Ischemic heart disease coronary angiography

A 64-year-old man with a history of ischemic heart disease underwent coronary angiography with 150 ml of iopromide (iodine 370 mg/ml). One hour later he had visual hallucinations (moving objects, pictures of familiar persons), which resolved about 40 hours later without any treatment. He had taken the following drugs for a year nifedipine 10 mg tds, metoprolol 50 mg bd, and aspirin 325 mg/day. His serum creatinine concentration was in the reference range and there was no history of allergies or previous exposure to contrast media. 

The block of middle fibers of LBB has to be included in the differential diagnosis of prominent R wave in VI (see Table 5.5). To make this diagnosis in patients with ischemic heart disease the involvement (ischaemia or necrosis) of lateral wall has to be rule out (coronary angiography and/or cardiovascular magnetic resonance-CMR-) (Fig. 5.64). In the case of lateral MI a positive T wave in VI is seen, and in case of block of middle fibers the T wave in VI is usually negative. 

Johnsen SP, Videbaek 1, Pedersen L, Steffensen R, Videbaek R, Niemann T, Nielsen TT, Sprensen HT. Survival trends among Danish patients undergoing coronary angiography for known or suspected ischemic heart disease a population based follow up study, 1992-2000. Heart 2006 92 27-31. 

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