by putmetosleep

There's an elderly man (85) who presented to the hospital with CP...sent for cardiac cath, and a stent was placed (not sure of which vessel). Post-cath, pt spent several days in ICU (not sure why...I don't know the whole story here, but I do know he did not code while in the cath lab and CVA was ruled out via head CT) and was agitated, hallucinating, and not recognizing family members...just generally not himself as far as I've been told. Was eventually transferred to a transitional care/rehab facility...muscle strength not at baseline, pt cannot walk without a walker and only for limited distances, and is still confused...
Pt history is not clear (there are a few family members who think the pt may have been showing mild signs of dementia over the last year, for example not remember what he was talking about right after having the conversation...while other family members think he was just fine prior to the cath). Pain medications have been dc'd. The family is being told that the pt is probably experiencing lingering effects from the anesthesia during the cath because of his advanced age...but cardiac caths are performed with only conscious sedation, in which case it would be very unlikely to experience such severe adverse effects that have lasted so long.
It sounds to me like some kind of hypoxic event...but if the pt was ruled out for CVA and didn't arrest...I'm really stumped. Of course it's hard to speculate without all the details (this is an extended family member of one of my friends, I don't know this person at all, they live in a different state...she told me the story and I can't stop thinking about it! It's bothering me) I'm definitely not asking for medical advice, I'm just stumped and wondering what you think might have caused the confusion/weakness/agitation post-cath. It's even harder because I only have fragments of what actually happened, and that information came from somebody without a medical background...you know how that goes. Info is probably not all that reliable. Anyhoo...

Re: Cath complications

It sounds like you don't have the full story and maybe neither does the family. Something happened to this man. Who knows what,, but something,, whether it be detectable or not. These symptoms just don't appear after a cath for no reason.

Re: Cath complications

Exactly...

Re: Cath complications

Sounds like the whole experience exacerbated some underlying condition, i.e. dementia. The family admits to episodes of forgetfulness. Placing these elderly patients in unfamiliar surroundings and pumping drugs into them for procedures can only make their confusion worse.

Sometimes I feel awful about what we do to these poor old folks

Re: Cath complications

Just because he was neg for CVA dosen't mean he didn't have a hypoxic event- global hypoxic encephalopathy isn't going to show up on a CT- it isn't that focal. More likely he is pretty functional in his home environment but a hospital stay, sleep depravation, unfamiliar routines and time schedules can make many borderline dementia patients confused. Couple this with cath lab IV dye to weaken his renal function, sedation for the proceedure, and any number of new "hospital standard" medications- (pepcid, reglan, morphine, NSAIDs..... that can cause confusion in the elderly. On top of that you have electrolyte changes from dieuretics, kidney function changes, diet changes and IV fluids. Don't forget about inactivity and narcotic use causing constipation or stool impaction. All this considered it isn't uncommon to have patients go off the deep end. If they can get him home (with some live-in help) I bet he returns to his baseline mental statein no time. If he managed to block off a coronary artery you can bet his carotids are a little sludged up as well. It dosen't take a embolic or hemorragic CVA to cause generalized cerebral ischemia- it may just be what he has been living with for some time.