Learning Cardiology

Q. Which of the following is incorrect regarding prevention of contrast induced nephropathy? A. Preprocedure hydration with 0.9% NaCl is better than 0.45% NaCl B. Low osmolar contrast media is better than iso-osmolar contrast media C. Preprocedure use of N-acetyl cysteine is not recommended D. Biplane angiography is useful in reducing the dose of contrast Answer: B. Low osmolar contrast media is better than iso-osmolar contrast media Explanation: Contrast induced nephropathy (CIN) Transient increase in creatinine by 0.5 mg/dl or 25% increase from baseline. Occurs in 5% of patients following cardiac angiography. It is non-oliguric, peak within 1 to 2 days and then return to baseline by 7 days but may rarely require chronic dialysis. Risk factors: DM Pre-existing renal dysfunction Multiple myeloma Volume depletion Other nephrotoxic drug therapy The recommended maximum dose of contrast to limit CIN is 3 ml/kg (or 5 ml/kg divided by S. creatin

Q. Which of the following agent is not used for treatment of coronary no-reflow? A. Nicardipine B. Adenosine C. Nitroglycerine D. Verapamil E. Nitroprusside Answer: C. Nitroglycerine Explanation: The intracoronary agents used for treatment of coronary no-reflow include- A. Adenosine (For RCA 18-24 mcg, LCA 24-36 mcg) B. Sodium nitroprusside (100 mcg) C. Nicardipine (200 mcg) D. Diltiazem (1 mg) E. Verapamil (100-200 mcg) Adenosine can also be given by intravenous route in 140-180 mcg/kg/min dose. Nitroglycerin is used for treatment of coronary vasospasm. It is primarily an epicardial vasodilator, and should not be used in situations like no-reflow where small vessel (arteriolar) dilation is required.