Guide to Cardiac Catheterization

Cardiac catheterization is a diagnostic procedure performed in a hospital or hospital-like setting by an experienced cardiologist. This invasive test is done to check for blockage in the coronary arteries, to check the function of the heart valves and to monitor the heart's pump function. Based on the findings of the cardiac catheterization, a cardiologist can pinpoint which treatment options are best for the patient.

Preparation

• Having a cardiac catheterization is a big decision. One of the most important tasks a physician and other health care professionals have is to properly educate patients about the procedure. Education includes what to expect before and during the procedure, as well as postprocedure care.

  The patient and his family must completely understand the risk, benefits and complications before proceeding. A consent form must be signed before the procedure can begin, except in the case of emergency.

  Before the procedure, the patient is shaven and prepped with an antibacterial solution, such as betadine. A sedative is given to the patient to relax her, but she is still awake enough to talk to the physician or nurse.

The Procedure

• Cardiac catheterization is divided into two steps: a right heart cath and a left heart cath. The right heart cath informs the physician of the pressures in the heart and is very useful in diagnosing heart failure and how strong the heart is pumping. The left heart cath shows blockages in the arteries supplying blood to the heart muscle.

  The procedure is performed by inserting a hollow tube or sheath into the artery in the groin (femoral artery) or the arm (brachial artery) and passing the flexible catheter through this sheath into the heart. The catheter's tip has a balloon that can be inflated and deflated with a syringe at the other end of the catheter, allowing it to pass through the vessels.

  Once the catheter is in place, a contrast dye is injected into the heart. The procedure of injecting this dye is also called an arteriogram or angiogram. The dye flows as the blood flows through the blood vessels and valves of the heart, allowing the physician to visualize the flow on a monitor. Narrowing or blockages along with leaking valves can be seen on the monitor.

Getting Back to Your Room

• The physician may or may not remove the sheath placed in your artery in the cardiac catheterization lab. If he doesn't, it will be removed by the nurse or tech after you have returned to your room. It may take a while for the blood thinners in your system to wear off, so the nurse may wait a period of time to remove this tube to lower your risk of bleeding.

  After it is removed, manual pressure may be held on the site and a pressure dressing may be applied. Frequent monitoring is necessary to make sure there is no bleeding at the site. Many times, patients are required to lay on their back for several hours. Pain relievers and measures can be taken to relieve back and leg discomfort.

Risks and Complications

• While a cardiac catheterization is a common procedure, risks and complications do exist. Many of these are minor, including the most common complication which is bruising around the insertion site, due to the puncture of the needle and the blood thinners on board.

  Other complications may include bleeding around the site, internal bleeding due to damage of the femoral artery which can cause a hematoma, damage to the coronary arteries resulting in a tear, abnormal heart rhythms that occur during the procedure and even kidney failure from the contrast or dye that is injected into the arteries. The most serious complications that can occur, although rare, are stroke and death.

The Results

• Depending on the results of a cardiac catheterization, the patient and his physician decide on treatment. If blockages are present, the physician may decide to treat the patient with medication, angioplasty (dilating the vessel with a balloon), stenting (designed to keep the vessel open) or coronary artery bypass surgery. If the heart valves are defective, the patient may require medication, further monitoring or valve repair or replacement surgery.

  Many cardiologists will perform an angioplasty and/or insert a stent to correct any blockages while their patient is in the cath lab, instead of bringing them back for an additional procedure.