Cardiac catheterization

(Coronary Angiography; Coronary Arteriography; Coronary Angiogram)

Cardiac catheterization – Definition

Cardiac catheterization is a test that uses a catheter (tube) and x-ray machine to assess the heart and its blood supply.

Cardiac catheterization – Reasons for Procedure

It is used to find the cause of symptoms, like chest pain, that could mean heart problems.

Cardiac catheterization helps doctors to:

• Identify narrowed or clogged arteries of the heart
• Measure blood pressure within the heart
• Evaluate how well the heart valves and chambers function
• Check heart defects
• Evaluate an enlarged heart
• Decide on an appropriate treatment

Cardiac catheterization – Possible Complications

If you are planning to have a cardiac catheterization, your doctor will review a list of possible complications, which may include:

• Bleeding at the point of the catheter insertion
• Damage to arteries
• Heart attack or arrhythmia (abnormal heart beats)
• Allergic reaction to x-ray dye
• Blood clot formation
• Infection

Some factors that may increase the risk of complications include:

• Allergies to medicines or x-ray dye
• Obesity
• Smoking
• Bleeding disorder
• Age: 60 or older
• Recent pneumonia
• Recent heart attack
• Diabetes
• Kidney disease

Cardiac catheterization – What to Expect

Prior to Procedure

Your doctor may order:

• Blood and urine tests
• Electrocardiogram (ECG, EKG) — a test that records the heart’s activity by measuring electrical currents through the heart muscle
• Chest x-ray
• Stress test

Talk to your doctor about your medicines. You may be asked to stop taking some medicines before the procedure, like:

• Anti-inflammatory drugs (eg, ibuprofen)
• Blood thinners, like warfarin (Coumadin)
• Clopidogrel (Plavix)
• Metformin (Glucophage) or glyburide and metformin (Glucovance)

Leading up to your procedure:

• Arrange for a ride to and from the procedure.
• The night before, do not eat or drink anything after midnight.

Cardiac catheterization – Anesthesia

Local anesthesia will be used at the insertion site. A mild sedative may be given one hour before the procedure or through an IV (needle in your arm) during the procedure. This will help you relax.

Cardiac catheterization – Description of the Procedure

During the procedure, you will receive IV fluids and medicines. An EKG will be monitoring your heart’s activity.

You will be awake but sedated so that you will be more relaxed. Your doctor will ask you to do basic functions such as coughing, breathing out, and holding your breath. If you feel any chest pain, dizziness, nausea, tingling, or other discomfort, tell your doctor.

The catheter will be inserted into an artery in either the groin or arm (usually at the crease opposite the elbow or at the wrist). The insertion area will be shaved, cleaned, and numbed. A needle will be inserted into a blood vessel. A wire will be passed through the needle and into the blood vessel. The wire will then be guided through until it reaches your heart. A soft, flexible catheter tube will then be slipped over the wire and threaded up to your heart.

The doctor will be taking x-ray pictures during the procedure to know where the wire and catheter are. Dye will be injected into the arteries of the heart. This will make the arteries and heart show up on the x-ray images. You may feel warm during the dye injection.

Once in place, the catheter can be used to take measurements. Blood pressure can be taken within the heart’s different chambers. Blood samples may also be taken. Multiple x-ray images will be taken to look for any disease in the arteries. An aortogram may also be done at this time. This step will give a clear image of the aorta (large artery leaving the heart). Once all the tests and images are complete, the catheter will be removed.

Sometimes, the doctor will do a balloon angioplasty and stenting if he finds an area in your arteries that is narrow or clogged. These procedures help to open narrowed arteries.

Finally, a bandage will be placed over the groin or arm area.

Cardiac catheterization – How Long Will It Take?

The procedure takes about 1-2 hours. Preparation before the test will take another 1-2 hours.

Cardiac catheterization – How Much Will It Hurt?

Although the procedure is generally not painful, it can cause some discomfort, including:

• Burning sensation (when skin at catheter insertion site is anesthetized)
• Pressure when catheter is inserted or replaced with other catheters
• A flushing feeling or nausea when the dye is injected
• Headache
• Heart palpitations

Pain medicine will be given when needed.

Cardiac catheterization – Average Hospital Stay

0-1 days

Cardiac catheterization – Postoperative Care

At the Care Center

• EKG and blood studies may be done.
• If the catheter was inserted in the groin area, you will likely need to lie still in bed and flat on your back for a period of time. If catheter was in the arm, you will likely be out of bed sooner.
• A pressure dressing may be placed over the area where the catheter was inserted to help prevent bleeding. It is important to follow the nurse’s directions.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Do not drive until your doctor says it is okay.
• Do not lift heavy objects or engage in strenuous exercise or sexual activity for at least 5-7 days.
• Change the dressing around the incision area as instructed.
• Your doctor will explain to you which medicines you can take and which ones to avoid. Take medicines as instructed.
• To lower your risk for further complications of heart disease, you can make lifestyle changes. These include eating a healthier diet, exercising regularly, and managing stress.
• Ask your doctor about when it is safe to shower, bathe, or soak in water.
• Be sure to follow your doctor’s instructions.

Cardiac catheterization – Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

• Signs of infection, including fever and chills
• Extreme sweating, nausea, or vomiting
• Change in sensation to affected leg or arm, including numbness, feeling cold, or change in color
• Redness, swelling, increasing pain, a lot of bleeding, or discharge where catheter was inserted
• Cough, shortness of breath, or difficulty breathing
• Extreme pain
• Chest pain
• Drooping facial muscles
• Changes in vision or speech
• Difficulty walking or using your limbs

In case of an emergency, call for medical help right away.