Patient Preparation: Appointments, pre-medication and instructions

Patient Preparation

Appointments, pre-medication and instructions

This starts with the referral call. Based on current evidence and literature, if the patient has symptoms and signs suggestive of an acute coronary syndrome or significant evidence of chronic coronary artery disease, we advise the patient /referring doctor to think of a catheter angiogram. However, if the patient insists on a cardiac CT despite this, then we go ahead with the procedure.

 We also confirm that the patient is not likely to be pregnant, if she is in the child-bearing age range.

 The two important issues in getting a good scan are

a) Stable low heart rate
b) Good breath-hold

To ensure a good-heart rate, we prescribe 50mg of an extended release metoprolol, called SELOKEN-XL. This is given two nights before if there is time, or the night before. Prior to prescribing the metoprolol, the following contraindications are ruled out.

1. Cardiac      failure
2. Bronchial      asthma
3. Severe      aortic stenosis
4. Pre-existing      bradycardia

 
Asthma is a relative contraindication. If there is physician supervision and there is time, we start with low doses of metoprolol, otherwise we ask the patient to come earlier and we prescribe 2.5mg of oral bisoprolol (CONCOR) and wait for half an hour. If the patient is fine, we add another similar dose and usually the heart rate comes down significantly.

 
We also give the following instructions

1. No      coffee or caffeinated stimulants for 24 hours
2. Four      hours fasting before the procedure time

The image below just shows a normal high-quality study showing the crux with a double PDA with no breath-hold or step artifacts.