Cardiac catheterization is a very common diagnostic test and is performed in hospitals and in free standing clinics each day. During the procedure, your physician inserts a thin tube into a blood vessel in your groin or arm. This tube is gently directed toward the heart and the coronary arteries. Once in position, dye is injected while x-ray pictures are taken. This test allows the physician to see if there are narrowings in the coronary arteries and just how well the heart is working. This allows the physician to have very precise information about your heart and assists in deciding what options of treatment are best for you.
Cardiac catheterization, also known as a heart cath or an angiogram, is indicated for the following reasons:
- Chest pain suspected of being angina (decreased oxygen to the heart muscle by blockages in the coronary arteries)
- An abnormal treadmill or stress test.
- Valve or suspected valve disease.
- Heart attacks or heart failure.
The following information can be obtained from a cardiac catheterization:
- Determine if there are any blockages in the coronary arteries or coronary artery bypass grafts.
- Determine how well the heart muscle works or contracts.
- Determine how well the heart valves are functioning.
- Measurement of pressures inside the heart.
- Determine if there are any birth defects or shunts present.
The results of a cardiac catheterization will be:
- Normal-meaning there is no narrowing or abnormality in the coronary arteries or structures of the heart.
- Mildly abnormal and can be treated with medications.
- There is a need for an intervention such as angioplasty, stent, or atherectomy.
- There is a need for open heart surgery, either for valve repair or coronary artery bypass.
Prior to the Procedure
A few days before your procedure, you will be asked to come to our office for pre-testing and to watch a short video. At that time if you have any questions, a healthcare professional will be available to answer them. Pre-testing may include blood work and an electrocardiogram (ECG or EKG). At that time you will also be asked to sign the consent form. Download the Consent Form today.
At that time, if you are not already taking a coated aspirin, you will be asked to begin doing so.
If you are allergic to shellfish or iodine, please inform your doctor at this time. Also, if you are diabetic or taking medication to thin your blood, you need to notify him/her as well.
You will be admitted to the hospital the morning of the procedure. The night before the procedure, you will be required to refrain from eating or drinking after midnight, except for taking your usual medications in the morning with sips of water (unless you have been advised to hold them.) With the exception of your wedding band, you should leave your jewelry at home.
You will be advised when to come to the hospital and where to go when arriving. In the holding area, you will have an IV (intravenous) line started and they will check to make sure your consent form is signed and that all of your pre-cath paperwork and lab work has been completed. You may leave your dentures in place and your glasses, however we do ask that you remove contact lenses. Before leaving for the cath lab, you will be asked to empty your bladder. A medication may or may not be given to you prior to you arriving in the cath lab. You will remain awake but comfortable throughout the procedure so you may follow the doctor’s instructions.
Members from the cath lab team will come for you when it is time for your procedure. You will be taken to the cath lab on a cart or gurney. When entering the room, you will note that the room will feel cool and there will be a number of nurses and technicians in the room, as well as lots of equipment. You will be asked to move to the cath lab table (a large x-ray table) and begin the preparation for the procedure. Most angiograms are performed by using the femoral artery located in the groin area. Both groin sites will be prepped by shaving, washing, then scrubbing the areas with a Betadine solution. Then sterile towels and drapes are placed from the neck down. On rare occasions, it is necessary to use the artery in the arm to perform the procedure.
What to Expect During the Procedure
The doctor will begin the procedure by numbing the area of the groin site with a local anesthesia that may sting like when you visit the dentist. Once the area is numb, a small puncture will be made into the blood vessel and a long thin tube (called a sheath) will be inserted to establish access into the artery. Catheters are then threaded up through the aorta (the main blood vessel leading to the heart) into the coronary arteries where dye is injected several times to assess blood flow through the artery.
The procedure is not painful, although you might feel a sensation of pressure in the groin area as the catheters are moved.
During the time the catheters are being advanced, a camera will be moving quickly above your chest and taking x-ray pictures while the table is moving in different angles. This is done so that we can see the artery from all angles. Once it is known what the coronary arteries look like, a catheter is placed into the aorta where pressure measures are made. This catheter is then advanced across the aortic valve and pressures within the pumping chamber (left ventricle) are obtained.
When the pressure measurements are complete, a radiopaque dye is injected into the pumping chamber. This shows how well the pumping chamber is squeezing. During this time, you might feel a warm sensation throughout your body for approximately 15-20 seconds. This is a normal response to the dye and is not a cause for concern. During the catheterization process, you may be asked to breathe deep and cough.
Once all measurements are complete, the catheter is withdrawn from your body. At this time the physician may select to use an arterial closure device. These devices are designed to minimize the amount of time you are immobilized in bed. The total time for the procedure, including preparation time is 30-45 minutes. You should let your physician know any time that you feel dizzy, nausea, tingling, numbness, or chest discomfort. During the procedure, all of the pictures are recorded digitally for storage on a CD ROM.
What are the risks?
Cardiac catheterization is a relatively safe procedure. The most common complication of cardiac catheterization involves bleeding from the artery at the puncture site, either outward or you may bleed inward into the surrounding tissue. This is called a hematoma. New techniques of pressure, as well as special closing devices decrease this risk considerably. Very rarely would surgical intervention or blood transfusion be needed for this complication. More serious complications can occur, such as allergic reaction, infection, damage to the artery, blood clots, heart attack, stroke, or even death. The doctor will discuss with you any additional risks or complications or questions you may have pertaining to your particular case.
After the Procedure
After the catheterization, if a closure device was not used, the sheath is removed from the artery and pressure is held for twenty to thirty minutes to stop the initial bleeding from the artery. An ice pack and sand bag are then placed. You will be required to lie flat for 6-8 hours, with the involved leg straight. You will need assistance in eating, drinking, or urinating during this time. Your nurse will be checking your blood pressure, pulses, and the insertion site.
If you feel any intense pain or warmth at the site, notify your nurse immediately. If you become uncomfortable from lying still, pain medication can be provided. After a set time, the nurse will slowly raise the head of your bed and allow you to carefully move and bend. You will walk the hallway with assistance and then be discharged home. If a closure device is used, the time of immobilization is less and the ice and sand packs are not used.
Discussion of Results
Your doctor will discuss preliminary results with you during and immediately following the procedure. He will discuss the conclusions with your family after the procedure. Your doctor or his nurse practitioner will then review the results and the treatment plan prior to your discharge.
Post Discharge Instructions
The following instructions are for those who had a catheterization, but had no other intervention. View the complete SDHC Discharge Booklet.
Driving: You should not drive home the day of the procedure due to the relaxing medicine you may receive. It is safe to resume driving the following day.
Bathing: Showers are allowed. Wash normally with any kind of soap and water but do not apply unusual pressure at the site of the catheter insertion. It is normal for this area to be tender, have a small lump, and be discolored. It is best to pat this area dry instead of rubbing. No baths are allowed for three days.
Site Care: If you would like, you may use a band-aid at the incision site. Watch for any signs of infection such as: drainage of pus, warmth, redness, or any fever greater than 100 degrees F. Bruising should gradually fade within one to two weeks and will lumps and bumps. If there is any increase in bruising, welling or any signs of infection, notify our office immediately at 303.744.1065.
Activity: To allow the artery to heal, avoid lifting more than 5-10 pounds, strenuous activity or housework for three days. You can walk or climb stairs to get where you are going. Generally, you may return to work the next day, unless you job requires physical demands beyond the above restrictions.