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Cardiac Catheterization

What is a Cardiac Catheterization?

Cardiac catheterization is a procedure used to diagnose and treat cardiovascular conditions.  During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.  Using this catheter, doctors can then do diagnostic tests such as measurement of pressures or injection of contrast dye that can be seen on fluoroscopy.  This procedure provides a great deal of information about your heart function.  It demonstrates the heart’s pumping ability, the pressure within the various heart chambers, detailed structure and flow information about the heart and blood vessels.Sometimes significant coronary artery disease is identified from diagnostic cardiac catheterization.  In these cases, coronary angioplasty and stents implantation can be performed immediately following the diagnostic study.

Why am I having Cardiac Catheterization?

Cardiac catheterization is done to see if you have a heart problem, or as a part of a procedure to correct a heart problem that is already known.  Cardiac catheterization can identify:

• Narrowing or blockages in your blood vessels that could cause chest pain
• Assess the amount of oxygen in your heart
• Measure pressures inside your heart
• Take sample of tissue from your heart
• Diagnose heart defects present from birth
• Look for problems with your heart valves

Cardiac catheterization is also used as part of some procedures to treat heart disease.  These procedures include:

• Angioplasty with or without stent placement. Angioplasty involves temporarily inserting and expanding a tiny balloon at the site of your blockage to help widen a narrowed artery. Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of it narrowing again (restenosis).

• Closure of holes in the heart. Some congenital heart defects involving holes in the heart can be treated by threading a catheter to the hole to close it, rather than having open-heart surgery.

• Repair or replace leaky heart valves. Using cardiac catheterization, doctors can repair or replace a leaking or narrowed heart valve. Sometimes, doctors will use catheterization to fix a leaking replacement valve.

• Balloon valvuloplasty. This procedure can open narrowed heart valves by threading a balloon-tipped catheter to the part of your heart valve that’s narrowed and inflating it.

• Heart arrhythmia treatment (ablation). Ablation is a procedure that scars your heart tissue to re-route the electrical signals that cause your heart to beat. Radiofrequency energy (heat), a laser or nitrous oxide (extreme cold) is applied through the catheter tip to the abnormal heart tissue. The energy destroys (ablates) the abnormal heart tissue causing the heart rhythm disorder.

• Blood clot treatment (thrombectomy). In this procedure, your doctor inserts a catheter into an artery and guides it to a blood clot in a blood vessel. Attachments on the catheter remove the blood clot

How should I Prepare for my Catheterization?

• Pack a small overnight bag in case you need to spend the night in the hospital.  Please, leave all valuables at home.

• Don’t eat or drink anything for 8 hours before your test, or as directed by your doctor.  If you have diabetes, ask for instructions about diabetes medications and insulin.  You will usually be able to have something to eat and drink soon after your test.   Medication prescribed by your doctor may be taken with sips of water, except for some diabetic medications.

• Make arrangement to have a family member or friend drive you home.

• Try to relax.  It’s common for people who are having a cardiac catheterization to feel anxious or nervous.  You’ll be given medications to help you relax during the procedure.

What can I expect during Cardiac Catheterization?

• Cardiac catheterization is usually performed while you’re awake, but sedated.  An Intravenous line will be inserted in your hand or arm, and will be used to give you any additional medications you might need during your procedure.   You will also have electrodes placed on your chest to check your heartbeat during the test.

• Just before the procedure, a nurse or technician may shave the hair from the site where the catheter will be inserted.  Before the catheter is inserted in your artery, you’ll be given a shot of anesthetic to numb the area.  You may feel a quick stinging pain before the numbness sets in.

• Typical sites for vascular entry are either the wrist or the groin area.  Vascular access needle is inserted into your artery.  This is followed by introduction of a thin flexible wire called the guide-wire into the needle.  Needle is then removed.

• A tubular and flexible plastic sheath is advanced over the guide-wire and placed in the artery.  This serves as a passageway for the insertion of catheters.

• Through the sheath a long soft plastic tube or catheter is inserted and guided toward the heart.  Catheters with different shapes may be used during the procedure.   Your cardiologist will rotate and gently manipulate the catheter to guide its tip into the opening of the coronary artery.

• Once the catheter is engaged in the coronary arteries, contrast dye will be injected while X-ray machine records the flow of contrast dye in your coronary arteries.

• Once the testing is complete, the catheter will be removed and pressure will be applied to the vascular access site for approximately 15-20 minutes. You will then be taken back to your room, or to a special care area where monitoring of your heart rhythm is available.

• It usually takes several hours to recover from a cardiac catheterization.   You’ll need to lie flat for one to four hours after the procedure to avoid bleeding and to allow the artery to heal.

• You’ll be able to eat and drink after the procedure.  The length of your stay in the hospital will depend on your condition.  You may be able to go home the same day as your catheterization, or you may need to stay overnight or longer.   Longer stays are more common if you have a more serious procedure immediately after your catheterization, such as angioplasty and stent placement.

What is the Risk of Cardiac Catheterization?

As with most procedures done on your heart and blood vessels, cardiac catheterization has some risks.  Major complications from cardiac catheterization are rare, though.  Risks of cardiac catheterization include bruising, bleeding, heart attack, stroke, damage to arteries, irregular heart rhythms, allergic reactions to the dye or medication, tearing the tissue of your heart or artery, kidney damage, infection, and blood clots.