What is cardiac catheterization?
Cardiac catheterization is an essential tool for diagnosing and guiding the treatment of heart disease. It enables LI Community Hospital cardiologists to visualize and assess the condition of the coronary arteries, and it provides vital information for treating blockages that can restrict blood flow to the heart.
Cardiac Catheterization Procedure
At Long Island Community Hospital , a cardiac catheterization is performed as a follow-up diagnostic procedure when other tests indicate the presence of such conditions as: coronary artery disease, valvular heart disease, congestive heart failure and/or certain congenital (present at birth) heart conditions, such as atrial septal defect (ASD) or ventricular septal defect (VSD).
During a cardiac catheterization procedure, a small tube, or catheter, is advanced from an artery in the groin or the wrist through a large artery – known as the aorta – and then into the heart. As the catheter is moved to different parts of the heart, specific pressure measurements are obtained. A contrast dye is injected into the coronary arteries that enables a special X-ray “movie” (fluoroscope) to visualize how well the arteries are supplying blood and oxygen to the heart muscle. This is especially important in assessing blockages or narrowing in the coronary arteries.
Why your physician is referring you for a cardiac catheterization procedure
A cardiac catheterization provides certain unique information and may be performed to assist in the diagnosis of:
- Atherosclerosis, which is a gradual clogging of the arteries over many years by fatty materials (lipids and cholesterol) and other substances in the bloodstream.
- Cardiomyopathy, or an enlargement of the heart due to thickening or weakening of the heart muscle, often due to long-standing untreated or undertreated hypertension or prior heart attacks.
- Congenital heart disease, which are defects present at birth, noted 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 (CHF), a condition in which the heart muscle has become weakened to the 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, which is a malfunction of one or more of the heart valves that may cause an obstruction or a backing up of the blood flow within the heart.
A cardiac catheterization may also be performed if you have recently had one or more of one or more of the following cardiac symptoms:
- Chest pain or angina.
- Shortness of breath.
Often a screening examination such as an electrocardiogram (ECG or EKG) or stress test can suggest the possibility of some type of heart disease process that needs to be explored further. A cardiac cath may be ordered by your physician as a follow-up.
There are many other reasons for your physician to recommend a cardiac catheterization. These include evaluation of myocardial perfusion (blood flow to the heart muscle) or if chest pain or angina occurs after a:
- 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).
- Cardio MEMS Implantation – A wireless device that is implanted in the pulmonary artery of the heart. The miniature wireless sensor is implanted using a minimally invasive technique and transmits cardiac output and certain pressures in the heart along with heart
rate that is critical to the management of patients with heart failure.
What you can expect before, during and after the procedure
Before the Procedure:
- Your physician will explain the procedure to you and offer you the opportunity to ask any questions.
- You will be asked to sign a consent form that gives your permission to do the test. Always read any consent form carefully and ask questions if something is not clear.
- You will need to fast for a certain period of time prior to the procedure. The cath lab scheduling coordinator will notify you how long to fast, but it’s usually overnight.
- You will be asked about your medications (prescription and over-the-counter) and herbal supplements that you are taking and if you have certain heart valve diseases, as you may need to receive an antibiotic prior to the procedure.
- Notify your physician/cath lab team 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.
- You may receive a sedative prior to the procedure to help you relax.
- Arrange to have someone to drive you home after the procedure.
During the Procedure:
A cardiac catheterization may be performed as part of your stay in a hospital, but is often scheduled as an outpatient procedure. Procedures may vary depending on your condition. Generally, a cardiac catheterization follows this process:
- You will remove any jewelry or other objects that may interfere with the procedure. You will be permitted to wear your dentures or hearing aids, if you use either of these.
- You will change into a hospital gown.
- An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication, sedation and to administer IV fluids, if needed.
- You will be placed on your back on the procedure table.
- An ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes will be connected to your chest to allow constant monitoring before, during and after the procedure.
- Additionally, your vital signs (heart rate, blood pressure, breathing rate and oxygenation level) will be monitored by an RN 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 may receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake and rather comfortable during the procedure.
- The pulses in the extremity below the catheter insertion site will be frequently assessed so that the circulation to the limb below the site can be checked after the procedure.
- A local anesthetic (numbing agent) will be injected into the skin where the catheter will be inserted.
- 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. The typical site for access is the femoral artery (groin) or the radial artery (wrist).
- 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. For a few brief moments, you may feel some effects when the contrast dye is injected into the IV line, such as a flushing sensation, a salty or metallic taste in the mouth and/or a brief headache.
- After the contrast dye is injected, a series of rapid, brief, sequential X-ray images of the heart and coronary arteries will be made to create the X-ray movie.
- Once sufficient information has been obtained, the catheter will be removed. The insertion site may be closed in several ways: collagen to seal the opening in the artery, sutures (stitches) or by applying manual pressure over the area to keep the blood vessel from bleeding and placing a dressing on the insertion site. Your physician will determine which method is appropriate for you.
After the Procedure in the Hospital:
- You may be taken to the recovery room for observation. You will remain flat in bed for several hours after the procedure. An RN will frequently monitor your vital signs, the insertion site and the circulation/sensation in the affected leg. In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bed rest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.
- Once your bed rest is 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 will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
- When you have completed the recovery period, you may be discharged to your home unless your physician decides otherwise. Prior to discharge, you will be given the results of the cardiac cath. Your nurse will also review discharge instructions with you and answer all of your questions. You will be provided with an educational packet as well.
Once You’re Home:
- 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.
- Make sure to keep the insertion site clean and dry. Your physician/cath lab team will give you specific bathing instructions. You will also be given instructions on how and when to contact your physician should you have any problems or concerns.
- You will see your physician within a few weeks after your cardiac catheterization.
- You may be advised not to participate in any strenuous activities. However, most patients resume driving in a few days and return to work within the week. Your physician will instruct you about when you can return to work and resume normal activities.
- Your Registered Nurse from the Cath Lab will call you to check on your condition and to answer any additional questions you might have.