RELATIVE CONTRAINDICATIONS TO DIAGNOSTIC CARDIAC CATHETERIZATION




RELATIVE CONTRAINDICATIONS TO DIAGNOSTIC CARDIAC CATHETERIZATION


1. Uncontrolled ventricular irritability: the risk for ventricular
tachycardia/fibrillation during catheterization is increased if
ventricular irritability is uncontrolled

 2. Uncorrected hypokalemia or digitalis toxicity

 3. Uncorrected hypertension: predisposes to myocardial

ischemia and/or heart failure during angiography

 4. Intercurrent febrile illness

 5. Decompensated heart failure, especially acute pulmonary
edema

 6. Anticoagulation state; international normalized ratio (INR) >1.8, femoral approach

 7. Severe allergy to radiographic contrast agent

 8. Severe renal insufficiency and/or anuria, unless dialysis is
planned to remove fluid and radiographic contrast load


IDENTIFICATION OF THE HIGH-RISK
PATIENT FOR CATHETERIZATION

 Age
• Infant: < 1 y old
• Elderly: > 70 y old

 Functional class
• Mortality ↑ 10-fold for class IV patients compared with I
and II

 Severity of coronary obstruction
• Mortality ↑ 10-fold for left main disease compared with
one- or two-vessel disease

 Valvular heart disease as an independent lesion
• Greater risk when associated with coronary artery disease
Left ventricular dysfunction
• Mortality ↑ 10-fold in patients with low ejection fraction
(< 30%)

 Severe noncardiac disease

 Renal insufficiency

 Insulin-requiring diabetes

 Advanced peripheral and cerebral vascular disease

 Severe pulmonary insufficiency

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