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Contraindications and side effects of commonly used medications in coronary CT angiography

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Abstract

For certain clinical applications, coronary CT angiography (CCTA) has become a useful tool for the noninvasive evaluation of coronary artery atherosclerosis. To optimize image quality in CCTA, medications are often given prior to scanning to slow the heart rate or distend the arteries. These medications have side effects and are contraindicated in certain patient populations. Metoprolol is the ß-blocker of choice in CCTA, and it has been shown to be effective in achieving the goal heart rate of less than 65 beats per minute for CCTA and in minimizing variability of heart rate. It is contraindicated in patients with hypotension or high degree AV block, and it must be used with caution in patients with asthma or obstructive pulmonary disease, patients with decompensated heart failure, and those with vasospastic or vasoocclusive disease. Diltiazem, the calcium channel blocker of choice in CCTA, is a reasonable alternative for heart control, particularly in patients with asthma or bronchospastic disease, and patients with orthotopic heart transplants that have been sympathetically denervated. Sublingual nitroglycerin is especially useful in order to dilate distal arteries to improve stenosis visibility. However, it is contraindicated in patients on erectile dysfunction medications and those with severe anemia. It must be used cautiously in patients with aortic stenosis or other preload-dependant cardiac pathologies.

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Authors and Affiliations

  1. Washington University School of Medicine, 4323D Laclede Ave, St. Louis, MO, 63108, USA

    Mansoor Khan

  2. Department of Radiology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8131, St. Louis, MO, 63110, USA

    Kristopher W. Cummings, Fernando R. Gutierrez & Sanjeev Bhalla

  3. Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8225, St. Louis, MO, 63110, USA

    Pamela K. Woodard

  4. Division of Cardiovascular Diseases, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8086, St. Louis, MO, 63110, USA

    Ibrahim M. Saeed

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  1. Mansoor Khan
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  2. Kristopher W. Cummings
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  3. Fernando R. Gutierrez
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  4. Sanjeev Bhalla
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Correspondence to Mansoor Khan.

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Khan, M., Cummings, K.W., Gutierrez, F.R. et al. Contraindications and side effects of commonly used medications in coronary CT angiography. Int J Cardiovasc Imaging 27, 441–449 (2011). https://doi.org/10.1007/s10554-010-9654-8

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  • DOI: https://doi.org/10.1007/s10554-010-9654-8

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