Cardiac Catheterization
What is cardiac
catheterization?
A cardiac
catheterization or “heart cath” is an
examination that is done in the cardiac
catheterization laboratory to detect heart
disease and evaluate the condition of your
heart. During the test, x-ray movies and
pressure recordings of the arteries and chambers
of the heart are made. The status of your
heart’s main pumping chamber is assessed as is
the function of the valves within the heart.
This information will help your doctor decide
which form of therapy, if any is best for you.
Following the
diagnostic portion of the test, your doctor may
decide to treat one or more blockages found
within your heart arteries. This entire
procedure can take one to three hours to
complete.
What happens
during the procedure?
After you arrive
in the cardiac catheterization laboratory (cath
lab), the cath lab staff will review the
proposed procedure with you. They will ask you
about the medications you are currently taking
and when you last took your medications. You
will be asked when you last ate. A small
intravenous line (IV) will be placed in a vein
in your arm to enable the administration of
medications. You will be given a sedative to
help you relax. Your groin or arm will be
scrubbed with a special antiseptic solution and
you will be covered with sterile drapes. This is
done to prevent any infection at the puncture
site.
To perform the
catheterization study, a catheter (small hollow
plastic tube) will be inserted into an artery
and/or vein in either the groin or arm. Before
the procedure begins, your doctor will numb your
groin or arm with an anesthetic. This will cause
a slight sting or bruising sensation that only
lasts a few moments. As the catheter is
inserted, you may feel some discomfort, although
most people feel only pressure. If you have
pain, please let your doctor know.
Using a special
x-ray unit (fluoroscopy), the catheter will be
directed to the heart. You will not feel the
catheter as it moves through the blood vessels
or heart chambers. As the catheter enters your
heart, you may feel some extra heartbeats.
Pressures within the heart chambers will be
measured, blood samples may be taken and x-ray
dye (which makes the arteries and chambers of
your heart visible on x-ray) will be injected to
study the size and contraction of the different
chambers. When the dye is injected to study the
size and contraction of the different chambers.
When the dye is injected, a warm flushing
sensation may be felt over most of your body.
This sensation will last for about thirty
seconds. X-ray dye will also be injected into
each of your coronary arteries to look for
blockages within these vessels. While these
x-ray pictures are taken, you may be asked to
take a deep breath and hold it for about five
seconds. You may be occasionally asked to cough,
as coughing helps clear the dye from your
coronary arteries. If the study does not show
significant blockages or if proceeding with
intervention is not elected at this time, the
catheter (s) will be removed (see Post Procedure
Care below)
If the
diagnostic portion of the study shows blockage
(s) within your coronary artery (ies), your
cardiologist may choose one or a combination of
methods to open the blockage (s). A description
of the method that your doctor may use to open
the blockage (s) can be found on the following
page. In general, all of the methods involve
placing small devices into your coronary
arteries. A hollow tube or catheter is
positioned at the opening of your coronary
artery or bypass graft and through this a small
wire can be steered across the blockage. This
wire acts as rail over which various devices can
be placed. At times these devices may
temporarily interrupt the flow of blood through
the artery being worked upon and chest pain can
result. If you experience any chest pain or
other discomforts during the procedure, please
tell your cardiologist or the cath lab staff. We
will make every effort to minimize your
discomfort.
POST PROCEDURE
CARE
At the end of
the procedure, the catheters are removed from
the body but the sheaths through which the
catheters are introduced into the body are often
left in place. This is because blood thinners
are used during the procedure to minimize the
risk that clots will form. Until the blood
thinners have worn off, the sheaths cannot be
safely removed. The sheath (s) may be removed in
the cath lab or later in your room depending
upon the status of the blood thinners.
Alternatively, special blood vessel closure
devices can be used to enable the sheath (s) to
be removed immediately. If the catheterization
was done from your are, your doctor may close
the artery and the skin with several stitches
and a pressure dressing will be applied.
Stitches are not usually needed when the groin
is used. Pressure will be held for a variable
amount of time depending on the dose of blood
thinners used and whether or not a coronary
intervention occurred.
After sheath
removal, you will be required to lie flat in bed
with your leg straight for a variable amount of
time. If an artery closure device is used, this
may require minimal bed rest. If pressure is
used, you will remain at bed rest for about six
hours. You may have your head raised about
fifteen degrees and you may roll from side to
side. You blood pressure and dressing will be
checked frequently for the first three to six
hours. If you feel a warm wet sensation in the
groin area, apply pressure and call your nurse.
The skin around the puncture site or incision
may look bruised or slightly swollen. If you
notice coldness or discoloration of your leg or
arm, notify your nurse. It is common to feel
some numbness along the inside of your thigh due
to the local anesthetic that is used. You may
have pain medication to relieve any discomfort
that you may have.
PREPARTATION FOR
CARDIAC CATHETERIZATIN WITH INTERVENTION
Because it is
possible that you may experience nausea during
the procedure, you will be required to fast
(have nothing to eat or drink) for several hours
before the test. If your test is in the morning,
you will begin your fast the evening before. If
your test is in the afternoon, you may have a
light (tea and toast) breakfast in the early
morning on the day of the procedure and then
have nothing further to eat or during until your
catheterization is completed. In either case,
take your usual medications with a small amount
of water the morning of the procedure.
If you smoke, do
not smoke after your evening meal. This will
help your coronary arteries to return to their
normal state of relaxation. It is recommended
that you empty your bladder before going to the
catheterization laboratory.
Prior to
entering the hospital, notify your cardiologist
if you have ever had a reaction to x-ray dyes,
antiseptics, anesthetics, or any drugs. It is
also important to tell the doctor if you have
any history of bleeding tendencies or if you
have been on anticoagulant medication (coumadin,
ticlid, persantice, aspirin, or arthritis
medications).
FOLLOW-UP
INSTRUCTIONS
A bruise or lump
may develop at the puncture site and remain of a
week or more. If there is extensive bruising,
some discoloration and tenderness may last for
several weeks. Notify your doctor if you notice
new bleeding, increased tenderness, redness or
drainage from the catheterization site, fever,
or change in color, temperature, or sensation in
the limb used for the catheterization.
There may be
changes in your medications following this
procedure, especially if an intervention was
done. Your cardiologist or his associate will go
over this with you before discharge. If you have
any questions about medications, your post
procedure visit or any instructions, please ASK!
If you were provided medications at the time of
discharge and will run out before your next
office visit, please call the office.
