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Cardiac Catheterization
What Is Cardiac Catheterization?
Cardiac catheterization, also known as cardiac cath or heart
catheterization, is a medical procedure used to diagnose and treat some
heart conditions. It lets doctors take a close look at the heart to
identify problems and to perform other tests or procedures.
Your healthcare provider may
recommend cardiac catheterization to find out the cause of symptoms
such as chest pain or irregular heartbeat. Before
the procedure, you may need to diagnostic tests, such as blood
tests, heart imaging tests, or a stress test, to determine how well your
heart is working and to help guide the procedure.
During cardiac catheterization, a long, thin, flexible tube called a
catheter is put into a blood vessel in your arm, groin or upper thigh,
or neck. The catheter is then threaded through the blood vessels to your
heart. It may be used to examine your heart valves or take samples of
blood or heart muscle. Your doctor may also use ultrasound, a test that
uses sound waves to create an image, or they may inject a dye into your
coronary arteries to see whether your arteries are narrowed or blocked.
Cardiac catheterization may also be used instead of some heart surgeries
to repair heart defects and replace heart valves.
Cardiac catheterization is safe for most people. Problems
following the procedure are rare but can include bleeding and blood
clots. Your healthcare provider will monitor your condition and may
recommend medicines to prevent blood clots.
Who Needs a cardiac catheterization?
Your healthcare provider may recommend cardiac
catheterization to find out what is causing
symptoms of a heart problem or to treat or
repair a heart problem.
Cardiac catheterization can be used for
different purposes.
-
Give a better understanding of other test
results, such as echocardiography
(echo), cardiac
MRI, and cardiac
CT scan. This is especially helpful if
the results from those tests could not
identify the problem or differ from what
your doctor finds when examining you.
-
Diagnose heart conditions such as arrhythmia, heart
attack, pulmonary
hypertension, cardiomyopathy, coronary
heart disease, and heart
valve diseases, including aortic stenosis and mitral
regurgitation.
-
Evaluate you before a possible heart
surgery, such as a heart
transplant.
-
Measure oxygen levels and blood pressure in
the chambers of your heart and the pulmonary arteries.
Your doctor may do other procedures to diagnose
or treat your condition during cardiac
catheterization.
-
Collect biopsies of small samples
of heart tissue for more laboratory testing.
Biopsies can be used for genetic testing,
to check for myocarditis (a type of heart
inflammation), or to look for transplant
rejection.
-
Use coronary
angiography to look at the
heart or blood vessels by injecting dye
through the catheter.
-
Perform minor heart surgery to
treat congenital
heart defects and replace or widen
narrowed heart valves.
-
Use percutaneous
coronary intervention (PCI) to
open narrowed or blocked areas of the
coronary arteries. PCI may include balloon
dilation, also known as angioplasty ,
or stent placement.
Most people who have heart attacks or
underlying heart disease have narrowed or
blocked coronary arteries.
-
Apply catheter
ablation to treat arrythmias.
Who should not have cardiac catheterization?
Your doctor may wait to do the procedure or
recommend that you do not have cardiac
catheterization if you have any of the following
conditions:
- Abnormal electrolyte levels
in your blood
- Acute gastrointestinal
bleeding
- Acute kidney failure, or serious kidney
disease that is not being treated with
dialysis
- Acute stroke
- Blood that is too thin from blood-thinning
medicines or other causes
- High levels of digoxin, a heart medicine used to
treat heart
failure or arrhythmia,
in your blood
- Previous serious allergic reaction to the
dye that is used during cardiac
catheterization
- Severe anemia,
which is a lower-than-normal amount of red
blood cells or hemoglobin
- Unexplained fever
- Untreated infection
Preparing for a Cardiac Catheterization
Before cardiac catheterization, you will meet
with your cardiologist, a doctor who specializes
in the heart. You will be asked about your
medical history, including what medicines you
are taking and any allergies you may have, and
you will have a physical exam. You will also get
instructions on how to prepare for the
procedure.Diagnostic tests and procedures
You may need to have some tests before your
catheterization procedure.
- An electrocardiogram
(ECG or EKG) looks at your
heart’s rhythm and other electrical
activity. It can show arrhythmias, heart
attacks, and other heart problems.
- A chest
X-ray looks at your lungs, your
heart, your major blood vessels, and other
structures in your chest.
- An echocardiogram
(echo) looks at the structure and
function of your heart.
- A stress
test looks at how well your
heart works during physical stress. The
stress may be physical exercise, such as
walking on a treadmill, or it may be caused
by a medicine that can be given to get the
same effect.
-
A cardiac CT (computed tomography) scan looks
for narrowing of your heart’s blood vessels
and problems with the heart, larger blood
vessels, and heart valves. These pictures
may also help your doctor plan for
procedures to open the coronary arteries.
-
Cardiac MRI (magnetic resonance imaging) provides
information on the structure and function of
your heart, as well as the type and severity
of heart disease.
-
Blood tests check for certain
diseases and conditions. A complete blood
count (CBC) checks your hemoglobin and
platelet levels. Blood chemistry tests check
how well your liver and kidneys are working.
Other tests may check your blood’s ability
to clot.
Preparing for the procedure
Talk to your healthcare providers about your
medical history, including medicines you take,
other surgical procedures you’ve had, and any
medical conditions you have, such as diabetes or
kidney disease.
Your healthcare provider will talk to you about
how to prepare for the procedure, including:
- When to arrive at the hospital and where to
go.
- When you should stop eating or drinking.
- If and when you should start or stop taking
medicines.
- How long you should expect to stay.
- What happens during the procedure.
- What to expect after the procedure,
including potential problems, such as
bleeding or soreness.
- Instructions for recovering after the
procedure, including what medicines to take.
During Cardiac Catheterization
Cardiac catheterization takes place in a
catheterization laboratory, or cath lab, which
is similar to a small operating room. The
procedure is often done in a hospital, but you
may be able to have the procedure in a
catheterization lab located in a medical clinic,
depending on the reason for the procedure.
How is cardiac catheterization done?
Before cardiac catheterization, an intravenous
line (IV) will be placed in a vein in your arm.
Through this IV, you will get medicine to either
help you relax or make you sleep during the
procedure.
You will get numbing medicine at the site where
the doctor will insert the catheter. This may be
in the upper thigh, arm, or neck or under the
collarbone. The doctor will place a needle into
the blood vessel. A guidewire is inserted into
the needle, and the needle is taken out. Then
the doctor places a small tube called a sheath
in the blood vessel around the guidewire. The
guidewire is removed. The catheter is then
inserted through the sheath. Your doctor watches
X-ray images to see where to place the tip of
the catheter.
Once the catheter is in place, your doctor may
use it to perform tests or treatments on your
heart. For example, your doctor may inject a dye
into the catheter to look at blood flow in the
heart. The dye will enter your blood vessels and
make your coronary arteries visible in X-ray
images.
Possible risks
Cardiac catheterization is a relatively safe
procedure, and complications are rare. However,
as with any procedure involving the heart and
blood vessels, there are some risks.
Possible risks include the following:
-
Allergic reaction to the dye
-
Irregular heart rhythm (arrhythmia)
-
Bleeding or discomfort where the
catheter was inserted
-
Blood clots
-
Collapsed lung, called pneumothorax
-
Damage to blood vessels, heart valves, or
the heart from the catheter
-
Heart attack
-
Hypothermia, or very low body
temperature, especially for small children
-
Infection
-
Low blood pressure from
bleeding or as a reaction to the procedure
-
Need for a blood
transfusion
-
Need for emergency surgery to
repair a tear in a blood vessel, such as
the aorta or
a coronary artery, and restore blood flow to
the heart. This may be done using a coronary
artery bypass graft (CABG).
-
Side effects of the medicine to help you
relax or sleep, if used. These can
include nausea, vomiting, confusion, or an
allergic reaction.
-
Side effects of radiation. Although
not an immediate risk, repeated radiation
exposure from X-rays used to place the
catheter may increase the risk of cancer and
leukemia, skin damage, and cataracts later
in life. This is especially true for
children.
-
Stroke
What happens after the procedure?
After the procedure, your doctor will remove the
catheters, sheath, and guidewire. A dressing,
accompanied by pressure, will be applied to the
site where the catheter was inserted to stop the
bleeding. The pressure may be applied by hand or
with a sandbag or other device.
You will be moved to a recovery room, where you
will lie in a bed. Your healthcare provider will
monitor your heartbeat and blood pressure.
Depending on your health before the cardiac
catheterization and any additional procedures
done during the cardiac catheterization, you may
have to spend the night in the hospital. Ask
your healthcare provider about what medicines to
take and when to resume activity as you recover
from the procedure.
Recovering from a Cardiac Catheterization
If you have had cardiac catheterization, it is important
that you receive follow-up care, know about the possible
complications that may occur after the procedure, and follow
the treatment plan that your healthcare provider recommends
for your condition.
Receive follow-up care
It is important to get routine follow-up care after you have cardiac
catheterization. Talk with your healthcare provider about how often to
schedule office visits.
-
Adopt a heart-healthy
lifestyle, especially
if your cardiac catheterization was needed because of coronary heart
disease or heart attack.
-
Ask when
you can resume physical activity and lifting objects, and what level
of activity is best for you.
-
Follow
instructions on how to care for the site where the doctor
accessed your blood vessel, including information about when you can
take a bath or swim.
-
Keep any
follow-up appointments or tests.
-
Take any
medicines as directed by your doctor.
-
Talk to
your healthcare provider about any blood tests you may need
if you were placed on blood thinners after your procedure.
When to call the doctor
Late complications from cardiac catheterization are rare but can be
serious. A small bruise and tenderness at the access site is normal.
Call your healthcare provider immediately if you experience any of the
following, as they may be signs of serious problems:
- Bleeding from the access site that cannot be stopped with firm
pressure
- Chest pain or shortness of breath
- Dizziness
- Fever
- Increased pain, redness, or bruising at the access site
- Irregular, very slow, or fast heartbeat
- Swelling at the access site
- Yellow or green discharge draining from the access site
- Your leg or arm that was used for access becoming numb or weak, or
any part of it turning cold or blue
Other serious complications after catheterization, although rare,
include heart attack and stroke. Know the signs
of a heart attack and signs
of a stroke, and call
9-1-1 immediately if you or someone else is having symptoms.
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