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PubMed1986

Transient visual disturbance during cardiac catheterization with angiography.

The occurrence of visual disturbances following cardiac catheterization with angiographies was studied in a prospective study of 2,006 consecutive adult patients. The overall incidence of visual disturbances was 1.0% and of complete blindness 0.2%. Women had higher incidence than men (2.0 versus 0.6%, p less than 0.01) and patients with a history of angina pectoris with normal coronary arteries had higher incidence than those with coronary artery stenosis (3.7 versus 0.8%, p less than 0.02). Thirteen of twenty patients also had signs of mental confusion. An abnormal electroencephalogram was found in 8 of 13 patients studied. Other neurological findings were observed in one patient only. All patients had complete recovery within 24 hours. Thus, the incidence of visual disturbances is found to be higher than earlier reported, but the visual loss is transient with a benign course.

Adolescent↗
PubMed2001

Groin dressing after cardiac catheterization. Comparison between light dressing with thin transparent tape (Tegaderm) and conventional tight/pressure dressing with an elastic adhesive bandage (Tensoplast).

Post cardiac catheterization puncture site care is usually done with a tight pressure dressing by an elastic adhesive bandage (Tensoplast) due to the belief that it should prevent bleeding. The practice is uncomfortable to the patients. The authors compared a new way of dressing using light transparent tape (Tegaderm) to the conventional tight pressure one. 126 post coronary angiography patients were randomized to have their groins dressed either with Tensoplast or with Tegaderm. Patients ambulated 8 hours after the procedures. The groin was evaluated for pain, discomfort and bleeding complications. 49 per cent in the Tensoplast vs 26.9 per cent in the Tegaderm group experienced pain (p value of 0.01). 55.5 per cent in the Tensoplast group vs 11.1 per cent in the Tegaderm group reported discomfort. 4.7 per cent in the Tensoplast vs 1.6 per cent in the Tegaderm group developed bleeding or hematoma. Dressing of the puncture site after cardiac catheterization with Tegaderm was more comfortable than the conventional Tensoplast without any difference in bleeding complications.

Adhesives↗
PubMed1997

Radiation safety in the cardiac catheterization laboratory.

Over the years, permissible radiation exposure of operators working with x-ray equipment has become progressively reduced. The number of cardiac catheterizations and related interventional procedures has increased and the procedures have become more prolonged. The patient receives relatively infrequent primary radiation while the operator receives frequent but mainly secondary radiation. The operator uses protective barriers, correct positioning of the patient and careful techniques to reduce radiation exposure. The effects of radiation are cumulative and permanent. They may be stochastic or nonstochastic, and somatic and/or genetic, and onset may be delayed for many years. To minimize exposure of patient and operator, cardiologists need a better understanding of radiation physics and of cardiac x-ray equipment. Technical breakthroughs such as digital imaging, pulse fluoroscopy, reduction of frame rates from 60 or 30 frames/s to 15 frames/s, and progression to the filmless laboratory will substantially reduce radiation. This review discusses current cardiac x-ray equipment, possible future developments, radiation, and techniques for reducing radiation and improving safety in the cardiac catheterization laboratory.

Cardiac Catheterization↗
PubMed1995

Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis, and treatment. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions.

This report represents the first guidelines for prevention, diagnosis, and treatment of anaphylactoid reactions to contrast media occurring specifically during cardiac catheterization. The incidence of contrast media complications in the catheterization laboratory is 0.23% with 1 death per 55,000. Anaphylactoid reactions are nonimmune mediated, but histamine release and other mediators produce a clinical presentation indistinguishable from anaphylaxis. In patients with known previous reactions, pretreatment with steroids and diphenhydramine and the use of nonionic contrast media have significantly reduced the potential of recurrent reaction. Minor reactions such as limited urticaria may be watched for progression or treatment with diphenhydramine, whereas more serious reactions such as angioedema or laryngeal edema require airway stability and ephinephrine administration. Shock should be vigorously treated simultaneously with intravenous epinephrine and large volumes of normal saline. If the patient can be stabilized, the study should be completed as histamine, leukotrienes, and other vasoactive products should be relatively depleted.

Anaphylaxis↗
PubMedDate not supplied

Preparing adult patients for cardiac catheterization: informational treatment and coping style interactions.

OBJECTIVE: To examine the interacting effects of coping style and type of preparatory informational treatment on cardiac catheterization patient anxiety. DESIGN: Pretest-posttest randomized control group design. SETTING: Canadian, university-affiliated, large urban hospital. SUBJECTS: 145 adult patients (107 men and 38 women) scheduled for their first cardiac catheterization. Age range was from 34 to 78 years. Mean educational level was 10.72 years. OUTCOME MEASURES: Subject's coping style (monitoring [information seeking] or blunting [information avoiding]) was assessed by means of Miller's Behavioral Style Scale. Subject's anxiety was assessed by means of Speilberger's A-Trait and A-State Inventory. INTERVENTION: After coping style assessment, monitors and blunters were randomly assigned to receive one of three preparatory informational treatments: (1) videotaped procedural modeling information; (2) videotaped procedural-sensory modeling information; and (3) procedural-sensory information booklet. RESULTS: Subjects' anxiety was assessed before and after intervention (Time 1 and Time 2) and before and after catheterization (Time 3 and Time 4). Analysis of variance techniques applied to the anxiety data largely confirmed the hypothesized interaction between subjects' coping style and type of preparatory informational treatment. Monitors who received the procedural-sensory modeling video treatment and blunters who received the procedural modeling video treatment reported significant reductions in A-state anxiety at Time 2 and maintained that decrease at Time 3. In contrast, monitors and blunters who received the other preparatory informational treatments reported a significant increase in A-state anxiety or a nonsignificant change in A-state anxiety at Time 2 and Time 3. At Time 4 monitors and blunters in each of the treatment groups reported a significant decrease in A-state anxiety. CONCLUSIONS: Two unexpected findings emerged from the study: (1) female monitors and blunters reported significantly higher A-state anxiety levels than their male counter-parts at preintervention, and (2) significant differences were observed among the preintervention A-state anxiety means of male monitors in the three preparatory treatment groups. These findings limit the conclusions that can be drawn from the study but provide direction for future research in the preparatory area.

Adaptation, Psychological↗
PubMed2005

Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States, 1995--2001.

OBJECTIVE: To examine recent trends in racial and ethnic disparities in cardiac catheterization for acute myocardial infarction (AMI) to determine whether disparities documented from the 1980s through mid-1990s persist, and evaluate whether patient and hospital characteristics are associated with any observed disparities METHODS: Cross-sectional analyses of 585,710 white, 51,369 black and 31,923 Hispanic discharges from hospitals in the Nationwide Inpatient Sample (which includes data on all discharges from 951 representative hospitals in 23 states) that had performed cardiac catheterization from 1995--2001 with a primary diagnosis of AMI. Adjusted procedure rates and prevalence ratios (PR) were computed to compare catheterization rates by race and ethnicity. MEASUREMENTS AND MAIN RESULTS: Catheterization rates were higher for whites than blacks for all years examined; rates among Hispanics increased during this period and approached the rate among whites. After adjustment for age, demographics, comorbidity, year and hospital characteristics, rates (per 100 discharges) were 58.4 for whites, 50.1 for blacks (PR 0.87; 95% CI 0.84-0.91) and 55.2 for Hispanics (PR 0.95; 95% CI 0.90-0.99). CONCLUSIONS: These nationwide data suggest blacks remain less likely than whites and Hispanics to undergo catheterization during a hospitalization for AMI. Whether this disparity stems from patient or provider factors remains to be determined.

Adolescent↗
PubMed1980

Pyrogenic reactions after inadvertent infusion of endotoxin during cardiac catheterizations.

In April 1976 the attack rate of chills and fever with or without falls in blood pressure increased in association with cardiac catheterizations. Fevers were associated with coronary angiography and right and left heart catheterizations. Blood cultures were negative, and reactions did not correlate with amounts of contrast materials infused or with procedures done by a single operator. Significant numbers of Acinetobacter calcoaceticus (var. anitratus) and a Pseudomonas species were cultured from hospital-reservoir distilled water when it was flushed through a catheter before gas sterilization. This same water after ethylene oxide sterilization contained 2 x 10(5) ng/mL of endotoxin by limulus lysate test and was positive by rabbit pyrogen test. When washed reusable cardiac catheters were sterilized daily or when disposable catheters were substituted, febrile reactions ended. Pyrogenic reactions in patients undergoing cardiac catheterizations correlated with emptying retained endotoxin with injected contrast material from reused washed-sterilized catheters.

Acinetobacter↗
PubMedDate not supplied

Case report: trivalvular rheumatic stenosis: documentation of disease progression by serial cardiac catheterization.

A 56-year-old female with known rheumatic tricuspid stenosis was admitted for treatment of palpitations, abdominal discomfort and supraventricular tachyarrhythmias. Twenty years after an initial study, cardiac catheterization disclosed additional mitral and aortic stenoses. Trivalve prosthetic replacement was recommended, but cardiac arrest occurred, allowing pathologic confirmation of the hemodynamic findings. Documentation of disease progression in nonoperated multivalvular rheumatic heart disease by cardiac catheterizations over such extended intervals of time has not previously been described. Also, the clinician is warned that historical and physical signs in such cases can underplay the actual severity and extent of disease, and he should not, therefore, be misled by unimpressive findings that the valvular deformity is insignificant.

Aortic Valve Stenosis↗
PubMedDate not supplied

[Surgery in children with atrial septal defects without cardiac catheterization].

We describe the results of surgical repair of atrial septal defects in 36 children who did not undergo pre-op cardiac catheterization. These cases were seen at the Hospital de Cardiologia y Neumología Dr. Luis Méndez del Centro Médico Nacional. There were 24 (67%) females and twelve (33%) males. The mean age was 6.4 +/- 2.4 years with a range from three to thirteen. All cases had auscultatory findings typical of atrial septal defect. Five patients with associated tricuspid murmur (chest film showed grade I cardiomegaly in 21 (58.3 per cent), grade II cardiomegaly in fifteen (41.7 percent). Pulmonary artery shadow was normal in 24 (66.6 percent) and increased in twelve (33.3%). Pulmonary blood flow was increased in all of them. Electrocardiogram showed sinus rhythm in 35 (97.2%). In one instance left atrial rhythm; all EKGs demonstrated right axis deviation, complete right bundle branch block and right ventricular hypertrophy with diastolic overload. Only three had right atrial hypertrophy. The M-mode echocardiogram showed right ventricular dilatation in all and paradoxically septal motion in 26 (72.2%). Two-dimensional echo with the subxiphoid view allowed direct visualization of the defect in all cases. We performed contrast echocardiogram in eight cases and Doppler echocardiogram in six of them. Cardiac surgery findings were ostium secundum atrial septal defect in 34 (94.4%). Two of them also had partial anomalous venous connection. All had uneventful recovery. We conclude that in typical atrial septal defects operative repair is feasible without prior cardiac catheterization.

Adolescent↗
PubMedDate not supplied

A non-traditional approach to cardiac education: the use of cardiac catheterization films.

In this age of shorter hospitalization and consumer demand for more indepth knowledge concerning health state, the need for innovative strategies in cardiac education continues to be a challenge to nurses in a cost containment environment. The use of a patient's own cardiac catheterization film as an adjunctive teaching strategy has not been discussed in the literature. Our experience has shown that the use of these films leads to time efficient and highly individualized delivery of patient education which facilitates patient participation in decision making regarding medical therapy. In addition, concepts found within education theory, such as involving the learner in discussion, associating new concepts with past experiences, incorporating as many senses as possible in the learning experience, and providing content that is immediately useful, are easily incorporated when cardiac catheterization films are used. This article will discuss how an innovative non-traditional strategy may complement traditional approaches to cardiac patient education.

Cardiac Catheterization↗
PubMed2004

Risk of local adverse events following cardiac catheterization by hemostasis device use and gender.

Hemostasis devices are primarily used to stop bleeding from the femoral artery catheterization site after cardiac diagnostic or interventional procedures. Studies assessing the effectiveness of hemostatic devices compared to manual compression have produced mixed results regarding the relative risk of serious adverse events, such as hemorrhage. This study assessed the relative risk of serious complications following the use of the two main types of hemostasis devices (as compared with manual compression), and assessed the relative rates of these complications by gender.

Analysis of Variance↗
PubMed1991

Value of transesophageal echocardiography during complex or high-risk coronary interventions in the cardiac catheterization laboratory.

The increasing complexity of coronary intervention and the limitations of hemodynamic and electrocardiographic monitoring have facilitated the introduction of new imaging techniques in the cardiac catheterization laboratory. Transesophageal echocardiography (TEE) has proved valuable for left ventricular (LV) monitoring during high-risk surgery, but its reported use in the cardiac catheterization laboratory has been limited. Accordingly, we assessed the feasibility and value of TEE during complex or high-risk coronary intervention in the catheterization laboratory. The TEE probe was successfully introduced in 53 of 54 (98%) attempted cases. The primary imaging goals were LV monitoring in 39 (74%), left main coronary artery (LMCA) imaging in 9 (17%) and both in 5 (9%) cases. LV monitoring was successful in 43 of the 44 (98%) attempted cases. In 25 (58%) of these, additional important observations were made by TEE that were not apparent by symptoms, or hemodynamic, electrocardiographic or radiographic monitoring. These included unexpected changes in regional myocardial function (n = 20), alteration in LV size (n = 2), exclusion of considered pericardial tamponade (n = 2) and detection of unsuspected mitral regurgitation (n = 1). Management of the interventional procedure was directly influenced by the findings of TEE in 11 of the 43 (26%) monitored cases. The LMCA was successfully visualized in 13 of the 14 (93%) attempted cases. In 11 of these, measurement of the stenotic lesion diameter by TEE correlated well with quantitative angiography both before (r = 0.83, standard error of the estimate = 0.01, p less than 0.002) and after (r = 0.80, standard error of the estimate = 0.03, p less than 0.005) intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

Correlation between echocardiography and cardiac catheterization in assessing the severity of aortic stenosis.

The severity of aortic stenosis was assessed by echocardiography in 81 consecutive adult patients, 40 of whom underwent cardiac catheterization. The patients' mean age was 54 +/- 16.4 years. A good correlation was found between the severity of aortic stenosis assessed by cross-sectional echocardiography and cardiac catheterization. Aortic valve separation of 7 mm or less occurred only in severe aortic stenosis whereas a separation of 12 mm ruled out any significant aortic stenosis. A separation of 8-11 mm constituted a 'grey' area between mild and severe aortic stenosis. Cross-sectional echocardiography provides a reliable method for crude evaluation of aortic stenosis.

Adolescent↗
PubMed1995

Cardiac catheterization and test occlusion of the interatrial communication after the fenestrated Fontan operation.

OBJECTIVES: Our objective was to determine whether catheterization data obtained after a fenestrated Fontan operation influenced patient management or predicted functional status. BACKGROUND: Cardiac catheterization after a fenestrated Fontan operation is undertaken to identify residual lesions and to observe the patient's response to test occlusion of the baffle fenestration. METHODS: Sixty patients undergoing both a fenestrated Fontan operation before July 1991 and a postoperative catheterization before March 1992 were included in the study. Catheterization data were collected according to a test occlusion protocol; these data were reviewed, and the patient's clinical status at follow-up was ascertained. RESULTS: Test occlusion resulted in a significant increase in systemic venous pressure, arterial oxygen saturation and arteriovenous difference in oxygen content (p < 0.0001). After test occlusion, systemic venous pressure was 40% higher and systemic venous saturation 23% lower among patients with an unfavorable versus a favorable response to test occlusion, although differences between the two groups were subtle or inapparent in the baseline state. Branch pulmonary artery stenosis (identified and balloon dilated in 6 patients) and grade 2 or 3 aortopulmonary collateral vessels (identified and coil embolized in 20) were associated with elevation in systemic venous pressure (p < 0.01). After an average of 2 years of follow-up, there were no deaths, and 50 (83%) of 60 patients were in New York Heart Association functional class I. The only postoperative characteristic significantly associated with being in functional class I at follow-up was a systemic venous pressure < 17 mm Hg. CONCLUSIONS: Cardiac catheterization with test occlusion of the interatrial communication provides useful information after a fenestrated Fontan operation. Conditions associated with elevated systemic venous pressure should be sought and treated, and the response of systemic venous pressure to test occlusion should be considered when deciding whether to close an interatrial communication.

Cardiac Catheterization↗