Cardiac Catheterization

What is cardiac catheterization?

Cardiac Catheterization is common, relatively painless, nonsurgical procedure that can help your doctor diagnose a heart problem. To perform the procedure a cardiologist inserts a long, flexible tube called a catheter into an artery and gently guides it toward your heart. Once the catheter is in place, x-rays and other tests are done to help your doctor evaluate how well your heart is working.

Cardiac Catheterization can show:
If the blood vessels in your heart are clogged
If your heart is pumping normally can blood is flowing correctly
If you were born with any heart problems

What do I need to know about cardiac catheterization?

Cardiac catheterization is performed to detect the presence of heart disease, determine its severity, and learn how it affects the heart’s capacity to function. The test results help to diagnose and treat the condition. On the day before the procedure, you will probably be asked not to eat or drink anything after midnight, and your groin or forearm will be shaved.

What is the catheterization procedure?

Cardiac catheterization is performed by a cardiologist in a special laboratory, under sterile conditions. Before the procedure, the area that was shaved will be scrubbed with an antiseptic agent. You will then receive an injection of local anesthetic just beneath the skin. The injection may feel similar to that of a bee sting. The doctor will then insert one or more sterilized, fluid-filled thin plastic tubes (catheters) into a blood vessel in your arm or groin. More than one catheter may be inserted into an artery and vein at the same time, or a catheter in the artery or vein may be exchanged sequentially for another catheter. The doctor then gently advances the catheter through the blood vessels and into your heart with the aid of an x-ray machine (fluoroscope). The blood vessels and heart do not have nerves in the inner linings; therefore the procedure causes minimal discomfort. With the catheter in place, the doctor next measures the pumping capacity of your heart as well as the blood pressure in the various chambers of your heart and lungs. These measurements enable the cardiologist to determine the effectiveness of the heart as a pump and whether or not has been impaired by any disease process that can harm the valves of the heart muscle or coronary arteries.

During the procedure, a dye that shows up on x-ray is rapidly injected into the chambers of your heart. This allows your doctor to produce a ventriculogram, or movie, of the heart as it pumps. As the dye is injected, you may experience a sensation of warmth or flushing, but this is a normal reaction, and will last only 20-30 seconds. The dye is also injected directly into your coronary arteries, which deliver oxygen-containing blood to the heart muscle. Here, you may also experience transient chest discomfort while the dye is injected. The movie of the dye flowing through the coronary arteries is called a coronary arteriogram. Depending on your medical condition, the cardiologist may also need to administer certain additional drugs. Drugs are given to thin the blood (heparin), to dilate the coronary arteries and reduce the workload of the heart (nitroglycerin), to control the heart’s rhythm (antiarrhythmic), and/or to relieve angina. You will need to lie still throughout the procedure, on a firm, thin, x-ray table, which does cause some back discomfort.

What is the proper follow-up care?

After the procedure has been completed, your care is determined in part by the site of catheter entry. If the procedure has been done through a blood vessel in the groin, you will usually need to lie flat on your back for at least 6 hours and sometimes for as long as 12 to 18 hours. Most patients can go home on the morning after the procedure, though many hospitals now do this as an outpatient procedure, so that the patient can go home late in the afternoon or early in the evening following an early morning procedure. If the catheterization is done via the arm, you usually do not need to stay in bed afterwards and sometimes can go home four to six hours later. Your physician will advise necessary restrictions of work or physical activity depending on your cardiac condition.

What are some possible complications?

The risks of cardiac catheterization include the possibility of blood clot forming that causes a stroke or heart attack, bleeding, damage or obstruction of a blood vessel and even death. However, in medically stable patients undergoing elective cardiac catheterization for the evaluation of coronary artery or valvular heart disease, the risk of a potentially fatal result is less than 1 in 500 cases

If there is swelling or bleeding from the catheterization site or if the extremity becomes cold, pale, or numb following discharge, you must immediately contact your physician.

Catheterization Preparation

What are the pre-procedure requirements?

Before your cardiac catheterization, your doctor will explain the procedure, risks and benefits. You will be required to sign a legal consent form thereby authorizing the consultant to perform the procedure.

What do I need to know before the procedure?

If your catheterization is scheduled for early morning, you probably will not be allowed to eat or drink anything after midnight. The skin of catheterization site will be shaved and prepared with antiseptic solutions to protect against infection.

What should I expect during the procedure?

When you reach the catheterization laboratory, you will be placed on a narrow padded table. During catheterization, the physician will move the table to view your heart from different angles. The X-ray camera will be moved around you to get the best possible pictures. Special foam pads, called electrodes, will be placed on your chest and connected to a monitor so that your heartbeat can be monitored.

Cardiac catheterization usually takes 1 hour or less. You will be awake throughout the procedure, although the physician may order some medication to help you relax. (Some patients even doze off.)

When the physician is ready to begin, he will inject a local anesthetic at the insertion site. The injection may feel a little uncomfortable, but it will numb the area before he puts in the catheter. When the catheter is going in, you should feel a little pressure but no pain.

If the catheter meets blockage-where arteriosclerosis has narrowed a blood vessel, for example, the physician will withdraw the catheter and start from another insertion area.

When the catheter enters your heart, you may experience a fluttering or flip-flop sensation. Tell the physician if you do but do not be alarmed as it is a normal reaction. You are likely to feel a warm sensation, some nausea or the urge to urinate if dye is injected but these feelings will pass quickly. Throughout the procedure, remember to let the physician or the nurse know if you have chest pain.

During the procedure, your physician may ask you to cough. These actions help to advance the dye through your heart. The physician may also ask you to breathe deeply, which will give him a better view of your heart. When the physician removes the catheter, he will put a special bandage on your arm or groin. Along with the bandage you will also have a sandbag applied for 4-6 hours. The anesthetic will still be working, so you should not feel anything.

What do I need to know after the procedure?

After your catheterization, you’ll need to remain lying down for 4-6 hours. If the catheter was inserted in your groin, you’ll be asked not to move your leg to prevent bleeding.

The nurse will do frequent blood pressures and checking of the insertion site, so do not be alarmed. The x-ray contrast liquid may cause you to urinate more than usual. You may be asked to drink a lot of fluid to help flush the contrast liquid out of your system.

Inform the Nurse:

  • If you feel any chest pain or discomfort at the insertion site.
  • The arm or leg used for insertion becomes cold or numb.
  • You feel warmth or wetness around the insertion site.
  • As soon as the test results are available, the physician will talk to you and your family about them.
  • Do not hesitate to ask the doctor or nurse any questions you may have.

Call Your Doctor If:

  • The insertion site begins to bleed.
  • You feel any chest pain or discomfort at the insertion site.
  • The arm or leg in which the catheter was inserted feels cold or numb.
  • Bruising or swelling increases.