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ABOUT 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 with angioplasty (see Percutaneous
Coronary Interventions). 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 moved to a special table in the cath lab. Adhesive patches
will be attached to your arms and legs so your electrocardiogram
(ECG) can be monitored. You may 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 burning sensation which 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 heart
beats. 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, 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 being 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 blockages(s) within
your coronary artery(ies), your cardiologist may choose one or a
combination of methods to open the blockage(s) (see Percutaneous
Coronary Interventions). 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 a 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 sheaths(s) to be removed immediately. If the catheterization
was done from your arm, your doctor may close the artery and the
skin with several stitches and a pressure dressing will be applied.
Pressure may 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 four hours. You may have your head raised about fifteen degrees
and you may roll from side to side. Your 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.
PREPARATION FOR CARDIAC CATHETERIZATION
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 drink 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, persantine, aspirin,
or arthritis medications).
FOLLOW-UP INSTRUCTIONS
A bruise or lump may develop at the puncture site and remain for
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.
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