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PubMedDate not supplied

Cardiac catheterization: the patients' perspective.

OBJECTIVE: To identify the patients' experience of cardiac catheterization. DESIGN: Descriptive, qualitative, phenomenologic. SETTING: Large southeastern teaching hospital with an active cardiac catheterization laboratory and research center. PATIENTS: Ten men, between 44 and 73 years of age, who had undergone their first cardiac catheterization. RESULTS: The participants described feelings of loss of control of physical and personal self; an increased fear of the unknown during the test and especially of outcomes that might affect their future; a focus on time and its relationship to complication; a need not to be alone and not to be isolated after the test; and an awareness of spiritual belief in the good of others, trusting in their competencies. CONCLUSIONS: This study suggests the need for more attention to the psychologic aspects of the test, especially to the outcomes, negative as well as positive, and how they may affect the patient.

Adaptation, Psychological↗
PubMed2003

Prospective study of bacteremia after cardiac catheterization.

Nine hundred sixty consecutive cardiac catheterization procedures were studied prospectively for the presence of periprocedural bacteremia. Overall, among 960 procedures, only 4 were associated with clinically significant bacteremia. All 4 were related to the intravenous line and none to the cardiac procedure itself. Clinically nonsignificant bacteremias were correlated with procedural duration, multiple skin punctures, use of multiple balloons, and obesity.

Adult↗
PubMed2004

A prospective, randomized trial to determine the early and late reactions after the use of iopamidol 340 (Niopam) and iobitridol 350 (Xenetix) in cardiac catheterization.

BACKGROUND: Intravascular contrast agents presently used in modern digital catheter laboratories during cardiac catheterization are superior to older agents as regards patient tolerance. There are, however, significant differences between these agents. PURPOSE: The aim of this study was to determine the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 2 contrast agents currently used during cardiac catheterization: iopamidol 340 (Niopam) and iobitridol 350 (Xenetix). METHODS: This was a prospective, randomized, double-blinded trial. Two thousand and nineteen patients undergoing cardiac catheterization received one of the following contrast agents: iopamidol 340 (Niopam) and iobitridol 350 (Xenetix). Reactions that were possibly related to the contrast agents were recorded during hospital admission (early reaction) and after discharge (late reaction) by means of a questionnaire. RESULTS: The baseline characteristics were matched in both the groups. There was no significant difference in the incidence of heat sensation experienced between the 2 groups, (p = 0.1). Early non-heat reactions occurred in 3.2% of patients receiving iopamidol 340 (Niopam) and 3.6% of those receiving iobitridol 350 (Xenetix), (p = 0.65). Electrocardiographic changes were recorded in 0.7% of patients who received iopamidol 340 (Niopam), and 2.6% of those who received iobitridol 350 (Xenetix), (p = < 0.01). Seven patients (0.8%) receiving iobitridol 350 suffered ventricular fibrillation requiring DC cardioversion compared with none in the iopamidol 340 group (p = < 0.01). Late reactions (post discharge symptoms) occurred in 13.9% of those receiving iopamidol 340 (Niopam) and 18.5% of those receiving iobitridol 350 (Xenetix) (p = 0.02). CONCLUSIONS: Iobitridol 350 (Xenetix) was associated with more ECG changes and, importantly, ventricular fibrillation, than iopamidol (Niopam). There were no features to suggest other benefits from iobitridol 350. These results suggest that iopamidol 340 is a preferable contrast agent in cardiac catheterization.

Adult↗
PubMedDate not supplied

Cardiac catheterizations: regional variations in average hospital charges.

The number of cardiac catheterizations performed in the United States increased from 299,000 in 1979 to over 900,000 in 1988. Analyses of Metropolitan Life Insurance Company claims experience for 2,788 in-hospital, diagnostic cardiac catheterizations during 1988 revealed an average total charge of $4,820 and a length of stay of 2.8 days. Substantial geographic variation in charges existed, with California reporting the highest average charge ($7,990) and Wisconsin the lowest ($3,210). As the technology, professional experience and patient outcomes improve, the proportion of uncomplicated cardiac catheterizations being performed on an outpatient basis is also increasing. This development should result in major decreases in some of the costs associated with the diagnosis of heart disease.

Ambulatory Care↗
PubMed2001

Personality and coping with a common stressor: cardiac catheterization.

The association between coping and personality was examined in a sample of 204 cardiac catheterization patients who were asked to evaluate the use of specific coping strategies used to deal with their cardiac catheterization. Personality, as measured by the NEO Five-Factor Inventory (FFI), was moderately correlated with coping measures. In multivariate analyses, after considering confounding factors, Neuroticism was positively and Extraversion was negatively related to avoidance coping and Neuroticism was negatively associated with counting one's blessings as a coping strategy. Personality was not related to either problem solving or seeking social support coping strategies for individuals experiencing a cardiac catheterization. However, important covariates were associated with coping strategies. Not being married was negatively correlated with use of seeking social support and not having a confidant was negatively related with seeking social support and positively with avoidance. These results suggest that there are specific relationships between personality and coping, but these relationships are, for the most part, moderate in persons coping with a cardiac catheterization, and that coping processes are associated with individual differences in available social resources.

Adaptation, Psychological↗
PubMed2002

Cardiac catheterization in morbidly obese patients.

The safety and findings of cardiac catheterization and coronary angiography in morbidly obese patients with suspected coronary heart disease (CHD) have not been fully examined in the modern era. From a database of 4,978 patients undergoing diagnostic cardiac catheterization, we identified 110 with morbid obesity (body mass > or = 145 kg and body mass index > or = 40 kg/m(2)). Relative to all the other patients in this database, morbidly obese patients had a lower prevalence of CHD (45% vs. 72%; P < 0.05), reflecting a higher prevalence of false positive noninvasive tests. Overall, noninvasive tests were only 75% sensitive and 39% specific for CHD in this group. Use of radial access (66%) and femoral closure devices (24%) was much more frequent in the morbidly obese cohort. Complications were no more frequent in the morbidly obese group, with major (0 vs. 0.9%) and minor (4.7% vs. 3.5%) adverse outcomes being similar to the rest of the database. We conclude that cardiac catheterization using the radial artery or a femoral closure device is a safe and effective method of evaluating CHD in morbidly obese patients. In contrast, noninvasive testing is frequently not definitive and may be misleading.

Cardiac Catheterization↗
PubMed1998

Suitability of patient education materials for cardiac catheterization.

Changes in healthcare delivery for such diagnostic procedures as cardiac catheterization have resulted in an emphasis on patient self-study, using booklets and videotapes given to them before the procedure. This transition mandates an evaluation of the appropriateness and effectiveness of these materials. The purpose of this study was to systematically assess the suitability of materials used to prepare patients for cardiac catheterization. Three videotapes and four booklets were evaluated using the Suitability Assessment of Materials instrument. Concrete objective information (procedural and sensation information) was also evaluated. Scores revealed only one video and two booklets suitable for patient education. None received a superior rating. These results suggest that some patient educational materials used to prepare patients for cardiac catheterization are unsuitable. Clinicians should augment current suitable materials to enhance their effectiveness.

Cardiac Catheterization↗
PubMed2001

One center's experience with remifentanil infusions for pediatric cardiac catheterization.

OBJECTIVE: To investigate the efficacy of a remifentanil infusion for pediatric cardiac catheterization. DESIGN: Prospective. SETTING: University hospital. PARTICIPANTS: Children undergoing cardiac catheterization (n = 55). INTERVENTIONS: All patients (age range, 2 months to 12 years) were premedicated with an oral mixture of hydroxyzine and midazolam 60 minutes before the procedure. A remifentanil infusion was initiated at 0.1 microg/kg/min before the start of cardiac catheterization. Noninvasive systolic blood pressure, heart rate, oxygen saturation (SpO(2)), respiratory rate, and sedation score were recorded before the remifentanil infusion and every 15 minutes thereafter throughout the procedure. Episodes of apnea, vomiting, pruritus, and muscle rigidity and recovery time were noted. MEASUREMENTS AND MAIN RESULTS: There were no significant changes in systolic blood pressure, heart rate, SpO(2), or respiratory rate during the procedure. The sedation scale scores at 30, 45, 60, 75, and 90 minutes of remifentanil infusion were significantly lower than the scores recorded at baseline and 15 minutes. In 23 patients, the remifentanil infusion maintained a satisfactory level of sedation, but 32 patients required additional drugs (18 received midazolam, and 14 received midazolam plus ketamine). Recovery was rapid after the remifentanil infusion was discontinued, with a mean time of 2.04 +/- 2.32 minutes to reach a recovery score of > or =5. Three patients experienced apnea after bolus doses of remifentanil, 1 patient vomited, and 1 patient complained of pruritus. CONCLUSION: In pediatric cases in which other intravenous analgesics and sedatives are contraindicated, remifentanil infusion appears to be a suitable alternative based on its associated rapid recovery and stable hemodynamics.

Anesthetics, Intravenous↗
PubMed1990

Physical examination and echo Doppler study in the assessment of femoral arterial complications following cardiac catheterization.

Femoral arterial complications following cardiac catheterization have been well recognized. The development of an inguinal mass in these patients can represent a simple hematoma, a pseudoaneurysm, or an arteriovenous fistula. The utility of the physical examination in diagnosing these complications was assessed by using the echo Doppler study for comparison. This study shows that any single clinical sign should not be used in isolation, but a constellation of physical findings can suggest the correct diagnosis.

Aged↗
PubMed1990

Aortic valve tumor: an unusual cause of coronary obstruction during cardiac catheterization.

Coronary artery obstruction during cardiac catheterization is a rare but serious complication that has been reported to occur in 0.15 to 0.5% of cases. The most common causes of intraprocedural coronary occlusion include thromboembolism, air embolism, and coronary dissection. This report describes the angiographic findings of a patient who developed chest pain with electrocardiographic evidence of myocardial ischemia due to obstruction of the right coronary artery by an aortic valve tumor.

Aortic Valve↗
PubMed2006

An incidental finding during cardiac catheterization.

Coronary artery obstruction during cardiac catheterization is rare. It is a serious complication and has been reported to occur in 0.15 to 0.5% of cases. Thromboembolism, air embolism and coronary dissection have been described as the most common causes of intraprocedural coronary occlusion. Aortic valve masses can also cause coronary obstruction. We report the case of a young woman with a complication and an incidental finding during angiographic procedure. A surgical treatment was needed.

Adult↗
PubMed1984

Increased risk of severe protamine reactions in NPH insulin-dependent diabetics undergoing cardiac catheterization.

Protamine is widely used for reversing systemic heparinization after cardiac catheterization. Although rare, major reactions to protamine that simulate anaphylaxis occasionally occur and have previously been associated only with an allergic reaction to fish. Because neutral protamine Hagedorn (NPH) insulin includes protamine, it might be anticipated that NPH insulin-dependent diabetic patients would develop sensitivity to protamine. Of 866 consecutive patients undergoing cardiac catheterization over a 20 month period, 651 received protamine for reversal of heparinization. Of these, 8.5% (56/651) were diabetics and 2.3% (15/651) were NPH insulin-dependent diabetics. During this period seven patients were observed immediately after administration of protamine to have major adverse reactions that required the administration of catecholamines. One death ensued. Of the seven major reactions, four occurred in NPH insulin-dependent diabetics and one occurred in a patient with an allergy to fish. The incidence of major protamine reactions was 27% (4/15) in the NPH insulin-dependent diabetics vs 0.5% (3/636) in those with no history of NPH insulin use (p less than .001). This represents a 50-fold increased risk of a major reaction to protamine if the patient was receiving NPH insulin. Accordingly, we recommend that diabetics on NPH insulin and patients with allergies to fish undergo cardiac catheterization without the use of protamine or, when necessary, that protamine be administered cautiously in anticipation of a major adverse reaction.

Anaphylaxis↗
PubMed1985

Tricuspid stenosis and regurgitation in rheumatic heart disease: a prospective cardiac catheterization study in 525 patients.

Cardiac catheterization (CC) was done in 525 symptomatic patients. Tricuspid regurgitation (TR) was graded from right ventricular (RV) angiography (RVA) and compared with RV indicator curves (IC). Tricuspid stenosis (TS) was diagnosed from the mean diastolic gradient (MDG). Organic (O) disease was diagnosed from TS or from thickening of the tricuspid valve (TV) on angiography. TR was found in 137 patients (26%), of whom 46 (33.5%) had additional TS. All of the patients with TS had significant TR. OTR was more frequent (70.4%) and more severe (p less than 0.0001) than functional TR (FTR). There was no difference in pulmonary artery pressure between FTR and OTR except when associated with TS. The TV was explored in 56 patients. A MDG greater than or equal to 2 mm Hg correctly predicted TS in 91% of the patients and right atrial angiography in 100% of the patients. Organic thickening of the TV was predicted in 84%.

Adult↗
PubMed1989

[Diagnosis of pulmonary hypertension by pulsed Doppler echocardiography--comparison with cardiac catheterization].

31 patients undergoing diagnostic cardiac catheterization for suspected congenital heart disease and 30 normal subjects were examined by pulsed Doppler echocardiography. Spectrum analysis of the shape of flow velocity curve and instantaneous flow velocities of the pulmonary artery during systolic period was made and their ratio calculated. The results showed that there was a remarkable difference between the flow velocity curve of pulmonary hypertension (PH) and that of normal pulmonary pressure. Combining with the characteristics of pulmonary arterial hemodynamics, a preliminary exploration was made on the mechanism of flow velocity curve changes. A ratio of flow velocities--PV% was proposed. The sensitivity and specificity for diagnosing PH with PV% were 94% and 100% respectively. There was a high correlation between PV% and pulmonary artery systolic pressure (r = -0.84) or pulmonary artery mean pressure (r = -0.82). It is concluded that PV% may eliminate many factors that influence the pulmonary artery hemodynamics and is a reliable, practical qualitative and quantitative index for diagnosing PH noninvasively.

Adolescent↗
PubMed1992

Anticoagulant effect of iohexol vs. ioxaglate during cardiac catheterization.

Contrast agent safety during cardiac catheterization (CC) may relate in part to anti- or procoagulant effect. We studied these effects in 177 patients who underwent standard CC (N=112) or percutaneous transluminal coronary angioplasty (PTCA) (N=65) and received either iohexol (N=111) or ioxaglate (N=66). Patients received either 0 or 2000u heparin for CC or 10,000u for PTCA. The groups were similar in regards to age, sex, amount of contrast used, and procedure time. Partial thromboplastin time (PTT) and activated clotting time (ACT) were both significantly increased (P less than .01) in patients who received 10,000u heparin irrespective of type of contrast agent although larger increases were seen in the iohexol group. With 2000u of heparin, ACT and PTT increased significantly (P less than .01) only in the iohexol group. PTT and ACT actually decreased to similar and significant (P less than .01) degrees after both iohexol and ioxaglate when heparin was not used. We conclude: 1) commonly used measures of anticoagulant (ACT and PTT) show greater prolongation after either 2000 or 10,000u of heparin with iohexol than ioxaglate, 2) ACT and PCT appear to shorten with both iohexol and ioxaglate if no heparin is used. This data would suggest that ioxaglate does not have an anticoagulant advantage over iohexol.

Aged↗
PubMed1988

Current complications of diagnostic and therapeutic cardiac catheterization.

Data from 2,883 cardiac catheterizations performed during an 18 month period (from July 1986 through December 1987) were analyzed to assess the current complication profile of diagnostic and therapeutic procedures. Procedures performed during the study period included 1,609 diagnostic catheterizations, 933 percutaneous transluminal coronary angioplasties and 199 percutaneous balloon valvuloplasties. Overall, the mortality rate was 0.28% but ranged from 0.12% for diagnostic catheterizations to 0.3% for coronary angioplasty and 1.5% for balloon valvuloplasty. Emergency cardiac surgery was required in 12 angioplasty patients (1.2%). Cardiac perforation occurred in seven patients (0.2%), of whom six were undergoing valvuloplasty, and five (2.5% of valvuloplasty attempts) required emergency surgery for correction. Local vascular complications requiring operative repair occurred in 1.9% of patients overall, ranging from 1.6% for diagnostic catheterization to 1.5% for angioplasty and 7.5% for valvuloplasty. Although the complication rates for diagnostic catheterization compare favorably with those of previous multicenter registries, current overall complication rates are significantly higher because of the performance of therapeutic procedures with greater intrinsic risk and the inclusion of increasingly aged and acutely ill or unstable patients.

Aged↗
PubMed1976

Bacterial endocarditis after cardiac catheterization.

Bacterial endocarditis is a rare complication of cardiac catheterization. We present the history of a patient who developed fatal, acute bacterial endocarditis following diagnostic cardiac catheterization. The implications regarding antibiotic prophylaxis and catheterization technique are discussed.

Cardiac Catheterization↗