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The haemodynamic response to ST segment changes during coronary arteriography
Insights
Contrast media during coronary arteriography can cause ST segment changes and elevated left ventricular filling pressure. These hemodynamic effects are linked to contrast injections, especially in coronary artery disease patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Contrast media used in coronary arteriography can induce electrocardiographic and hemodynamic alterations.
- Clinical decisions to repeat procedures are often based on patient symptoms like chest pain, bradycardia, or hypotension.
Purpose of the Study:
- To investigate the relationship between ST segment changes and left ventricular end-diastolic pressure during coronary arteriography.
- To correlate these changes with different patient groups including coronary artery disease, syndrome X, and coronary artery spasm.
Main Methods:
- Studied 25 patients undergoing coronary arteriography: 15 with coronary artery disease, 2 with syndrome X, 3 with coronary artery spasm, and 5 controls.
- Monitored ST segment changes and measured pulmonary arterial diastolic pressure using a transducer-tipped catheter to infer left ventricular filling pressure.
Main Results:
- Normal controls showed no significant changes.
- Syndrome X patients exhibited ST segment depression without hemodynamic alterations.
- Coronary artery spasm and coronary artery disease patients demonstrated ST segment depression concurrent with increased pulmonary arterial diastolic pressure.
- Repeated contrast injections sometimes led to a summation effect, exacerbating ST segment disturbances and left ventricular filling pressure.
Conclusions:
- Coronary arteriography with contrast media can precipitate significant ST segment disturbances and elevate left ventricular filling pressures.
- These hemodynamic changes are particularly evident in patients with coronary artery disease and spasm, even in the absence of overt symptoms.
Abstract:
Contrast media are known to cause electrocardiographic and haemodynamic changes during coronary arteriography. There is a tendency to proceed with repeated coronary arteriography unless patients develop chest pain, bradycardia or hypotension. We have related the changes in the ST segment to changes in left ventricular end-diastolic pressure, measuring pulmonary arterial diastolic pressure with a transducer tipped catheter. Twenty-five patients were studied, 15 patients with coronary arterial disease, 2 with syndrome X, 3 with coronary arterial spasm (and underlying coronary disease) and 5 normal controls. In control patients, no changes in the ST segment or pulmonary arterial diastolic pressure were recorded. Patients with syndrome X developed ST segment depression in the absence of changes in pulmonary arterial diastolic pressure. Those with coronary arterial spasm and underlying coronary disease developed ST segment depression and a rise in pulmonary arterial diastolic pressure following most injections. In coronary arterial disease, both painful and silent ST segment depression was noted with a rise in pulmonary arterial diastolic pressure. In some instances, a summation effect arose with repeated injections. Major disturbances in the ST segment may occur during coronary arteriography and result in elevation of left ventricular filling pressure.