Cardiac Catheterization
Cardiac catheterization is a common diagnostic test performed thousands of times a day. The patients who are told that a heart catheterization is necessary always have questions about the procedure. Here is a simple review of the heart's anatomy.
Anatomy of the Heart
The heart is a muscular organ composed of four chambers; two upper chambers called atria and two lower chambers called ventricles. These four chambers pump blood through the body in a rhythmic pattern with the help of the four valves in the heart. The movement of blood through the body can be felt at the wrist or neck and is known as the pulse.
Although the heart is full of blood, it cannot receive oxygen and nutrients from the blood inside the chambers. The heart muscle must rely on the arteries on the surface of the heart to nourish it and keep it working properly. These surface arteries are known as the coronary arteries. There are three main coronary arteries: the right coronary artery, the left anterior descending coronary artery and the circumflex coronary artery These three arteries branch into thousands of small arteries like a tree trunk brunches into limbs, bringing oxygen and nutrients to the heart muscle cells.
Occasionally, these arteries become narrowed due to a build-up of fat, cholesterol and calcium and cannot carry enough oxygenated blood to the muscle This reduced flow of blood through the narrowing is a lot like what happens to the plumbing in our homes as the pipes become rusty with a build-up of mineral deposits - not as much water can flow.
Coronary Artery Disease
The term coronary artery disease refers to any abnormal condition of the coronary arteries that interferes with the delivery of an adequate supply of blood to the heart muscle More than 95 percent of all coronary artery disease is atherosclerosis.
When the heart muscle does not get enough oxygenated blood to meet its demands, it experiences a hunger for more oxygen. This hunger is felt by the patient as a tightening, pressure, or fullness in the chest we term angina pectoris. In order to treat coronary artery disease most effectively, we must have an accurate picture of the coronary arteries. The only way we can actually see these arteries is by injecting dye into them during a cardiac catheterization.
Cardiac catheterization is also useful in diagnosing other kinds of heart trouble such as defective heart valves, muscle disease and problems of the heart which you may have been bom with which are known as congenital abnormalities.
Cardiac Catherization Procedure
Overview
During cardiac catheterization, your physician will insert a long, thin tube into a blood vessel in your groin or arm. The tube will be gently directed to the heart and to the origin of the coronary arteries. Dye is then injected into the coronary artery while x-ray pictures are taken. The dye in the coronary arteries is seen by the x-ray as a white line. A disruption of the white line may signify an area of plaque build-up inside the wall of the artery.
During this same procedure, dye is injected into the heart's pumping chambers in order to see how well the heart muscle is contracting and how well the valves are working. Pressure measurements are also taken at this time and are interpreted by a computer.
What You Can Expect To Experience
Pre-Catherization
You will be admitted to the cathing facility the afternoon before or the morning of the procedure You will be asked to come to our office before your procedure for pre-testing. This may include blood work, ECG, chest x-rays and a breathing test. You will also view a short movie about the procedure- A nurse will make sure we have a complete list of your regular medications and give you instructions. The nurse will also listen to the blood flow in your neck and leg arteries with a stethoscope. After midnight prior to the day of your procedure, you will be asked not to eat or drink anything, except enough water to take your medications.
About one hour before the procedure, you will be given a mild sedative to help you relax, but not put you to sleep. An intravenous line will also be started. You will remain awake throughout the procedure so you may follow the doctor's instructions and let him know if you are uncomfortable or having any problems.
Catheterization
On your arrival to the cath lab, you will be asked to move onto a large ray table The table may feel a bit and you will see a lot of equipment around you. Nurses and technicians will prepare you for the procedure ( placing EKG electrodes on your chest, cleansing your groin area and elbow with antiseptic solution and cover you with sterile towels and sheets. When your doctor arrives, he will inject your groin or arm with a numbing medication known as Xylocaine.
After this medication has taken effect, your doctor will make a small puncture into your blood vessel where he will insert the catheter. The physician will watch the movement in the catheter by x-ray. You may feel some pressure at the site of the insertion. You will not feel the catheter inside your body. Once the catheter has been guided to your heart, the dye is administered through the catheter.
When this occurs, you may feel flush all over your body This will last only for some 15 to 20 seconds. This is a normal reaction to the dye and is not a cause for concern. There may be several injections of the dye, and the catheter may be moved around during the procedure. This is necessary to get different views of your heart and coronary arteries.
During the catheterization procedure you will be asked to breathe deep and cough. This coughing is very important as it helps get the dye out of your heart. So when the doctor asks you to cough, please cough forcefully. The entire time in the cath lab will probably be one to two hours. Be sure to let your physician know if at any time you feel dizziness, nausea, tingling, numbness or chest discomfort.
Once the catheterization is complete the catheter is removed and firm pressure is applied for approximately 30 minutes; also a large tight dressing will be put in place.
If you feel pain, dizziness, faintness or cold hands/feet, let the nurses know immediately You may have a backache from lying flat and you will probably feel cold soon after you come out of the cath lab These are normal feeling and they will go away very soon. But be sure to notify the nurses so they can offer you pain medication or extra blankets.
Post-Catheterization
After the catheterization, you will he returned to a recovery area or your room. You will have to lie flat in bed for six hours so the puncture site can heal You will be allowed to resume eating and drinking now. Your blood pressure and pulse, as well as the puncture site, will be checked frequently.
Results
Your Heart & Vascular Center physician will most likely discuss your findings with you and your family that same day or the following morning.
Discharge
Outpatient cases will be discharged and released later the same day of their procedure Inpatients will be discharged the following morning.
When the dressing is removed, you will notice a small bruise at the catheter insertion site, no larger than the size of a quarter. You may also feel a hard lump at the insertion site, The bruise may become slightly larger and darker the first few days you are home.
The bruise and the lump are the result of the blood vessel's normal healing process and in one to two weeks will completely disappear. If you are uncomfortable about the size or appearance of the bruise, or are experiencing discomfort, please call our office immediately.
A cardiac catheterization does not treat or cure heart disease, but it does give your physician very precise information about your heart. You and your physician can now decide what options of treatment are best for you.