bleeding occurs at arterial access site for cardiac catheterization prior to pulling femoral artery sheath, discontinue heparin for 3-4 hr and document activated clotting time (ACT) <180 sec or aPTT <45 sec achieve sheath hemostasis >4 hr before discharge... 

Other investigators reported the results of a phase II trial in which 337 patients were randomized to receive recombinant fibroblast growth factor-2 (FGF-2) or placebo during cardiac catheterization. Although the primary end point—a significant improvement in exercise tolerance... 

The current situation is exemplified by a study of clinical staff exposures in cardiac angiography at the Montreal Heart Institute (Renaud, 1992). Extensive measurements of staff exposures were made using thermoluminescent dosimeters (TLDs) for 15,000 procedures in three cardiac catheterization laboratories over a 5 y period (1984 to 1988). The TLDs were located under the protective apron at the waist and at the collar outside and above the apron. Readings were made at three-month intervals, with a minimum reportable value of 0.2 mSv. Average values (in mSv per y) for various groups of staff, based on measurements with TLDs worn at the collar, are given in Table 3.3. 

Other uses of fluoroscopy would have the potential for higher cumulative collar exposures. For example, abdominal interventional and angiography procedures typically use image intensifiers and x-ray field sizes which are larger than those used in a cardiac catheterization laboratory. Depending on the orientation of the primary beam, the scattered radiation from the patient may have greater intensity in these other clinical situations than in a cardiac catheterization laboratory. 

RENAUD, L. (1992). A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization, Health Phys. 62, 10—15. 

Chronic radiodermatitis after cardiac catheterization has been observed in a 62-year-old woman taking ciprofibrate. A second catheterization performed when she had stopped taking it did not provoke new lesions (37). 

Ischemic heart disease is the leading cause of death in the United States today (American Heart Association, 2001). In 1998, over 450,000 deaths were attributable to ischemic heart disease. This year over 1.1 million citizens will have a new or recurrent myocardial infarction. One of the consequences of non-fatal myocardial infarction is congestive heart failure (CHF), afflicting 22% of men and 46% of women surviving heart attacks over the subsequent five years. Currently, there are over 4.7 million Americans living with CHF, and these patients have a five year mortality of 50%. The mainstay of therapy for ischemic heart disease is revascularization. Nearly 2,000,000 cardiac catheterizations and 553,000 coronary artery bypass surgical procedures are performed annually (American Heart Association, 2001). 

From December 2001 through February 2003, 76 patients with a clinical indication of PCI for a de novo lesion were included in this protocol. The procedures were performed in the cardiac Catheterization Laboratories at Otamendi Hospital in Buenos Aires, Argentina (30,34). 

It is evident that during all types of cardiac catheterization (Table I) atrial fibrillation (AF) can occur and that several patients will present with preexisting AF It is the most common type of arrhythmia in adults (I), The prevalence goes from less than I % in persons younger than 60 years of age to more than 8% in those olderthan 80 years of age (2). The age-adjusted incidence for women is about half that of men. 

During cardiac catheterization, intravenous anticoagulation is given to prevent venous thrombosis and left-sided emboli. In... 

Taylor AJ, Hotchkiss D, Morse RW, et al. PREPARED Preparation for Angiography in Renal Dysfunction a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction. Chest 1998 I 14 1570-1574. 

Fang J, Eisenhauer A, Profiles in cardiomyopathy and congestive heart failure, Textbook Grossman s Cardiac Catheterization, Angiography, and Intervention. Seventh Edition, Lippincott Williams Wilkins, 2005. 

Professor of Medicine Director, Center for Interventional Vascular Therapy Director, Cardiac Catheterization Laboratories... 

Director, Cardiac Catheterization Laboratories Columbia University Medical Center New York-Presbyterian Hospital New York NY USA... 

For the appropriate development of covariate distribution models, the pharmaceutical industry has huge amount of data in their clinical databases. In addition, there are also public databases available which can be used, like the Congestive Heart Failure Database (http //www.physionet.org/) derived from patients undergoing cardiac catheterization at Duke Medical Centre during 1990-1996 (about 4000 patients, data on demographics, risk factors histories, cardiac catheterization, EKG, cardiac scores, follow-up data). 

Early 1900s Treatment of histamine shock, pellagra (niacin deficiency) and rickets (vitamin D deficiency) Electrocardiography and cardiac catheterization... 

Administration For myocardial infarction, intracoronary delivery of the drugs is the most reliable in terms of achieving recanalization. However, cardiac catheterization may not be possible in the 2 to 6 hour therapeutic window, beyond which significant myocardial salvage becomes less likely. Thus thrombolytic agents are usually administered intravenously, since this route is rapid, inexpensive, and does not have the risks of catheterization. 

As many as 20% of patients taking adequate doses of a tricyclic antidepressant experience marked postural hypotension. This effect is not consistently correlated with plasma concentrations and tolerance does not develop during treatment (35-37). The mechanism for this effect is uncertain it has been attributed to a peripheral antiadrenergic action, to a myocardial depressant effect, and to an action mediated by alpha-adrenoceptors in the central nervous system (38). Studies of left ventricular function in man are conflicting. One study of systolic time intervals showed a decrement in left ventricular function with therapeutic doses (39), while two in which cardiac function was observed directly during cardiac catheterization after overdosage showed no evidence of impaired myocardial efficiency, whereas the hypotension persisted after left ventricular filling pressures and cardiac output had returned to normal (40,41). 

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