Iatrogenic Cardiovascular Complications: Part I. Semi‐Noninvasive Procedures and Diagnostic Invasive Procedures

Abstract

This article reviews cardiac and noncardiac complications encountered with various procedures used in cardiology practice. Some of the common complications associated with transesophageal echocardiography are hypoxia, laryngospasm, bronchospasm, and brady‐ or tachyarrhythmias. Death is a rare complication. The overall prevalence of complications associated with external cardioversion is low. Major complications include death, cardiac arrhythmias, pulmonary edema, systemic embolism, and cerebral embolism. The main indication for endomyocardial biopsy at present is to assess cardiac transplant rejection. Complications occurring most frequently are carotid artery puncture, arrhythmias, and conduction abnormalities. The most commonly occurring complications of electrophysiological studies are pneumothorax, venous thrombosis, and hypotension. Cardiac catheterization is an invaluable procedure in the assessment of patients with ischemic heart disease. Major complications include vascular complications, arrhythmias, complications due to contrast agents, and death. Central venous catheterization is used to deliver medication and parenteral nutrition and also in the hemodynamic monitoring of patients. Local infection, sepsis, noninfectious phlebitis, and catheter dislodgment are some of the more commonly occurring associated complications. Swan‐Ganz catheters are indicated for the hemodynamic monitoring of critically ill patients. Major associated complications include pneumothorax, arterial 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, intraaortic balloon pump rupture, vascular complications (mainly limb ischemia), and death. Some of the common underlying mechanisms responsible for complications during interventional procedures are abrupt closure, noreflow phenomenon, coronary artery spasm, distal embolization, and side branch occlusion. The use of abciximab may be associated with an increased risk of major bleeding. Acute profound thrombocytopenia is another potential complication associated with abciximab use. Heparin usage may be associated with bleeding, thrombocytopenia, skin necrosis, osteoporosis and hypersensitivity reactions. Some of the more common complications of thrombolytic therapy are bleeding, myocardial rupture, hypotension, allergic reactions, anaphylaxis, thromboembolic complications, reperfusion arrhythmias, and splenic rupture.