MHVI Owners Manual . Procedures . Cardiac Procedures . Cardiac Catheterization

What is Cardiac Catheterization?
Cardiac catheterization is a commonly used specialized technique for studying the structure and function of the heart. It allows your cardiologist to view the blood supply to the heart, as well as to view the various chambers and valves of the heart. There are several terms you may hear being used for this procedure. They are "heart cath," "coronary angiogram," "arteriogram," or "angiography." These terms all mean the same thing. Specifically, cardiac catheterization will help your cardiologist:

Determine the presence, location, and severity of any blockage in the arteries supplying the heart.
Evaluate the function of the heart muscle and valves.
Assess the damage done to the heart from heart attack, infection, and/or trauma.
Assess the status of bypass surgery grafts.

Heart catheterizations at St. Joseph Mercy Hospital are performed by cardiologists who specialize in this procedure. They are assisted by a team of highly trained nurses and technicians.

The Heart and How it Functions
To help you understand the cardiac catheterization procedure, it will be helpful for you to be aware of the basic structure of the heart and how it works.

Anatomy of the Heart
The human heart is a muscular organ, about the size of your fist, located behind and slightly to the left of the breastbone (sternum). There are four chambers in the heart: two upper chambers (atria) that receive blood from the veins and two lower chambers (ventricles) that pump blood to the lungs and body. Valves are located between these chambers and prevent blood from flowing backward, much like one-way doors.

Blood Flow Through the Heart
Blood from the body enters the right atrium, then flows through the tricuspid valve into the right ventricle. When the right ventricle is filled, it contracts, forcing the blood through the pulmonary valve into the pulmonary artery, which takes it through the lungs. From the lungs, the blood flows back into the heart through the pulmonary veins to the left atrium. The blood leaves the left atrium through the mitral valve and flows into the left ventricle. When full, the left ventricle contracts and forces the blood through the aortic valve into the aorta. The aorta, with its numerous branches, carries the blood throughout the body. All organs of the body require a blood supply.

Coronary Arteries
Blood is delivered to the heart muscle through the coronary arteries. These arteries lie on the surface of the heart. The right and left coronary arteries are the two main vessels which carry blood to the heart muscle. The left coronary artery has two main branches: the Left Anterior Descending (LAD) branch and the Circumflex Artery, which supply blood to the front, left side and back of the heart. The Right Coronary Artery (RCA) branch usually supplies blood to the bottom of the heart.

Diseases of the Heart
Through the procedure of cardiac catheterization, diseases of the heart can be diagnosed and treated. The coronary arteries may be affected by a disease known as atherosclerosis. In this condition, cholesterol deposits form in the arteries and normal blood flow through them is reduced. This process is similar to the progressive formation of rust or corrosion found in plumbing fixtures. When the obstruction in a coronary artery is greater than 70 percent, the blood flow and thus the oxygen supply to the heart muscle is significantly reduced. This may result in chest discomfort which is called angina pectoris. When a coronary artery is completely blocked, usually by a blood clot formed in the artery, damage to the heart muscle occurs. This is called a myocardial infarction or heart attack. Another form of heart disease is valvular heart disease. When the valves in the heart are not functioning properly, the flow of blood through them is decreased due to leakage or obstructions. This interferes with the ability of the heart to pump blood effectively. The most common causes of valve malfunction are rheumatic fever, bacterial infection, abnormal development at birth and the aging process.

Preparing for Your Heart Catheterization

Before you arrive
Catheterization is usually done as an outpatient procedure or your physician might order a catheterization during your hospital stay. You will be instructed not to eat or drink anything for several hours before the procedure to lower the chance of nausea or vomiting during the procedure. The cardiac catheterization itself will last less than one hour. You should plan to spend four to six hours afterward with us while your recovery is being monitored. After the procedure has been explained to you, you will be asked to sign a consent form to undergo the cardiac catheterization.

Please let your cardiologist know if:

You are taking blood thinners.
You are diabetic.
You are allergic to any medications, especially X-ray dye or iodine.
You are pregnant or suspect you may be pregnant.

When you arrive
At the catheterization lab, you will be placed on a stretcher and your blood pressure and pulse will be checked. The staff will prepare you for the procedure by placing small sticky patches (electrodes) on your chest to allow for the monitoring of your heart rhythm during the procedure. They will also insert an intravenous line (IV) in your arm to provide fluids and to allow medications to be given during the procedure. Your groin area will be shaved and scrubbed to prevent infection at the site where the catheter is inserted. Because your assistance (deep breaths, coughing) is required at times, you will be awake throughout the entire procedure. A mild sedative will be given to you before the test to help you relax. You will then be taken into the room where the procedure will be performed. Sterile towels will be placed over you to maintain a germ-free area.

What to Expect During the Heart Cath Procedure
The catheterization is performed using a soft, narrow, flexible plastic tube called a catheter. The cardiologist will numb the area where it will be inserted. In most cases, the artery in the groin area is used, but occasionally the arm may be used. The catheter will then be inserted through a blood vessel and gently advanced into the heart under X-ray guidance. When the catheter is in the heart, it will touch the inner wall of the heart at times. You may feel some extra heartbeats. These may feel like fluttering sensations or palpitations, but they should not alarm you. X-ray dye is injected through the catheter into the heart chambers and blood vessels so that they can be seen by X-ray and permanent X-ray pictures can be taken. During this injection, you may experience a warm, flushing sensation throughout your entire body. This will last only a few seconds. You may also experience a slight headache or mild feeling of nausea at this time. This also passes quickly. When all of the necessary pictures have been taken, the catheter is removed and pressure is applied to the insertion site for about 10-20 minutes. A dressing will be placed over the insertion site and you will be taken to a recovery area. Following the heart catheterization, your physician will talk with you and your family about the preliminary results and suggest an appropriate plan of care.

After the Procedure
When you return to the recovery area, your blood pressure, pulse, and catheter insertion site will be checked frequently. You may eat after the test and you will be encouraged to drink plenty of fluids to flush your system of the X-ray dye. You will need to avoid moving the leg or arm used during the procedure. You will be asked to not bend the limb for several hours. Bed rest will be required for a period of time, however, your nurse will give you more specific instructions regarding limitations of activity. If you have any discomfort, swelling or bleeding at the catheter insertion site or numbness/coldness in the limb used for testing, please tell your nurse so that it can be checked. Although most people experience no pain following heart catheterization, your physician will prescribe a pain medication should you need it.

Possible Risks and Complications
In any medical procedure, including a heart catheterization, there is some risk involved. The staff who perform this procedure are specially trained and the catheterization lab is fully equipped to handle any possible emergency that may arise. Complications, although rare, can occur. These may include bleeding, allergic reaction, blood clots, infection, rhythm disturbances, injury to the heart or vessels, and in very rare cases, heart attack or death. If you have any specific questions or concerns regarding the risk involved, please do not hesitate to ask your cardiologist.

When You Go Home

When you go home after your procedure, please be aware of the following information.

FOR THE NEXT THREE DAYS, PLEASE FOLLOW THESE INSTRUCTIONS

Keep the site clean and dry. Observe the insertion site for any of these changes:

Bleeding:: It is not normal for your site to bleed. If your site starts to bleed, lie down, apply pressure to the site, and call your physician. If the bleeding is severe or will not stop, call 911 or contact your local emergency services.
Swelling:: It is normal for a small knot to appear at the site for a few days after the procedure. Notify your physician if the swelling at the site increases.
Tenderness or Discomfort:: It is normal to have some discomfort at the insertion site. If the discomfort increases in intensity or becomes very painful, notify your physician. If you experience any flank or low back pain or discomfort, notify your physician.
Numbness or Tingling:: It is not normal to feel numbness or tingling in your leg/arm after the procedure. If numbness and/or tingling is constant, progressive or severe, notify your physician. If your leg/arm becomes cold or turns blue in color, seek emergency help immediately.
Infection:: If your site becomes infected, contact your physician. There should only be a minimal clear drainage from your site. If drainage increases and/or becomes cloudy or pus-like, contact your physician. Other signs to watch for include increased swelling, increased tenderness, increased warmth, chill and/or fever.

Activity

For 24 hours:

Do not drink alcoholic beverages.
Do not drive a car or operate heavy equipment.

For three days:

Do not sit for more than an hour without getting up to walk around (i.e., car trips over one hour, desk jobs, watching TV, etc.).
Do not push, pull or lift heavy objects (five to ten pounds or more).
Do not take a tub bath (you may take a shower).

After three days you may resume normal activity.

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