Cardiac
Catheterization
(Cardiac
Cath, Coronary Arteriogram, Coronary Angiogram)
What
is cardiac catheterization?
Cardiac
catheterization is performed to further diagnose
coronary artery disease, valvular heart disease,
congestive heart failure, and/or certain congenital
(present at birth) heart conditions, such as atrial
septal defect or ventricular septal defect, when
other less invasive types of diagnostic tests
indicate the presence of one of these conditions.
In cardiac
catheterization (often called cardiac cath), a
very small hollow tube, or catheter, is advanced
from a blood vessel in the groin or arm through
the aorta into the heart. Once the catheter is
in place, several diagnostic techniques may be
used. The tip of the catheter can be placed into
various parts of the heart to measure the pressures
within the chambers. The catheter can be advanced
into the coronary arteries and a contrast dye
injected into the arteries.
The
use of fluoroscopy (a special type of x-ray, similar
to an
x-ray “movie”) assists the physician
in the location of blockages in the coronary arteries
as the contrast dye moves through the arteries.
A small sample of heart tissue (called a biopsy)
may be obtained during the procedure to be examined
later under the microscope for abnormalities.
An additional
technique called intravascular ultrasound (IVUS),
a technique that uses a computer and a transducer
that sends out ultrasonic sound waves to create
images of the blood vessels, may be used during
a cardiac cath. The use of IVUS provides direct
visualization and measurement of the inside of
the blood vessels and may assist the physician
in selecting the appropriate treatment needed
in each particular situation.
The
person will remain awake during the procedure,
although a small amount of sedating medication
will be given prior to the procedure.
Other
related procedures that may be used to assess
the heart include resting or exercise electrocardiogram
(ECG or EKG), Holter monitor, signal-averaged
ECG, chest x-ray, computed tomography (CT scan)
of the chest, echocardiography, electrophysiological
studies, myocardial perfusion scans, radionuclide
angiography, magnetic resonance imaging (MRI)
of the heart, and ultrafast CT scan. Please see
these procedures for additional information.
A cardiac
catheterization may be performed to assist in
the diagnosis of the following heart conditions:
- atherosclerosis -
a gradual clogging of the arteries over many
years by fatty materials and other substances
in the blood stream
- cardiomyopathy -
an enlargement of the heart due to thickening
or weakening of the heart muscle
- congenital heart disease
- defects in one or more heart structures
that occur during formation of the fetus, such
as a ventricular septal defect (hole in the
wall between the two lower chambers of the heart)
- congestive heart failure
- a condition in which the heart
muscle has become weakened to an extent that
blood cannot be pumped efficiently, causing
buildup (congestion) in the blood vessels and
lungs, and edema (swelling) in the feet, ankles,
and other parts of the body
- valvular heart disease
- malfunction of one or more of
the heart valves that may cause an obstruction
of the blood flow within the heart
A cardiac
catheterization may also be performed if you have
recently had an episode(s) of one or more of the
following cardiac symptoms:
- chest pain or angina
- shortness of breath
- dizziness
- fatigue
If a
screening examination such as an ECG or stress
test suggests a possibility of some type of heart
disease process that needs to be explored further,
a cardiac cath may be ordered by your physician.
Other
reasons for a cath procedure include evaluation
of myocardial perfusion (blood flow to the heart
muscle) if chest pain or angina occurs after the
following:
- heart attack
- heart bypass surgery
- coronary angioplasty
(the opening of a coronary artery using a balloon
or other method) or placement of a stent (a
tiny expandable metal coil placed inside an
artery to keep the artery open)
There
may be other reasons for your physician to recommend
a cardiac catheterization.
Possible
risks associated with cardiac catheterization
include, but are not limited to, the following:
- bleeding at the catheter
insertion site (usually the groin, but the arm
may be used in certain circumstances)
- blood clot or damage
to the blood vessel at the insertion site
- infection at the catheter
insertion site
- problems with heart
rhythm (usually temporary)
- ischemia (decreased
blood flow to the heart tissue), chest pain,
or angina
- stroke (rare)
The
amount of radiation used with fluoroscopy during
a cardiac catheterization procedure is considered
minimal; therefore, the risk for radiation exposure
is very low.
If you
are pregnant or suspect that you may be pregnant,
you should notify your physician due to risk of
injury to the fetus from a cardiac catheterization.
Radiation exposure during pregnancy may lead to
birth defects. If you are lactating, or breastfeeding,
you should notify your physician.
There
is a risk for allergic reaction to the cath dye.
Patients who are allergic to or sensitive to medications,
contrast dye, iodine, shellfish, or latex should
notify their physician. Also, patients with kidney
failure or other kidney problems should notify
their physician.
For
some patients, having to lie still on the cardiac
catheterization table for the length of the procedure
may cause some discomfort or pain.
There
may be other risks depending upon your specific
medical condition. Be sure to discuss any concerns
with your physician prior to the procedure.
- Your physician will
explain the procedure to you and offer you the
opportunity to ask any questions that you might
have about the procedure.
- You will be asked to
sign a consent form that gives your permission
to do the test. Read the form carefully and
ask questions if something is not clear.
- Notify your physician
if you have ever had a reaction to any contrast
dye, or if you are allergic to iodine or seafood.
- Notify your physician
if you are sensitive to or are allergic to any
medications, latex, tape, and anesthetic agents
(local and general).
- You will need to fast
for a certain period of time prior to the procedure.
Your physician will notify you how long to fast,
usually overnight.
- If you are pregnant
or suspect that you may be pregnant, you should
notify your physician.
- Notify your physician
if you have any body piercings on your chest
and/or abdomen.
- Notify your physician
of all medications (prescription and over-the-counter)
and herbal supplements that you are taking.
- Notify your physician
if you have heart valve disease, as you may
need to receive an antibiotic prior to the procedure.
- Notify your physician
if you have a history of bleeding disorders
or if you are taking any anticoagulant (blood-thinning)
medications, aspirin, or other medications that
affect blood clotting. It may be necessary for
you to stop some of these medications prior
to the procedure.
- Your physician may
request a blood test prior to the procedure
to determine how long it takes your blood to
clot. Other blood tests may be done as well.
- Notify your physician
if you have a pacemaker.
- You may receive a sedative
prior to the procedure to help you relax. If
a sedative is given, you will need someone to
drive you home afterwards.
- The area around the
catheter insertion site (groin area) may be
shaved.
- Based upon your medical
condition, your physician may request other
specific preparation.
A cardiac
catheterization may be performed on an outpatient
basis or as part of your stay in a hospital. Procedures
may vary depending on your condition and your
physician’s practices.
Generally,
a cardiac catheterization follows this process:
- You will be asked to
remove any jewelry or other objects that may
interfere with the procedure. You may wear your
dentures or hearing aids if you use either of
these.
- You will be asked to
remove clothing and will be given a gown to
wear.
- You will be asked to
empty your bladder prior to the procedure.
- An intravenous (IV)
line will be started in your hand or arm prior
to the procedure for injection of medication
and to administer IV fluids, if needed.
- You will be placed
in a supine (on your back) position on the procedure
table.
- You will be connected
to an ECG monitor that records the electrical
activity of the heart and monitors the heart
during the procedure using small, adhesive electrodes.
Your vital signs (heart rate, blood pressure,
breathing rate, and oxygenation level) will
be monitored during the procedure.
- There will be several
monitor screens in the room, showing your vital
signs, the images of the catheter being moved
through the body into the heart, and the structures
of the heart as the dye is injected.
- You will receive a
sedative medication in your IV before the procedure
to help you relax. However, you will likely
remain awake during the procedure.
- Your pulses below the
catheter insertion site will be checked and
marked so that the circulation to the limb below
the site can be checked after the procedure.
- A local anesthetic
will be injected into the skin at the insertion
site. You may feel some stinging at the site
for a few seconds after the local anesthetic
is injected.
- Once the local anesthetic
has taken effect, a sheath, or introducer, will
be inserted into the blood vessel. This is a
plastic tube through which the catheter will
be inserted into the blood vessel and advanced
into the heart. If the arm is used, a small
incision (cut) may be made to expose the blood
vessel for insertion of the sheath.
- The catheter will be
advanced through the aorta to the left side
of the heart. Fluoroscopy will be used to assist
in advancing the catheter to the heart.
- Once the catheter is
in place, contrast dye will be injected through
the catheter to visualize the heart and the
coronary arteries. You may feel some effects
when the contrast dye is injected into the IV
line. These effects may include a flushing sensation,
a salty or metallic taste in the mouth, and/or
a brief headache. These effects usually last
for a few moments.
- You should notify the
physician if you feel any breathing difficulties,
sweating, numbness, nausea and/or vomiting,
chills, itching, or heart palpitations.
- After the contrast
dye is injected, a series of rapid, sequential
x-ray images of the heart and coronary arteries
will be made. You may be instructed to take
in a deep breath and hold it for a few seconds
during this time.
- Once sufficient information
has been obtained, the catheter will be removed.
The insertion site may be closed with a closure
device that uses collagen to seal the opening
in the artery, by the use of sutures, or by
applying manual pressure over the area to keep
the blood vessel from bleeding. Your physician
will determine which method is appropriate for
your condition.
- If a closure device
is used, a sterile dressing will be applied
to the site. If manual pressure is used, the
physician (or an assistant) will hold pressure
on the insertion site so that a clot will form.
Once the bleeding has stopped, a very tight
bandage will be placed on the site. A small
sandbag or other type of weight may be placed
on top of the bandage for additional pressure
on the site, especially if the site is in the
groin.
- You will be assisted
to slide from the table onto a stretcher so
that you can be taken to the recovery area.
NOTE: If the insertion was in the groin, you
will not be allowed to bend your leg for several
hours. To help you remember to keep your leg
straight, the knee of the affected leg may be
covered with a sheet and the ends tucked under
the mattress on both sides of the bed to form
a type of loose restraint.
If the insertion site was in the arm, your arm
will be kept elevated on pillows and kept straight
by placing your arm in an arm guard (a plastic
arm board designed to immobilize the elbow joint).
In addition, a plastic band (works like a belt
around the waist) may be secured around the
arm near the insertion site. The band will be
loosened at given intervals and removed at the
appropriate time as determined by your physician.
In
the hospital:
After
the procedure, you may be taken to the recovery
room for observation or returned to your hospital
room. You will remain flat in bed for several
hours after the procedure. A nurse will monitor
your vital signs, the insertion site, and circulation/sensation
in the affected leg or arm.
You
should immediately inform your nurse if you feel
any chest pain or tightness, or any other pain,
as well as any feelings of warmth, bleeding, or
pain at the insertion site in your leg or arm.
Bedrest
may vary from two to six hours depending on your
specific condition. If your physician placed a
closure device, your bedrest may be of shorter
duration.
In some
cases, the sheath or introducer may be left in
the insertion site. If so, the period of bedrest
will be prolonged until the sheath is removed.
After the sheath is removed, you may be given
a light meal.
You
may feel the urge to urinate frequently because
of the effects of the contrast dye and increased
fluids. You will need to use a bedpan or urinal
while on bedrest so that your affected leg or
arm will not be bent.
After
the specified period of bed rest has been completed,
you may get out of bed. The nurse will assist
you the first time you get up, and will check
your blood pressure while you are lying in bed,
sitting, and standing. You should move slowly
when getting up from the bed to avoid any dizziness
from the long period of bedrest.
You
may be given pain medication for pain or discomfort
related to the insertion site or having to lie
flat and still for a prolonged period.
You
will be encouraged to drink water and other fluids
to help flush the contrast dye from your body.
You
may resume your usual diet after the procedure,
unless your physician decides otherwise.
When
you have completed the recovery period, you may
be discharged to your home unless your physician
decides otherwise. If this procedure was performed
on an outpatient basis, you must have another
person drive you home.
At
home:
Once
at home, you should monitor the insertion site
for bleeding, unusual pain, swelling, and abnormal
discoloration or temperature change at or near
the insertion site. A small bruise is normal.
If you notice a constant or large amount of blood
at the site that cannot be contained with a small
dressing, notify your physician.
If your
physician used a closure device for your insertion
site, you will be given specific information regarding
the type of closure device that was used and how
to take care of the insertion site. There will
be a small knot, or lump, under the skin at the
site. This is normal. The knot should gradually
disappear over a few weeks.
It will
be important to keep the insertion site clean
and dry. Your physician will give you specific
bathing instructions.
You
may be advised not to participate in any strenuous
activities. Your physician will instruct you about
when you can return to work and resume normal
activities.
Notify
your physician to report any of the following:
- fever and/or chills
- increased pain, redness,
swelling, or bleeding or other drainage from
the insertion site
- coolness, numbness
and/or tingling, or other changes in the affected
extremity
- chest pain/pressure,
nausea and/or vomiting, profuse sweating, dizziness,
and/or fainting
Your
physician may give you additional or alternate
instructions after the procedure, depending on
your particular situation.
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