Hyponatremia is a relatively common electrolyte disorder. Although severe acute hyponatremia following coronary angiography is rare, potentially lethal neurologic manifestations may result. We describe a patient with severe, symptomatic hyponatremia, an unusual complication of coronary angiography. Lack of familiarity with contrast media-related hyponatremia caused a delay in diagnosis and therapy in our case. The diagnosis of acute hyponatremia should be considered in any patient who develops behavioral or neurologic manifestations following coronary angiography. Prompt diagnosis and treatment is essential to avoid permanent neurologic damage or death.
Coronary Angiography ; Humans ; Hyponatremia ; Neurologic Manifestations ; Recognition (Psychology)

OBJECTIVEWe previously showed that factorial score of somatization, which was obtained by the examination of symptom checklist-90 (SCL-90), was higher in patients received transfemoral coronary catheterization than norm. The aim of the present study was to compare the patient's psychologic status between transradial approach and transfemoral approach percutaneous coronary catheterizations.

METHODSA total of 198 inpatients (105 transfemoral, 93 transradial) underwent scheduled first time coronary catheterizations were enrolled. All patients were studied by symptom SCL-90 on present psychologic status 24 hours before and 24-48 hours after coronary catheterizations.

RESULTSAge, sex, weight, smokers, employment, educational background, marriage status, family relations, family history of cardiovascular disease, income and medical insurance status were similar between the two groups. There was also no difference in diabetes, hypertension history as well as coronary heart disease confirmed by coronary catheterization between the 2 groups. Compared with the status before the procedure, factorial scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, global severity index and total positive symptoms were significantly reduced after percutaneous coronary catheterizations (1.50 +/- 0.51 vs. 1.64 +/- 0.53, 1.50 +/- 0.48 vs. 1.67 +/- 0.55, 1.28 +/- 0.41 vs. 1.38 +/- 0.49, 1.42 +/- 0.43 vs. 1.55 +/- 0.53, 1.38 +/- 0.41 vs. 1.58 +/- 0.54, 1.32 +/- 0.35 vs. 1.44 +/- 0.41, 1.38 +/- 0.34 vs. 1.49 +/- 0.42, and 23.08 +/- 17.30 vs. 27.72 +/- 18.79, respectively, P all < 0.05). Scores on somatization, depression and positive symptom severity index were significantly lower in patients received transradial coronary catheterizations than those received transfemoral coronary catheterization approach (1.52 +/- 0.51 vs. 1.62 +/- 0.53, 1.43 +/- 0.54 vs. 1.54 +/- 0.43 and 2.36 +/- 0.66 vs. 2.50 +/- 0.43, respectively, P all < 0.05).

CONCLUSIONPatients' psychologic status improved significantly after percutaneous coronary catheterizations. Improvement on psychologic status is significantly better in patients underwent transradial coronary catheterizations than that underwent transfemoral coronary catheterizations.

Aged ; Angioplasty, Balloon, Coronary ; methods ; psychology ; Coronary Angiography ; psychology ; Coronary Disease ; psychology ; therapy ; Femoral Artery ; Humans ; Middle Aged ; Radial Artery ; Self-Assessment

OBJECTIVETo compare the prior coronary angiography (CAG) psychological status in chest pain patients with and without coronary artery disease (CAD).

METHODSNinety-nine patients with chest pain and scheduled for CAG were selected by cluster sampling method. The mental status was measured by Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale-17 (HAMD-17) 24 hours before CAG, and the risk factors for CAD were also determined.

RESULTSThere were 43 patients with HAMA score > or = 14, 18 patients with HAMD-17 score > or = 14 and 16 patients with both scores > or = 14. CAD was diagnosed in 46 patients by CAG. HAMA score was significantly higher in patients without CAD than patients with CAD (14.1 +/- 7.1 vs. 11.1 +/- 6.7, P < 0.05).

CONCLUSIONSIncidences of anxiety and depression were high in chest pain patients prior CAG and incidence of anxiety prior CAG was significantly higher in chest pain patients without CAD compared to chest pain patients with CAD.

Adult ; Aged ; Chest Pain ; diagnostic imaging ; psychology ; Coronary Angiography ; psychology ; Coronary Artery Disease ; psychology ; Cross-Sectional Studies ; Depressive Disorder ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Stress, Psychological

OBJECTIVETo study the psychologic status and their influencing factors in patients suspected of having coronary disease before and after coronary catheterization.

METHODSA hundred fifty-eight inpatients (125 men, 33 women, mean age 66.1 +/- 9.6 years) who underwent a scheduled coronary catheterization for the first time and fulfilled entry criteria were enrolled. All the patients were examined by Symptom Check List-90 (SCL-90), a standard self-report symptom inventory on present psychologic status, within 24 hours before the coronary catheterization (after the information consent) and the third day after the procedure.

RESULTS(1) Before coronary catheterization, factorial scores of somatization, anxiety and phobic anxiety were higher than norm (P < 0.05 or P < 0.01). After the procedure, only somatization score was higher (P < 0.01). (2) Men had higher scores on obsessive-compulsive and psychotism than women (P < 0.05 and P < 0.01, respectively), however, women had higher scores on phobic anxiety (P < 0.05). (3) Compared with patients having coronary disease, those with angiographically normal coronary arteries seemed to have higher scores of somatization, obsessive-compulsive, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotism, global severity index and positive symptoms (P < 0.05 or P < 0.01). (4) After the procedure, significantly decreases in obsessive-compulsive, depression, hostility, global severity index and positive symptom severity index (P < 0.05 or P < 0.01) were seen. (5) Patients merely underwent coronary angiography had higher score in phobic anxiety construct than those having had coronary angiography and percutaneous transluminal coronary angioplasty (1.34 +/- 0.38 vs 1.15 +/- 0.23, P < 0.05). (6) When compared with the degree of explanation under informed consent, specific risk was not informed mentioned, a higher score in positive symptom severity index was seen (2.56 +/- 0.48 vs 2.46 +/- 0.37, P = 0.02). (7) Higher score was seen on positive symptom severity index when patients aged 70 years or more (2.62 +/- 0.45) than those under 60 years old (2.47 +/- 0.43, P < 0.05) or between 60 and 69 years old (2.45 +/- 0.40, P < 0.01).

CONCLUSIONSPatients' psychologic symptoms before and after the coronary catheterization seemed to be related to many factors. The most important appeared one was coronary catheterization itself. Women, patients with angiographically normal arteries, those of 70 years old or more were more likely to have elevated psychologic distress. Detail information including specific risk regarding the procedure was not associated with the increase of psychological symptoms. The findings emphasized the importance of psychologic assessment and counseling for patient who had undergone a scheduled coronary catheterization.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; psychology ; Anxiety ; physiopathology ; Coronary Angiography ; Coronary Disease ; psychology ; therapy ; Depression ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Personality Inventory ; standards ; Sex Factors ; Stents ; psychology ; Stress, Psychological ; etiology ; therapy

PURPOSE: Prediction of the proximal right coronary artery (pRCA) through electrocardiography (ECG) is very important because pRCA occlusion has frequently been suspected in right ventricular infarction, which has a high mortality rate. The aim of this study is to investigate characteristic ECG finding of pRCA occlusion distinguishable from mid or distal RCA. METHODS: A review was conducted retrospectively of 630 patients with chest pain in the ED who underwent coronary angiography (CAG) from June 2007 to December 2013 and CAG of 89 among them resulted in only RCA occlusion exempting other coronary vessels. The patients were divided into two groups: subjects with pRCA (n=32) occlusion and below the mid RCA (n=57) occlusion. In each subset, features of ECG were searched and analyzed. RESULTS: ECG of patients with occlusion of the pRCA showed more prominent ST depression in lead I (-0.68 mm vs -0.22 mm, p=0.027) and ST elevation in V1 (0.94 mm vs 0.09 mm, p=0.001) than in the below portion. Both ST depression (< or =0 mm) in I and ST elevation (>0.5 mm) in V1 classified according to cutoff value using Youden index J were closely related to pRCA occlusion other than mid or distal RCA (OR 7.16, p<0.001). CONCLUSION: Discrimination of pRCA occlusion from mid or distal RCA in ECG through ST depression in lead I and ST elevation in lead V1 might be valid as a sentinel of right ventricular infarction.
Chest Pain ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Depression ; Discrimination (Psychology) ; Electrocardiography* ; Humans ; Infarction ; Mortality ; Myocardial Infarction ; Retrospective Studies

PURPOSE: The purpose of this study was to identify the factors that predict discomfort after coronary angiography or percutaneous coronary intervention (PCI) among hospitalized patients. METHODS: A total of 203 patients who underwent coronary angiography or PCI were recruited from C hospital located in S city, J province, from June through August 2008. The level of discomfort was measured and standardized by two instruments, discomfort questionnaire and the Visual Analogue Scale (VAS). RESULTS: Stepwise multiple regression showed that the factors predicting the level of discomfort were type of angiography, gender, previous angiography, dysuria, pre-information, and sleep satisfaction, which together explained 30.6% of the total variance of the level of discomfort. CONCLUSION: Patients who had previous experience with these procedures, received a pre-information about the upcoming procedure, had no dysuria, and had slept well after the procedure were less likely to complain discomfort. Pre-informed education should be given by nurses to patients who will have an angiography or PCI to reduce their physical and emotional discomforts.
Adult ; Aged ; Aged, 80 and over ; Angioplasty, Transluminal, Percutaneous Coronary ; Coronary Angiography/*psychology ; Coronary Disease/psychology/radiography ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Preoperative Care ; Questionnaires ; Sex Factors ; Sleep ; Urination

PURPOSE: To evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores. MATERIALS AND METHODS: The 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD. RESULTS: In the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02−1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82−5.34, p<0.001), and CAC 1−9 (OR 1.80, 95% CI 1.08−3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02−1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93−0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14−5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model. CONCLUSION: Smoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.
Angiography ; Asymptomatic Diseases ; Body Mass Index ; Calcium ; Cholesterol, HDL ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Creatinine ; Discrimination (Psychology) ; Dyslipidemias ; Humans ; Hypertension ; Lipoproteins ; Risk Factors ; Smoke ; Smoking

BACKGROUND/AIMS: This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain. METHODS: Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death. RESULTS: The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant. CONCLUSIONS: CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.
Angina, Unstable ; Calcium ; Chest Pain ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Death ; Discrimination (Psychology) ; Electrocardiography* ; Follow-Up Studies ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Odds Ratio ; Prognosis

PURPOSE: N-13 ammonia uptake and retention in the myocardium is related to perfusion and metabolism. There are several potential advantages of N-13 ammonia positron emission tomography (PET) to detect myocardial ischemia, such as higher spatial resolution, greater counting efficiencies, and robust attenuation correction. But there are few reports comparing Tc-99m myocardial perfusion single photon emission tomography (MPS) and N-13 ammonia PET. We thus compared adenosine stress N-13 ammonia PET/CT and Tc-99m sestamibi MPS in patients with suspected coronary artery stenosis. MATERIALS AND METHODS: Seventeen patients (male 13 : 63+/-11 years old) underwent adenosine stress N-13 ammonia PET/CT (Discovery ST, GE), Tc-99m sestamibi MPS (dual head gamma camera, Hawkeye, GE) and coronary angiography within 1 week. N-13 ammonia PET/CT and Tc-99m sestamibi MPS images were assessed with a 20-segment model by visual interpretation and quantitative analysis using automatic quantitative software (Myovation, GE). RESULTS: Both sensitivities and specificities of detecting an individual coronary artery stenosis were higher for N-13 ammonia PET/CT than Tc-99m sestamibi MPS (PET/CT: 91%/ 89% vs MPS: 65%/ 82%). N-13 ammonia PET/CT showed reversibility in 52% of segments that were considered non-reversibile by Tc-99m sestamibi MPS. In the 110 myocardial segments supplied by the stenotic coronary artery, N-13 ammonia PET/CT showed higher count densities than Tc-99m MPS on rest study (p<0.01), and the difference of count density between the stress and the rest studies was also larger on N-13 ammonia PET/CT. CONCLUSION: Adenosine stress N-13 ammonia PET/CT had higher diagnostic sensitivity and specificity, more reversibility of perfusion defects and greater stress/rest uptake differences than Tc-99m sestamibi MPS. Accordingly, N-13 ammonia PET/CT might offer better assessment of myocardial ischemia and viability.
Adenosine ; Ammonia ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Gamma Cameras ; Head ; Humans ; Myocardial Ischemia ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Retention (Psychology) ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND OBJECTIVES: To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). However, often it is not easy to determine such a dose. This study assessed the usefulness of the ratio of CM-dose to estimated glomerular filtration rate (eGFR) in predicting the risks of CIN and sought to determine the safe level of CM-dose/eGFR in patients undergoing non-emergent percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those with ne-phropathy requiring dialysis (NRD) were also evaluated. RESULTS: Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3% and 80%, respectively. Of patients (n=51) with g-I/eGFR > or =1.42, 23.6% (13/51) and 7.8% (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001) and NRD (0%, 0/171, p<0.001). CONCLUSION: It can be concluded that a g-I/eGFR <1.42 is a simple, useful indicator for determining the safe CM-dose based on the pre-PCI eGFR values. Furthermore, g-I/eGFR might have a close relationship with the development of NRD as well as CIN.
Acute Kidney Injury ; Angiography ; Contrast Media ; Dialysis ; Discrimination (Psychology) ; Glomerular Filtration Rate ; Humans ; Incidence ; Iodine ; Percutaneous Coronary Intervention ; ROC Curve ; Sensitivity and Specificity