A patient guide to cardiac catheterization
Cardiac catheterization involves the insertion of a long, flexible tube (called a catheter) into an artery, usually in the groin. The catheter is routed to your heart where an X-ray dye is emitted into the artery. The dye enables the cardiologist to get an accurate picture of your heart, which aids in the diagnosis and treatment of coronary artery disease.
The catheterization is an extremely valuable tool in diagnosing and treating coronary artery disease. The procedure provides the cardiologist with a detailed picture of your heart’s anatomy and function, including its pumping chamber, valves and the status of previous bypass surgery grafts. It also allows your cardiologist to assess damage to the heart, including blockages, abnormalities or damage from a previous heart attack.
Your coronary arteries
The catheterization procedure is most commonly used to identify blockages in the coronary arteries, and to assess their severity.
Your heart pumps oxygen-rich blood, which is carried by the arteries to the rest of your body. The coronary arteries carry blood from the aorta to the heart itself. The three main coronary arteries are the left anterior descending artery, the left circumflex artery and the right coronary artery.
When your arteries are narrowed by plaque, it reduces the amount of oxygen-rich blood that can flow to your heart. The lack of oxygen causes chest pain, called angina, and is a warning that your heart’s needs are not being met. It also means you are at high risk for a heart attack.
NOTE: Not everyone with coronary artery disease has chest pain. You may feel very different signs and symptoms, including pain in the arms, jaws, neck or back, or dyspneal fatigue.
Preparing for your catheterization
· you should not eat or drink after midnight on the night before your procedure, unless otherwise directed by your cardiologist
· you should continue to take prescribed medications as directed, using as little water as possible, with these exceptions:
· do not take diuretics (water pills) the morning of your procedure unless instructed by your cardiologist or the catheterization team
· take only half the normal dose of insulin on the morning of your procedure. you may perform the daily blood sugar test
· do not take coumadin (a blood thinner) for three days before the procedure, unless otherwise instructed by your cardiologist
· if you are unsure about any of the medications that you take, please check with your cardiologist as soon as possible
You should pack an overnight bag with personal items, in the event that you are admitted to the hospital following your procedure. Please leave any jewelry, money, credit cards or other valuables at home.
You must bring someone to drive you home from the hospital. Also, someone should stay with you during the first 24 hours after the procedure.
The procedure
You’ll be taken into the catheterization laboratory (also called the cath lab) where your care team will review your chart and transfer you to a catheterization table.
The femoral artery in your groin is the most common site for inserting the catheter, and will involve a small incision in the skin. A team member will shave the area of your groin where the catheter will be inserted, apply an antiseptic solution to the groin, and drape you with sterile sheets or towels. Your doctor will then inject a local anesthetic at the catheter insertion point.
A sheath (larger tube) is inserted into the artery first, followed by a guide wire and the catheter. The guide wire and catheter are advanced to the heart using an X-ray.
Contrast dye is then injected into the heart arteries and pumping chamber. This allows the heart and its arteries to be seen on an X-ray monitor, and for permanent X-ray images to be taken. You may feel a warm, flushing sensation when the dye is injected into the heart. This is normal, and usually lasts only a few seconds.
When your procedure is completed, the cardiologist will remove your catheter. Bleeding from the catheter insertion point will be controlled either with handheld pressure, sutures, or a plug or other closure device.
Bleeding is unlikely after the procedure. However, if you feel sharp pain or a “wet” sensation at the insertion site, notify the catheterization team immediately.
“How long do I have to stay?”
Your stay in the hospital will vary according to the procedure you receive. In the case of a “same day” discharge, you will be required to stay 2-8 hours before being released.
Prior to your discharge, you will be provided with information regarding diet and medications, when you can resume physical activity, and when you can return to work. Please take all prescribed medications as directed – they are an important part of the recovery process. Follow-up appointments will allow the cardiologist to monitor your progress. they may include stress testing.
You must bring someone to drive you home from the hospital. Also, someone should stay with you during the first 24 hours after the procedure.
Please don’t hesitate to ask if you have any questions before your discharge.
Treatment options
There are three ways for your cardiologist to treat coronary artery disease: medications, coronary intervention or bypass surgery. common coronary interventions include angioplasty and stenting. These are designed to open narrowed arteries, relieve symptoms and decrease the risk for a heart attack.
Angioplasty and stents
Percutaneous transluminal coronary angioplasty (known simply as “angioplasty” or PTCA) is a technique that involves inflating a balloon in a narrowed artery.
the balloon compresses the plaque on the inside of the artery to restore proper blood flow. Continued use of the X-ray dye enables the cardiologist to see the artery on a monitor, and immediately determine the success of the procedure. The balloon may be inflated several times during the procedure.
Many patients also receive stents (thin, stainless steel mesh tubes) to support the artery wall and prevent the artery from renarrowing (called restenosis). The stent is placed over the balloon catheter, guided to the narrowed area, and expands as the balloon expands. Once the stent is fully expanded, the balloon is deflated and removed, leaving the stent in place.
Most patients experience some chest pain during angioplasty, as blood flow is blocked while the balloon is inflated. The pain decreases as the balloon is deflated. The cardiologist will remove the catheter when he/she is satisfied that blood is flowing through the artery properly.
Recovery is the same for angioplasty and stent patients. If you do receive a stent, however, you will likely be given a different medication. You will also be given a wallet card that identifies you as a stent recipient.
Other interventions
Your cardiologist may also recommend other coronary interventions as part of your treatment. They may include special catheters, cutting tools or devices to vacuum blood clots back into the catheter.
Clinical research
Iowa Heart Center cardiologists are involved in several clinical research studies to assess new, cutting-edge technologies in the treatment of coronary artery disease. you may be asked to participate in one of these trials. Participation is strictly voluntary, and will not affect the quality of your care.
Bypass surgery
If your blockage is too tight and you are not a candidate for angioplasty, or in the event of other technical difficulties, your cardiologist may recommend bypass surgery.
Bypass surgery (known as coronary artery bypass grafting, or CABG) creates new routes for blood flow to the heart. A blood vessel from the leg or chest (the graft) is attached to the aorta, then to the coronary artery below the blockage. The new graft essentially bypasses the blockage, restoring normal blood flow to the heart.
Bypass surgery is a complex medical procedure, performed by a cardiothoracic surgeon under general anesthesia.
