Dilution of Verapamil During Intraarterial Administration

This study will be a randomized, single-blind, prospective trial designed to evaluate the efficacy and safety of intra-arterial (IA) Verapamil diluted with normal saline compared to undiluted IA Nicardipine during transradial access (TRA) for percutaneous coronary angiography. Patients who are 18 years or older and undergoing non-emergent percutaneous coronary angiography via TRA will be included. Patients who are non-English speaking, pregnant, or intubated will be excluded. Patients will be randomized to one of the two following groups:Group 1 will receive IA Verapamil 5 mg (2mL) diluted with 8 mL of normal salineGroup 2 will receive IA Nicardipine 400 mcg (undiluted, 8 mL)The investigators will document the patient's level of discomfort on the Visual Analogue Scale 30 seconds before and after administration of IA Verapamil/Nicardipine. The investigators will also document the presence of radial artery spasms.

Inclusion CriteriaEnglish Speaking patients who are age 18 or olderPatient must be able to provide own consent and communicate with staffPatient's undergoing transradial access (TRA) for the left heart catheterization (LHC)Exclusion CriteriaIntubated or sedated patientsAgitated patients requiring moderate sedation prior to TRAPatient's undergoing femoral access for the LHCNon-English speaking patientsContraindications to Verapamil or Nicardipine: including allergies to these medications, hypotension (mean arterial pressure <65), Bradycardia (heart rate<40)Emergent cardiac catheterizationInability to obtain radial artery accessConversion to radial artery access from another access site