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I think this slows my heart rate down too much and causes the extra beats to be thrown in. I've found that when I'm at rest is when I have the issues. I've gotten a 2nd opinion and was switched to metoprolol. We'll see if that works better.
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We are talking about LIMA from the right radial?

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At times, having the patient take in a breath will lift the catheter and help canulation of the coronary.

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You can use any catheter that points upwards (Tiger, Jacky, AL1, 2, 3 or even LIMA) and just advance Baby J wire and invariably it will go to Lt.

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Cardizem is contraindicated in (1) patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker, (2) patients with second- or third-degree AV block except in the presence of a functioning ventricular pacemaker, (3) patients with hypotension (less than 90 mm Hg systolic), (4) patients who have demonstrated hypersensitivity to the drug, and (5) patients with acute myocardial infarction and pulmonary congestion documented by x-ray on admission.

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For now I go to femoral if good pulse and no significant PVD and use closure device.

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The following postmarketing events have been reported infrequently in patients receiving diltiazem: acute generalized exanthematous pustulosis, allergic reactions, alopecia, angioedema (including facial or periorbital edema), asystole, erythema multiforme (including Stevens-Johnson syndrome, toxic epidermal necrolysis), exfoliative dermatitis, extrapyramidal symptoms, gingival hyperplasia, hemolytic anemia, increased bleeding time, leukopenia, photosensitivity (including lichenoid keratosis and hyperpigmentation at sun-exposed skin areas), purpura, retinopathy, myopathy, and thrombocytopenia.

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