Radiology, Vol 153, 577-582, Copyright © 1984 by Radiological Society of North America
Myocardial ischemia during intravenous DSA in patients with cardiac disease
JR Hesselink, LA Hayman, KJ Chung, BD McGinnis, KR Davis and JM Taveras
A prospective study was performed for 48 patients who had histories of
angina and were referred for digital subtraction angiography (DSA). Cardiac
disease was graded according to the American Heart Association (AHA)
functional classification system. Each patient received 2-5 injections of
40-ml diatrizoate meglumine and diatrizoate sodium (Renografin-76,
Angiovist-370, or MD-76) at 15 ml per second in the superior vena cava. Of
the 28 patients in functional Classes I or II (no or slight limitation of
activity), 11% had angina and 32% had definite ischemic ECG changes after
the DSA injections. Of the 19 patients in functional Class III (marked
limitation of activity), 63% had angina, and 58% had definite ischemic ECG
changes after the injections. One patient in functional Class IV (total
disability) developed ventricular fibrillation after the second injection.
These observed cardiac effects following bolus injections of hypertonic
ionic contrast media indicate that special precautions are necessary when
performing intravenous DSA examinations on this group of high risk
patients.
