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Cardiac Catheterization

Cardiac catheterization is a diagnostic procedure. This test can measure blood pressure and blood flow in the heart's chambers, examine the arteries of the heart (coronary arteries), and provide information about the pumping ability of the heart muscle. It is not surgery.

Long, flexible tubes called catheters, are used to both take measurements and to inject dye into your blood vessels and into your heart. The dye enables the doctor to take x-ray pictures (angiograms) of the heart and coronary arteries.

Cardiac catheterization is also performed to evaluate heart valve disease and congenital heart abnormalities.

Why does my doctor want me to undergo this test

Cardiac catheterization is performed for a variety of reasons. You may have presented to your physician with one or more of the following symptoms: shortness of breath, dizziness, palpitations or angina (pain or discomfort in the chest arm, or jaw).

You may have been taking nitroglycerin to relieve your angina, and recently your doctor has had to increase the dosage. Cardiac catheterization may be ordered to create pictures of your arteries (angiograms), which will help your doctor diagnose the existence and severity of coronary artery disease.

Sometimes your doctor wants information about the left lower chamber of your heart (left ventricle). In that case, cardiac catheterization may be used to create pictures of that chamber ( ventriculograms) Ventriculograms enable your doctor to visualize your left ventricle from many angles. They reveal much information about the ventricle's structure and functioning.

You might have already taken other less invasive diagnostic tests such a treadmill test, an echocardiogram or a nuclear scan. Based upon the results of those tests, your history, physical examination, and symptoms, your doctor has determined that additional information is required. Cardiac catheterization can provide that information.

Finally, you may be scheduled to undergo surgery on another part or system of your body. Your doctor has ordered a cardiac catheterization test to determine whether you have severe coronary artery disease. If so, he may want you to undergo one of two corrective procedures first. These are: coronary artery bypass surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA).

What are the risks of this test?
The risks associated with cardiac catheterization include: abnormal heart rhythms, perforation of a blood vessel, low blood pressure, infection, blood clots, allergic reaction to the dye, bleeding, kidney damage or failure, stroke, and heart attack. These events are rare.

What preparations should I make before this procedure?
Discuss your current medications with your physician. He may ask you to discontinue certain medicines such as anticoagulants prior to the catheterizatoin.. If you are taking insulin, your doctor will most likely recommend that you take a half dose. prior to the procedure.

Shower the night before. Do not eat or drink after midnight. If you have diabetes, consult your physician about eating. You may take approved medications with small sips of water.

Leave all valuables and money at home or with a relative. Do not wear any jewelry to the hospital. You may be allowed to wear eyeglasses, dentures or dental bridges. This varies from place to place.

If it is allowed, bring reading material with you. There may be periods of waiting before the actual procedure commences.

What happens on the day of the procedure?
Before the catheterization, a heart doctor (cardiologist), will examine you and review your medical history and diagnostic tests. He will explain the procedure and its risks and benefits, and will ask you to sign a consent form. Do not hesitate to ask questions and voice your concerns. Tell the doctor if you are pregnant or think you may be.

During your discussion with the doctor, he will ask you if you have any allergies, particularly to certain food or dyes. If you have allergic reactions to shellfish, and/or iodine-containing x-ray contrast liquid, you may be given medication to prevent an allergic reaction during the procedure.

You will also discuss your current medications. It is always a good idea to bring all your medicines with you whenever you visit a doctor or have a procedure performed. This enables the doctor to learn the exact dosages you are taking. Make sure to tell this doctor if you are taking nitroglycerin medicine.

Usually, you will have blood tests, an electrocardiogram, and a chest x-ray taken prior to the procedure.

Will I be given local or general anesthesia?
You may be given a mild sedative about 1/2 hour before the procedure to help you relax. You will stay awake throughout the procedure and will be asked to perform some simple tasks. At times you will be asked to take a deep breath, cough, turn your head to one side, or refrain from speaking for a few minutes while pressures are being measured.

You will be given a local anesthetic during the catheterization.

What happens during the procedure?
In most cases, the procedure takes place in the catheterization laboratory which is usually cold and dimly lit. The dimmed lights will make the TV screens that monitor the procedure appear brighter to the catheterization team. In addition to the television screens, you will see heart monitors, a blood pressure machine and other various instruments and devices in the laboratory.. You will lie on a bed near an x-ray camera. The camera will move across you on an arm over the bed.

Electrodes will be applied to your chest and back to monitor your heart rhythm at all times. A blood pressure cuff will be placed on your arm to monitor your blood pressure. You will be shaved and cleansed with antiseptic solution in the area of your groin where the catheter will be inserted. These steps are taken to prevent infection..

An intravenous line will be started in your arm to allow for the administration of medication during the procedure.

A local anesthetic will be injected into the skin to numb the insertion site. This stings a little bit. Then a small incision will be made in the skin. The doctors will use a special needle to puncture the blood vessel (vein or artery), into which the catheter. will be introduced. A radiologist or cardiologist will insert the catheter through a small incision in an artery or vein in your arm or groin. You will feel some pressure but no pain, If you do feel pain, let the doctor know, so more numbing medication can be given to you.

If the doctors want to view your left ventricle, the catheter will then be carefully threaded into your heart using X-ray ../images called fluoroscopy, to guide the insertion. When the catheter is in place, dye is injected to visualize the structures and vessels within the heart. The structures, vessels and blood flow are recorded immediately on the televisions screens. A permanent record is also produced.

If the doctors want to view your coronary arteries, the catheter is guided into each of the coronary artery openings. Dye is pumped into the arteries a few times. . This flow of dye. is also recorded on the television screens.

While the dye is moving through your blood vessels, you may feel hot or flushed for up to 30 seconds. Some people experience slight nausea or extra heartbeats.

How long does the procedure last?
The procedure takes from 20 to 40 minutes from the time of catheter insertion. The total procedure lasts about an hour to an hour and a half.

What will happen after the tests?
When the tests are finished, the catheter will be removed. If the femoral artery in the groin was used, firm pressure will be applied to the site for 10 to 20 minutes. Then bandages will be applied.. Sometimes a 5 pound sandbag will be placed on top of the bandages for 4 to 6 hours. This additional pressure helps to stop bleeding.

You will leave the catheterization laboratory and go to another room where you will have bed rest for up to six hours.. You must lie straight, with your head slightly raised. Depending on the insertion site, you should not bend your knee or arm. You may wiggle your foot and toes to prevent stiffness.

A nurse will check your insertion site. and vital signs. If you are in pain, ask her for medicine to relieve it. You may feel drowsy. Notify the nurse if you experience a sudden pain at the insertion site or if you have a warm, sticky or wet feeling around the site.

It's a good idea to drink a lot of fluids. This will hasten the removal of dye from your body.

You will be able to go home after the period of bed rest.

What happens when I get home?
Your doctor will tell you when you will be able to shower. It's usually after 24 to 36 hours. The bruise at the insertion site may take up to 2 weeks to heal. Call your doctor if pain or the size of the bruise increases.

What happens next?
The tests will provide your doctor with valuable information regarding your coronary arteries, the heart valves, your heart's electrical function, blood flow, and the presence of any blockages of blood flow. Based on this information your doctor will be better able to diagnose your heart problem and advise you.


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