Cardiovascular Procedures:
Cardiac Catheterization
Definition
Also called coronary angiography, coronary arteriography or coronary angiogram, these procedures are done to detect problems with the heart and its blood supply.
Reasons for Procedure
It is generally done after an individual experiences symptoms that could mean heart problems, like chest pain.
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 function
- Determine how well the four chambers of the heart function
- Check for congenital heart defects
- Evaluate an enlarged heart
- Decide on an appropriate treatment
- Allergies to medications, shellfish, or x-ray dye
- Asthma
- Pre-existing heart or lung conditions
- Obesity
- Serious recent or chronic illness
- Bleeding disorder
- Kidney disease
Prior to Procedure
Your doctor will likely do:
- Blood and urine tests
- Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
- Chest xray
- Stress test
In the days leading up to your procedure:
- Arrange for a ride to and from the procedure
- Check with your physician regarding eating or drinking before the procedure and if you should take your medications.
Anesthesia
Local anesthesia is applied to the insertion site. A mild sedative may be given before the procedure or through the IV during the procedure. General anesthesia is not typically required.
Description of the Procedure
During the procedure you will receive IV fluids and medications. An EKG will be monitoring your heart's activity.
You'll be awake, but sedated so that you'll be more relaxed and less anxious. Your doctor asks you to perform basic functions such as coughing, exhaling, and holding your breath. If you feel any chest pain, dizziness, nausea, tingling, or other discomfort, tell your doctor.
The catheter is threaded over a guide wire, inserted into an artery in your leg, and fed up and into the heart. Your doctor watches the threading and placement of the catheter with a fluoroscopy, which is a type of x-ray that takes pictures of moving organs.
Insertion of Catheter with Guide Wire
© 2008 Nucleus Medical Art, Inc.
The catheter measures blood pressure within the heart's different chambers and may be used to take blood samples. Dye is injected into the coronary arteries. Multiple x-ray images are taken to look for any disease in the coronary arteries. An aortogram, which gives a clear image of the aorta, may also be performed at this time. The catheter is then removed.
After Procedure:
- EKG and blood studies are done.
- Once the catheter inserted in your groin is removed, you will need to rest for a few hours on your back. Depending on the closure technique used, this will typically be between 2 and 6 hours.
- You will be encouraged to drink lots of fluids to flush the x-ray dye from your system.
How Long Will It Take?
The actual procedure takes 1-2 hours. The preprocedure tests take 1-2 hours. You should plan to arrive at least one hour prior to your procedure.
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 medication will be given when necessary.
Possible Complications
Complications are rare, but can include:
Blood clots, possibly resulting in heart attack, stroke, kidney damage, lung injury, or damage to arms or legs
Allergic reaction to x-ray dye
Arrhythmias (abnormal heart beats)
Bleeding at point of catheter insertion
Perforation or other damage to arteries
Infection
Heart attack
Pericardial tamponade—Accumulation of fluid in the heart sac that can interfere with the heart pumping
Average Hospital Stay
An increasing number of cardiac catheterization procedures are done on an outpatient basis. If a hospital stay is required, it is typically 1-2 days.
Postoperative Care
- You must have someone drive you home from the hospital.
- Do not take a bath the day after the procedure. You may shower.
- Do not lift heavy objects (more than 10 pounds) or engage in strenuous exercise or sexual activity for at least 1 week.
- Change the dressing around the incision area as instructed.
- Take medications as instructed by your physician.
- Notify your doctor if you experience any of the following:
- Bleeding - apply pressure and go to the nearest Emergency Room. Call 911 if needed.
- Fever
- Persistent tenderness in the groin or swelling
- Redness and/or warm to touch at the groin site
- Numbness, tingling or pain in the leg when walking
- Wound drainage
Special Instructions for Angioseal / Perclose Patients
- Do not use a hot tub, tub bath or swim until the skin site is healed.
- You may feel a pea-sized lump and/or note mild tenderness in the groin region.
- After 24 hours, remove the dressing. Gently clean with mild soap and water and dry the area. Cover site with a band-aid. Change the band-aid if it becomes soiled or wet. Cover with a new band-aid everyday until the skin heals.
- Modify your activity for 48-72 hours: no straining, no lifting greater than 10 pounds, avoid driving the day of discharge.
- Some bruising or discomfort is common during the healing process after these procedures. However, if you experience problems as stated above, call your physician.
Outcome
Your doctor will discuss the findings and suggest a treatment plan. The results may show an urgent need for surgery or stent or angioplasty.
Call Your Doctor If Any of the Following Occurs
- Signs of infection, including fever and chills
- Extreme sweating or nausea
- Leg feels cold, turns white or blue, or becomes numb or tingly
- Redness, swelling, increasing pain, excessive bleeding or bruising, or discharge at point of catheter insertion
- Extreme pain, including chest pain
- Difficulty breathing / dizziness
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
Call 911 at the first sign of a heart attack
- Chest discomfort for more than a few minutes
- Uncomfortable pressure, squeezing or tightness in chest
- Pain extending into the neck, jaw, stomach or or arms
- Shortness of breath for more than a few seconds
- Cold sweats, nausea, lightheadedness or vomiting
Delay may be deadly -- Call 911 immediately!
