title: Contraindications and side effects of commonly used medications in coronary CT angiography.
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.
authors.affiliation: Washington University School of Medicine, 4323D Laclede Ave, St. Louis, MO 63108, USA. mtkhan@gmail.com
authors.forename: Mansoor
authors.initials: M
authors.lastname: Khan
authors.forename: Kristopher W
authors.initials: KW
authors.lastname: Cummings
authors.forename: Fernando R
authors.initials: FR
authors.lastname: Gutierrez
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhalla
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Woodard
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Saeed
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D000075202:Contraindications; D017023:Coronary Angiography / Q000379:methods*; D004110:Diltiazem / Q000009:adverse effects*; D004347:Drug Interactions; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008790:Metoprolol / Q000009:adverse effects*; D005996:Nitroglycerin / Q000009:adverse effects*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014664:Vasodilation / Q000187:drug effects
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D002121:Calcium Channel Blockers; D004110:Diltiazem; D005996:Nitroglycerin; D008790:Metoprolol