Diagnostic Cardiac Catheterization
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Doctors refer patients for cardiac catheterization (angiogram) in cases where patients exhibit unstable angina, abnormal treadmill tests, valvular disease, heart attack, cardiomyopathy, or heart failure.
The day before the catheterization test, other procedures, such as ECG, chest x-rays and laboratory work, are performed in hospital. Patients are required to fast from midnight the night before the procedure. Patients take their medication as usual with sips of water. Patients are required to advise their doctor if taking blood thinners (Coumadin), water pills (diuretics), if they are diabetic, or if they are allergic to shellfish, or iodine. Patients should remove all jewelry and contact lenses.
Prior to the procedure patients are placed on a heart monitor with electrodes attached to the skin and an intravenous line is inserted. In the laboratory,
the patient is placed on a table and the catheter site is established by using an artery located in the groin, or an artery near the elbow on the arm.
The catheter insertion area is numbed using local anesthesia. Then a long tube, called a sheath, is inserted to access the artery. From there, catheters are threaded up through the aorta into the coronary arteries where dye is injected to assess blood flow. At the same time a camera is quickly moving over the patient taking x-ray pictures. The table may move back and forth to obtain views of the arteries from different angles.
Catheters are then used to assess pressure in the aorta and the left ventricle (chamber) of the heart. Finally a contrast solution (radiopaque dye) is injected into the heart chamber to measure muscle strength. Pressure measures are taken again as the catheter is removed from the heart chamber. The x-ray pictures are recorded on compact disc, which the doctor reviews and analyzes for final diagnosis.
If there is a blockage, the doctor may go ahead and perform an angioplasty (ballooning), and/or stent. The initial angiogram of the heart, including preparation time is approximately 30-45 minutes. If an angioplasty (ballooning) is required, it may take an additional 15 minutes to one and a half-hours.
After Procedure Care:
Back in the holding area , the catheter is removed and pressure is held for ten to fifteen minutes to stop the initial bleeding of the artery. In order to allow the artery to heal, patients are required to lay flat for a period of two hours. A nurse will assist with eating, drinking, or washroom visits, as well as monitoring blood pressure, pulses, and catheterization site. If the artery bleeds, there will be an extension of bed rest and discharge may be postponed. Patients are required to drink plenty of fluids to rehydrate and to flush out the radiopaque dye.
The most common complication involves bleeding from the artery at the catheter puncture site. This is called a hematoma. Rarely does this require surgical treatment, or blood transfusion. More serious complications can occur, including allergic reactions, infection, damage to the artery requiring surgical repair, blood clots, heart attack, stroke, or even death.
The doctor will explain the risks involved with the procedure as well as the preliminary test results. The doctor will review the images and consult with other physicians before making final recommendations. Prior to discharge from the hospital, the doctor will discuss the final results and treatment plan.
Patients with normal test results and those being treated with medications are to follow these discharge instructions:
- No driving the day of the procedure.
- No baths are allowed for three days, because bath water may promote infection. Showers are advised. Patients are to wash normally with soap and water,
but not to apply pressure around the catheter site. Pat dry instead of rubbing.
- Site care requires watching for signs of infection: pus drainage, warmth, redness at site, or increased body temperature greater than 100 degrees F.
Any bruising, or hematoma should diminish within one to two weeks. If increased bruising, swelling, or infection occurs, contact your doctor immediately.
- Avoid any strenuous activity, such as heavy lifting of more than five to ten pounds, working out, or housework for three days. Climbing, or walking
up stairs is permitted.
- Returning to work depends on the nature of your occupation and the healing process. Ask your doctor when you can return to work.
- When leaving hospital, the nurse or doctor will give you an explanation and/or prescriptions for all your medications. These instructions will include the medication's name, dosage, schedule, and possible side effects.