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      Bradycardia during Transradial Cardiac Catheterization due to Catheter Manipulation: Resolved by Catheter Removal

      case-report

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          Abstract

          Purpose. To report the resolution of bradycardia encountered during transradial cardiac catheterization through the catheter pullback technique in two cases. Case Report. A 62-year-old male and an 81-year-old male underwent coronary angiogram to evaluate for coronary artery disease and as a result of positive stress test, respectively. Upon engagement of the FL 3.5 catheter into the ascending aorta through the transradial approach, the first case developed bradycardia with a heart rate of 39 beats per minute. The second case developed profound bradycardia with a heart rate of 25 beats per minute upon insertion of the 5 Fr FL 3.5 catheter near the right brachiocephalic trunk through the right radial access. Conclusion. Bradycardia can be subsided by removal of the catheter during catheter manipulation in patients undergoing transradial coronary angiogram if there is a suspicion of excessive stretching of aortic arch receptors and/or carotid sinus receptors.

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          Risks and Complications of Coronary Angiography: A Comprehensive Review

          Morteza Tavakol, Muhammad Salman Ashraf, Sorin Brener (2012)
          Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading.
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            Coronary angiography from the radial artery--experience, complications and limitations.

            David Hildick-Smith, Martin D. Lowe, John Walsh … (1998)
            to assess the outcomes, complications and limitations of coronary angiography performed via percutaneous radial artery puncture. two hundred and fifty patients underwent diagnostic coronary angiography from the radial artery, 182 (72.8%) of whom had contraindications to the femoral approach, for example due to peripheral vascular disease (n=85), therapeutic anticoagulation (29), or failed femoral approach (17). Procedural success in this high-risk population was achieved in 231 patients (92.4%). Principle reasons for failure were unsuccessful radial access (5) and arterial spasm (5). Procedure duration (SD) for an operator's first 20 cases compared with cases thereafter (min) was 47.7 (16.7) vs. 41.5 (14.6), P=0.0004; fluoroscopy time (min) 9.7 (7.1) vs. 6.6 (5.1), P=0.0001 and procedural success 89.6% vs. 94.1%, P=ns. Complications included two deaths associated temporally with catheterisation, three cases of arterial dissection without ischaemic sequelae and one transient ischaemic attack. coronary angiography can be performed successfully from the radial artery, but this approach has limitations, which include the need to demonstrate dual palmar vascular supply, the prolonged learning phase, the procedural failure rate, patient discomfort and a demonstrable incidence of vascular and haemodynamic complications. We believe that radial coronary angiography should only be undertaken when there is a contraindication to the femoral approach.
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              Mechanisms mediating bradycardia during coronary arteriography.

              D L Eckberg, C W White, J Kioschos … (1974)
              Cardiac slowing occurring during diagnostic coronary arteriography was studied in 78 patients. Comparable degrees of slowing occurred with injections into the right and into the left coronary arteries into the contralateral artery, and with injections into the coronary artery giving rise to the sinus node artery and into the contralateral artery. Rapid intracoronary injections of isosmotic dextrose solution produced significantly less slowing than comparable injections of contrast medium. Slow injections of contrast medium produced cardiac slowing comparable to that caused by rapid injections of contrast medium. However, the cardiac slowing was significantly greater than that produced by rapid injections of dextrose solution. Inhalation of 100% oxygen did not alter the heart rate response to injections of contrast medium. Atropine produced dose-related attenuation of cardiac slowing. Bradycardia persisting after cholinergic blockade was significantly greater after injections into the coronary artery supplying the sinus node than it was after injections into the contralateral artery. Coronary arteriography produced transient, occasionally profound, arterial hypotension in 38 of 41 patients in whom arterial pressures were recorded. Arterial pressure did not change in three patients. This study suggests that the cardiac slowing which occurs during coronary arteriography in man is due primarily to a cholinergic reflex which may be a human counterpart of the Bezold-Jarisch reflex, observed heretofore only in experimental animals. This slowing appears to be mediated primarily by receptors sensitive to contrast medium, rather than by changes of coronary artery pressure, and secondarily, by direct depression of sinus node function by contrast medium.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Vasc Med
                Journal ID (iso-abbrev): Case Rep Vasc Med
                Journal ID (publisher-id): CRIVAM
                Title: Case Reports in Vascular Medicine
                Publisher: Hindawi
                ISSN (Print): 2090-6986
                ISSN (Electronic): 2090-6994
                Publication date (Print): 2017
                Publication date (Electronic): 1 March 2017
                Volume: 2017
                Electronic Location Identifier: 8538149
                Affiliations
                1Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
                2Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
                Author notes

                Academic Editor: Jaw-Wen Chen

                Author information
                http://orcid.org/0000-0003-0568-2816
                http://orcid.org/0000-0001-8468-4996
                http://orcid.org/0000-0002-0142-6260
                Article
                DOI: 10.1155/2017/8538149
                PMC ID: 5350482
                SO-VID: 9d8db2c1-d5b5-410a-a8ee-c28e7ba4e015
                Copyright © Copyright © 2017 Maheedhar Gedela et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 September 2016
                Date revision received : 6 February 2017
                Date accepted : 23 February 2017
                Categories
                Subject: Case Report

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