Iatrogenic cardiovascular complications: Part I. Semi-noninvasive procedures and diagnostic invasive procedures

This article reviews cardiac and noncardiac complications encountered with various procedures used in cardiology practice. Some of the common complica tions associated with transesophageal echocardiography are hypoxia, laryngo spasm, bronchospasm, and brady- or tachyarrhythmias. Death is a rare compli cation The overall prevalence of complications associated with external car dioversion is low. Major complications include death, cardiac arrhythmias, pulmonary edema, systemic embolism, and cerebral embolism. The main indicat ion for endomyocardial biopsy at present is to assess cardiac transplant re jection. Complications occurring mast frequently are carotid artery punctur e, arrhythmias, and conduction abnormalities. The most commonly occurring c omplications of electrophysiological studies are pneumothorax, venous throm bosis, and hypotension. Cardiac catheterization is an invaluable procedure in the assessment of patients with ischemic heart disease. Major complicati ons include vascular complications, arrhythmias, complications due to contr ast agents, and death. Central venous catheterization is used to deliver me dication and parenteral nutrition and also in the hemodynamic monitoring of patients. Local infection sepsis, noninfectious phlebitis, and catheter di slodgment are some of the more commonly occurring associated complications. Swan-Ganz catheters are indicated for the hemodynamic monitoring of critic ally ill patients. Major associated complications include pneumothorax, art erial puncture, air embolism, tracheal and esophageal puncture, arrhythmias , valvular damage, infection, thrombosis, and pulmonary infarction. The use of intra-aortic balloon pumps can be complicated by ischemia, bleeding, in traaortic balloon pump rupture, vascular complications (mainly limb ischemi a), and death. Some of the common underlying mechanisms responsible for com plications during interventional procedures are abrupt closure, no-reflow p henomenon, coronary artery spasm, distal embolization, and side branch occl usion. The use of abciximab may be associated with an increased risk of maj or bleeding. Acute profound thrombocytopenia is another potential complicat ion associated with abciximab use. Heparin usage may be associated with ble eding, thrombocytopenia, skirt necrosis, osteoporosis and hypersensitivity reactions. Some of the more common complications of thrombolytic therapy ar e bleeding, myocardial rupture, hypotension, allergic reactions, anaphylaxi s, thromboembolic complications, reperfusion arrhythmias, and splenic ruptu re.