Cardiac Catheterization

Cardiac Catheterization is a diagnostic test, not an operation. During the procedure a catheter (small, thin hollow tube) is inserted into an artery or vein and passed into the heart. This technique will give the doctor information on how well your heart is pumping and what the coronary arteries look like.

In some cases, this technique is used to treat Coronary Artery Disease (CAD). Coronary angiography is a test in which radiographic contrast material, or dye, is injected into the coronary arteries through the catheter. 

 The dye causes no discomfort but some individuals may experience sensation of flushing, hotness, shivering or a slightly metallic taste in the mouth. None of these symptoms are serious but do tell us if you experience them. The contrast material is iodine-based; some people have a known allergy to iodine, shellfish, or x-ray dye. If you are one of them, let your doctor know before the test. Medication can be given to prevent an allergic reaction.

The doctor will also inject contrast into the left ventricle, which is the main pumping chamber of the heart. This will allow him to see how well the heart muscle squeezes and if there has been any damage to the muscle.

These injections are digitally recorded and kept as part of a permanent record of the procedure. Although cardiac catheterization is a highly specialized diagnostic technique performed only in a specially equipped laboratory by carefully trained staff, it is a common procedure. In fact, more than one million people undergo cardiac catheterization every year in this country. More than 3,000 diagnostic catheterization procedures are performed annually at Genesis alone.

Why Should You Have a Cardiac Catheterization?

You may have had a heart attack or have been experiencing symptoms indicative of heart disease, such as shortness of breath, chest or jaw pain, and fatigue. It is also possible that you have not experienced symptoms, but are at risk for CAD due to family history or an abnormal EKG. You may have had an exercise/resting stress test during which changes were found on your EKG, and your doctor therefore advised further study.

Day of the Procedure

After your arrival to the hospital a nurse will check your vital signs (blood pressure, pulse and temperature) and obtain a current height and weight. An EKG may be done, and you will be asked to put on a patient gown. You may not be allowed to eat or drink after midnight, or you may have a light breakfast depending on the time of the day your procedure will be done.

The time of your procedure depends on many factors, including doctor availability and other patients needing emergency treatment. Pagers are available for family members/significant others, enabling them to have a flexible routine prior to the start of your procedure. (To request pagers, please ask your room nurse.) Medication will be administered before the procedure to help you feel relaxed, but you will remain awake. You may wear your glasses, dentures and wedding ring.

The Cath Lab

Most of the time a Cath Lab Staff member will bring you to the Cath Lab in a  wheel chair. Your family will be directed to waiting rooms and be regularly updated by the cardiologist and/or the staff; the procedure will take 1 to 3 hours.

The Cath Lab is kept cool because the large x-ray equipment and computers require cool air. You will be given warm blankets upon arriving to the lab, and more blankets are available anytime during the procedure should you become cold.

The table in the procedure room moves under you.  It takes about 20 minutes to prepare for the procedure before the doctor arrives. During this time, EKG patches are applied, an IV is started, and your groin will be slightly uncovered while it is shaved. For your privacy, your genitalia will remain covered. After your groin is shaved, the area will be washed with a sterile solution, and it is important to keep your hands at your sides.

The procedure is done under sterile technique to prevent any possibility of infection. Therefore, you will notice the staff wearing hats, masks and shoe covers. The doctor and the person assisting him will be wearing sterile gowns, gloves and protective goggles.

The Procedure     

After the site is numbed with local anesthetic, the doctor will make a small puncture with a needle into the artery. You may feel some pressure with the insertion of the sheath (small tube) into your groin, but it should not be painful. As the catheter is passed up to your heart and pictures are taken; you should not feel any discomfort other than some pressure at the groin site. If you should feel pain tell the nurse or doctor in the room.

The doctor may ask you to take a deep breath. This is to lower your diaphragm and give him/her a better view of the heart. To take a deep breath, don't bear down; simply take a full breath in gradually until the doctor tells you to breathe normally, then exhale. You will be asked to hold your breath for only 5-10 second intervals.

The left ventricle of your heart is studied by the rapid injection of dye. This will cause you to feel extremely warm, for about 15- 20 seconds. The contrast material (dye) is filtered out by the body and eliminated through the kidneys. Your heart beat and blood pressure will be closely monitored during catheterization.

The coronary arteries are studied by moving the x-ray camera to various angles around your chest and head. When the camera is at the angle the doctor wants, he/she may ask you to take a deep breath (as described earlier). You will hear the camera run as the artery is being injected with contrast material. When the camera stops you can breathe normally. This will last 5-8 seconds. Approximately 10 - 12 pictures will be taken. You can watch the screen during the study if you desire.

Percutaneous Transluminal Coronary Angioplasty (PTCA Or Balloon Angioplasty)

Your doctor may recommend a PTCA to follow your cardiac catheterization. A PTCA procedure improves blood flow to you heart. Special supplies are used for this procedure, including a small wire to cross the area of disease, and a balloon-tipped catheter to inflate within the area of disease. The wire and balloon catheters are positioned across the area of blockage and the balloon is inflated, compressing the plaque against the artery wall. It may be inflated several times, sometimes causing chest discomfort; although this is normal, please let your nurse know if you experience any pain or discomfort. A coronary stent may be placed. With the plaque pushed aside blood flow to the heart muscle is improved. The PTCA is a success when the narrowed artery has been opened wide enough to allow adequate blood flow.
           

Coronary Stents

A stent is a small metal coil, slotted or mesh tube that is placed in a coronary artery to help keep it open. Your doctor may choose to place a stent in the artery to help keep it open. The stent is mounted on a balloon catheter and advanced to the site of blockage. When the balloon is inflated, the stent is expanded, this also helps to further compress the plaque.

When the balloon is deflated and removed, the stent remains, supporting the wall of the artery. The stent is permanent in the artery. The stent helps hold the artery open, improves the blood flow and relieves symptoms of coronary heart disease. Within several weeks, the lining of the artery will grow over the stent and completely cover it.

Your doctor may prescribe an antiplatelet medication, this medication helps prevent blood clots from forming on the stent. It is very important that you continue taking your medication. Consult with your physician before stopping any of your medication.

Atherectomy

In rare circumstances, other tools and procedures may be used to help open arteries blocked by atherosclerosis plaques.

Rotational Atherectomy:

A Rotational Atherectomy is a diamond burr rapidly spins and pulverizes plaque into tiny particles. The particles dissipate without causing major damage.

Directional Atherectomy:

A Directional Atherectomy a rotating blade cuts slices of plaque, which are captured by the catheter and removed from the body.  

After The Procedure

When the procedure is complete, the groin catheter (sheath) may be removed and pressure applied to the puncture site for 20 to 30 minutes to stop the bleeding or one of several closure devices may be used to seal the artery. If the physician decides to leave the sheath in place it will be removed in a couple of hours in your room.

When you return to your room, your nurse will check your blood pressure and the puncture site frequently to be sure there is no bleeding. You will have an IV infusing, oxygen and an EKG monitor on, and you may eat and drink as your physician orders.

The physician requires you to remain flat in bed for a specified time. Your nurse will turn you and/or raise the head of your bed as the doctor orders. Your leg is to remain straight, and if you need to cough, laugh or sneeze, hold pressure over the Band-Aid applied to your groin. If you have some discomfort inform your nurse, pain medication has been prescribed and can be given. A bruise or small lump under the skin at the point of catheter insertion is common and will disappear in about a week. It is possible that your groin site may bleed after returning to your room.

Signs to watch for are:

• painfulness or a warm,
• wet feeling near the groin site

If you feel this, hold pressure on the site and call your nurse immediately. Your nurse may need to hold additional pressure to your groin or apply a pressure device.

If your arm was used for the catheterization, you may move it, but do not bend or lie on it, and report to your nurse any numbness or tingling in your hand or fingers.

You will be encouraged to drink plenty of liquids to flush the contrast material through the kidneys and out of your body. The contrast material may cause you to pass more urine than usual. Your nurse will bring you a bedpan or urinal when needed. It is important that you DO NOT get out of bed to use the bathroom.

After the procedure, the cardiologist will provide a progress report to your family.  Later your doctor will talk with you and your family about the results when you are back in your room, usually that same day.

When You Get Home

• Avoid heavy lifting (over 20 pounds) or strenuous exercise for three days.
• No driving for 2 days
• You may shower but do not take a tub bath or swim for one week.
• Watch for signs of infection including fever, increased swelling, drainage, or tenderness at the puncture site. 
• Do not have a MRI scan within 8 weeks of stent implantation without first discussing it with your cardiologist. 
• Call your doctor if you notice increasing chest pain or discomfort, marked shortness of breath or excessive fatigue with exertion, all of which may signal restenosis. 
• Call an ambulance and come to Genesis Medical Center East Campus, Illini Hospital or your local emergency department if: 
  • The puncture site begins to bleed, in a steady stream or soak your clothing (lie flat and apply firm downward pressure slightly above the puncture site) 
  • The bruising or swelling suddenly increases at the leg (or arm) in which the catheters were inserted.
  • Your affected leg/foot or arm/hand becomes numb, pale or cold to touch. Do not delay treatment awaiting a phone call from your physician. 

Follow Up Visit

You will need to call immediately upon discharge for a follow up appointment with your cardiologist. This visit will help monitor your healing process. In some cases, the treated artery may close again. If this occurs, it is most likely to happen in the first 6 months after your procedure. Tests may be done during this time also.

Cardiac Rehabilitation

Your doctor may refer you to a cardiac rehabilitation (cardiac rehab) program. This program will teach you ways to make lifestyle changes that can improve your heart health. These changes may also reduce your risk for future heart problems.

• If you smoke-quit
• Enjoy a diet low in fat and cholesterol
• Exercise regularly (consult physician before you start)
• Maintain proper weight
• Lower blood pressure
• Control diabetes
• Reduce stress

In Summary

It is important for you to realize that the benefits derived from cardiac catheterization far outweigh the risks. The more your doctor knows about the condition of your heart, the better the chance that treatment will be successful.

The knowledge gained from cardiac catheterization enables your doctor to make a much more informed decision about the kind of treatment you may need. It is possible that:

• You may be able to stop taking medications because your symptoms are not caused by your heart disease
• Your medication or dosage may be changed or a new medication prescribed. However, medication does not remove existing coronary blockage
• You may be advised to have surgery, possibly coronary bypass surgery or a repair to the heart's wall or it's valves.