Cardiac Catheterization

Your doctor has recommended you to have a cardiac catheterization or an angiogram of your heart.

Cardiac catheterization may be indicated for:

1. Unstable angina
2. Abnormal treadmill test
3. Valvular disease
4. Acute myocardial infarction (heart attack)
5. Cardiomyopathy and/or heart failure

The following information can be obtained from your cardiac catheterization:

1. Determine if there are any blockages in the coronary arteries or coronary artery bypass grafts
2. Determine how well the heart muscle squeezes (contractility)
3. Evaluate the heart valves
4. Measure various pressures inside the chambers of the heart
5. Determine whether there are any birth defects or shunts present

The results of your cardiac catheterization will fall into one of the following categories:

1. Completely normal
2. Treat with medications
3. Need for interventional therapy such as angioplasty (ballooning) or atherectomy (shaving)
4. Open heart surgery - repair or replace the heart valve and/or coronary artery bypass procedure (CABG)

Before the Procedure
Prior to your catheterization, pretesting will be required which will include: ECG, chest x-ray, and lab work. If you are coming from home, this testing needs to be arranged with the Pre-Admission Department and will be done prior to the day of your procedure. A class on cardiac catheterization and videos are offered in the Cardiac Conditioning Center at specific times during the day. The night before your procedure, the Admitting Department will call you at home between 6:00 - 9:00 p.m. to give you the time of arrival to the hospital in the morning. You should report to the Admitting Department at the designated time.

The night before the procedure, you will be required to fast after midnight. The morning of the procedure you should take your medications with sips of water. Consult with your doctor if you are on a blood thinner (Coumadin), water pills (diuretics), or if you are a diabetic.

If you are allergic to shellfish or iodine, please inform your doctor so premedication can be given prior to the procedure.

Prior to the procedure you will be placed on a heart monitor and an IV access site will be established. You should remove all jewelry, but you may leave on your wedding band. You also may leave partial or full dentures intact and you may also wear your glasses to the procedure if you wish to watch. We ask that you remove contact lenses.

You will be expected to sign consent forms before the procedure.

Right before leaving to go to the cath lab, you should empty your bladder. A preoperative medication may or may not be given prior to you leaving your room.

In the Cath Lab

Set-Up
When entering the cath lab, you are greeted by the cath lab team and placed on a table. You may note that the room will be cool. Electrodes will be placed on your chest to enable the team to monitor your heart during the procedure.

Most angiograms of the heart are performed by using the femoral artery located in the groin area. Both groin sites will be prepped by shaving, washing, then scrubbing the areas with Betadine, then sterile towels and drapes are placed from the neck down. If you have known peripheral vascular disease (any problems with blood supply to your legs), the doctor may need to use the artery in the arm at the elbow site to perform the procedure.

Procedure
The doctor will begin the procedure by numbing the area of the groin site with a local anesthesia that burns or stings a little before it takes effect. Then a long, thin tube, called a sheath, will be inserted to establish access into the artery. From there, catheters are threaded up through the aorta and then into the coronary arteries and dye is injected several times to assess blood flow through the artery.

As the catheter is being moved inside, you may notice slight pressure in the groin, but this is not painful.

At the same time, a camera will be quickly moving above your chest and taking x-ray pictures and the table may move back and forth to obtain views of the arteries from several different angles. Then a catheter is placed into the aorta where pressure measures are made. This catheter is then advanced across the aortic valve and pressures within the pumping chamber (left ventricle) are obtained. The catheter is then attached to an injector. The camera is placed to the right of you and a radiopaque dye is injected into the pumping chamber. This illuminates the pumping chamber and determines how well it squeezes. During this time, you may feel a warm blushing sensation throughout your body for approximately 30-45 seconds. Pressure measurements are again taken after injection of dye into the pumping chamber and as the catheter is withdrawn back across the aortic valve and then removed from your body.

The x-ray pictures are recorded on videotape and can be provided for "instant replay" as needed and then processed on movie film which the doctor can review and analyze for final diagnosis.

If there is a blockage that may be helped by angioplasty (ballooning) or atherectomy (shaving), as you are on the table, the doctor may go into either procedure provided your permission was previously granted and a surgical team is available for standby.

The initial angiogram of the heart including preparation time is approximately 30-45 minutes. If angioplasty (ballooning) or atherectomy (shaving) is additionally performed, it may take an additional 15 minutes to an hour and a half, depending on how technically difficult it is to open up the artery.

After the Procedures
Either immediately after the angiogram or when you get back to your hospital room, the sheath is removed from the artery and pressure is held for twenty to thirty minutes to stop the initial bleeding from the artery. An ice pack and sand bag are then placed. You will be required to lay flat with the involved leg straight for a period of four to eight hours to allow the artery to heal. This is a very important time and your cooperation is necessary. You may need your nurse to assist you to eat, drink or urinate during this time period. Your nurse will be checking your blood pressure, pulses, and site frequently after the procedure. If you feel a warm sensation or intense pain at the catheter site, notify your nurse immediately. If your back becomes stiff or sore during this time period, a pain medication can be provided as needed. After the allotted time of bed rest is completed, the nurse will slowly raise the head of your bed, and then will let you bend your leg and move around. You will need to walk the hallways with assistance prior to discharge home.

If the artery bleeds for any reason, there will be an extension of bedrest and discharge may then be postponed.

The contrast media used during the procedure acts like a diuretic or "water pill" so you may note frequent urination after the procedure. An abundance of oral fluids is encouraged for hydration and to flush the contrast media out of the kidneys.

If the arm approach is used, a large pressure dressing is applied over the incision and the arm will need to be straight for approximately four to six hours. Usually, you will be able to sit up in bed or in the chair and use the bathroom shortly after the procedure. If sutures are present from a cutdown procedure, they will be removed in approximately one to two weeks in the doctor's office.

What Are the Risks Involved?
With today's technology, cardiac catheterization is a relatively safe procedure. Although extremely rare, complications can occur since this is an invasive procedure. It is important to realize that the benefit of finding out the exact state of your heart far outweighs the risks of having the procedure done. The more information your doctor can obtain about your heart, the greater chance that the treatment recommended can be successful.

The most common complication involves bleeding from the artery at the puncture site, either outward or you may bleed inward into the surrounding tissue. This is called a hematoma. Rarely does this ever require surgical intervention or blood transfusion. More serious complications can occur, including allergic reaction, infection, damage to the artery which may require surgical repair, blood clots, heart attack, stroke or even death. The doctor will discuss with you any additional risks or complications or questions you may have pertaining to your particular case.

Discussion of Results
Your doctor will discuss preliminary results immediately at the conclusion of the procedure while you are on the table and then with your family in the waiting area. The cardiac catheterization films need to be developed and processed afterward which may take an additional 30-60 minutes. Your doctor will review them and may need to consult with other doctors before final recommendations may be made. Your doctor will come up to the room prior to discharge to discuss the final results and plan of treatment with you.

Post Discharge Instructions
The following instructions are for those who have had normal results or are being treated with medications but have had no other cardiac interventions or a heart attack.

Driving

If you are discharged home the same day of the procedure, you should not drive home due to the relaxing medication given during the procedure. Driving may be resumed the following day.

Bathing

Showers are allowed. Wash normally with any kind of soap and water but do not apply unusual pressure at the site of the catheter insertion. Pat dry instead of rubbing the skin dry around the site. No baths are allowed for three days because the bath water may be a medium for infection into the blood stream.

Site Care

You may or may not place a band-aid at the site. Watch for any signs of infection: drainage of pus, warmth, redness at the site or increased temperature greater than 100 degrees F. If you have any bruising, it should gradually fade within one to two weeks. A hematoma (collection of blood in the tissue) may be painful to touch but should also reduce in size and tenderness within one or two weeks. If increased bruising, swelling or infection is noted at the site, notify your doctor immediately.

Activity

To allow the artery to heal, you should avoid any lifting of more than 5-10 pounds, working out, any strenuous activity or housework for three days. You can walk or climb stairs to reach your destination.

Work

Ask your doctor when you will be able to return to work. The nature of your occupation plus your progress will determine this. You may return to work as soon as the next day to within a week.

Medications

Upon discharge, your nurse and doctor will give you an explanation and/or prescriptions of all your medications. These instructions will include the medication's name, dosage, schedule and possible side effects.

This educational material is designed to provide general information concerning this procedure. As always, if you have any questions, please discuss them with your doctor.