(Cardiac Cath, Coronary Arteriogram, Coronary Angiogram)
Cardiac catheterization is performed to further evaluate coronary artery disease, valvular heart disease, congestive heart failure, and/or certain congenital (present at birth) heart conditions, such as atrial septal defect or ventricular septal defect, when other less invasive types of diagnostic tests indicate the presence of one of these conditions.
In cardiac catheterization (often called cardiac cath), a very small hollow tube, or catheter, is advanced from a blood vessel in the groin or arm through the aorta into the heart. Once the catheter is in place, several diagnostic techniques may be used. The tip of the catheter can be placed into various parts of the heart to measure the pressures within the chambers. The catheter can be advanced into the coronary arteries and a contrast dye injected into the arteries.
The use of fluoroscopy (a special type of X-ray, similar to an X-ray "movie") assists the doctor in locating any blockages in the coronary arteries as the contrast dye moves through the arteries. A small sample of heart tissue (called a biopsy) may be obtained during the procedure to be examined later under the microscope for abnormalities.
An additional technique called intravascular ultrasound (IVUS), a technique that uses a computer and a transducer that sends out ultrasonic sound waves to create images of the blood vessels, may be used during a cardiac cath. The use of IVUS provides direct visualization and measurement of the inside of the blood vessels and may assist the doctor in selecting the appropriate treatment needed in each particular situation.
The person will remain awake during the procedure, although a small amount of sedating medication will be given prior to the procedure to ensure the patient remains comfortable during the procedure.
Other related procedures that may be used to assess the heart include resting or exercise electrocardiogram (ECG or EKG), Holter monitor, signal-averaged ECG, chest X-ray, computed tomography (CT scan) of the chest, echocardiography, electrophysiological studies, myocardial perfusion scans, radionuclide angiography, magnetic resonance imaging (MRI) of the heart, and cardiac CT scan. Please see these procedures for additional information.
A cardiac catheterization may be performed to assist in the diagnosis of the following heart conditions:
A cardiac catheterization may also be performed if you have recently had an episode(s) of one or more of the following cardiac symptoms:
If a screening examination such as an ECG or stress test suggests the possibility of a heart condition that needs to be explored further, a cardiac cath may be ordered by your doctor.
Other reasons for a cath procedure include evaluation of myocardial perfusion (blood flow to the heart muscle) if chest pain or angina occurs after the following:
There may be other reasons for your doctor to recommend a cardiac catheterization.
Possible risks associated with cardiac catheterization include, but are not limited to, the following:
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.
If you are pregnant or suspect that you may be pregnant, you should notify your health care provider due to risk of injury to the fetus from a cardiac catheterization. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your doctor.
There is a risk for allergic reaction to the cath dye. Patients who are allergic to or sensitive to medications, contrast dye, iodine, or latex should notify their doctor. Also, patients with kidney failure or other kidney problems should notify their doctor.
For some patients, having to lie still on the cardiac catheterization table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
A cardiac catheterization may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a cardiac catheterization follows this process:
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
Bedrest may vary from two to six hours depending on your specific condition. If your doctor placed a closure device, your bedrest may be of shorter duration.
In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.
You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.
You may resume your usual diet after the procedure, unless your doctor decides otherwise.
When you have completed the recovery period, you may be discharged to your home unless your doctor decides otherwise. Commonly patients who undergo angioplasty or placement of a stent, will spend the night in the hospital for careful observation. If this procedure was performed on an outpatient basis and a sedative was administered, you must have another person drive you home.
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your doctor.
If your doctor used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin at the site. This is normal. The knot should gradually disappear over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities for a period of time after the procedure. Your doctor will instruct you about when you can return to work and resume normal activities.
Notify your doctor to report any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.
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