What predisposing factors place patients at high risk for complications from cardiac catheterization?

Functional class: Patients classified as New York Heart Association Class IV are at 10 times higher risk than patients in Class I or II.

Severity of coronary atherosclerosis: Left main occlusive stenosis poses a 10 times higher risk than single-vessel occlusive coronary disease.

Valvular heart disease

Left ventricular dysfunction: Mortality rate is 10 times higher for patients with ejection fraction 30% compared to those with ejection fraction 50%.

Severe noncardiac disease (e.g., diabetes mellitus, renal insufficiency, peripheral vascular disease, chronic lung disease).

List some of the potential complications from a diagnostic cardiac catheterization and their frequencies.

Major Complications of Cardiac Catheterization

Death 0.1-0.2%

Myocardial infarction 0.1-0.3%

Cerebrovascular accident 0.1-0.3%

Minor, Transient, or Reversible Complications of Cardiac Catheterization

Vasovagal reactions 1.5-2.5%

Local vascular complications at access site 1-3%

Serious arrhythmias 0.3-0.5%

Allergic reaction to contrast agent 2%

Infection 0.5%

Nephropathy 0.5%

Complication rates depend on operator experience, equipment, and patient characteristics.

Describe the two most common sites of vascular access for cardiac catheterization.

Catheterization can be accomplished by introduction of catheters into the brachial or femoral artery and brachiocephalic or femoral vein. Whereas brachial artery cutdown and arteriotomy (Sones) was the original approach, the percutaneous femoral (Judkins) approach is now used most commonly. Choice of access site depends on preference and experience of the operator and the extent of peripheral vascular disease in the patient.

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