A cardiac catheterization, also known as a “cath”or angiogram, is a test that determines if there are blockages in your heart’s arteries (coronary arteries). Heart valve problems, overall heart function, and other congenital heart abnormalities are also evaluated on this test. This test is performed by a specially trained cardiologist assisted by specially trained nursing and technical staff, and includes continuous ECG and blood pressure monitoring.
You may have already had a test showing there is a heart problem. When you have a cardiac cath to evaluate your coronary arteries, the cath will show precisely where blockages are, how severe they are, and how many arteries are involved; this information will be more detailed than information obtained from non-invasive tests. When you have a cardiac cath to evaluate a heart valve, additional information is obtained that is not available on other types of tests, including direct measurement of pressures and gradients in the heart.
Sometimes the cardiac cath proves there is not a significant problem with the heart, even though non-invasive tests suggested there was an abnormality. The results of the cardiac cath will help the cardiologist determine the best treatment for you.
Be aware that if a significant coronary artery blockage is found, it is often possible for the cardiologist to open the blockage during the cardiac cath procedure. An angioplasty may be performed, where a tiny balloon is inflated inside the artery to open the artery at the point of blockage. A stent is often placed at the same time to hold the artery open once the catheter is withdrawn.
Overview of the Procedure
A cardiac cath is generally a safe procedure, but as with any invasive procedure, there is a small amount of risk. Your cardiologist will discuss the risks of the procedure before you sign a consent form.
During the procedure, a long, thin plastic tube called a catheter is passed through the blood vessels of the body to the heart. The entry site for the catheter is the arm or the groin area of the leg. Contrast agents or “dye” can be injected through this catheter into the heart arteries and chambers while x-ray pictures are taken. Angioplasty and stenting can also be performed.
The procedure is relatively painless since there are no nerve endings inside the blood vessels to feel the catheters being moved back and forth. The only significant discomfort is the local anesthetic injected into the skin before the catheters are placed. Patients are given as much sedation as they need to be relaxed during the test.
The entire procedure usually takes under one hour to complete.
Before the Cardiac Cath
You will be asked some questions regarding your health, including any allergies to food, medicine, or x-ray dye. If you are pregnant or think you may be, tell your doctor or nurse. You will need blood tests and an electrocardiogram (ECG) before the test. You will need to sign a consent form indicating that you understand the procedure and any risks that might be involved.
Please bring a list of the names and dosages of your current medications. Alternatively, you may bring your pill bottles with you.
Your doctor or the cardiac cath coordinator will give you special instructions regarding your medications. You may be instructed to stop taking blood thinners such as Coumadin several days prior to the test. Anti-platelet medications, such as aspirin or Ticlid, should not be discontinued unless your doctor specifically instructs you to do so. Dosages of insulin or pills for diabetes may be reduced the morning of the test. You may be instructed to stop taking Glucophage (Metformin) three days before the test. Take your usual medications the morning of the test with water unless otherwise directed. If you have any questions, do not hesitate to ask your doctor.
Do not eat or drink anything after midnight on the day of the angiogram. On the day of the test, please remove any hairpins, earrings, or nail polish. You may wear hearing aids or glasses during the procedure. At the hospital, you may be given medication to help you relax before the procedure. Your nurse will insert an intravenous line, or IV, in your arm that will be used during the procedure.
During the Cardiac Cath
In the catheterization laboratory, you will lie on a table under an x-ray camera. You will see television monitoring screens and a moving x-ray tube or camera. You may be able to see the pictures taken of your heart during the test. Small pads, called electrodes, will be placed on your chest to monitor your heartbeat. The hair at the site where the catheter is inserted will be shaved and the skin cleaned with a special soap. A large drape will then be placed over your body to create a sterile field where the doctor will work. The doctor will then numb the skin in the arm or the leg. Additional medicine may be given in your IV to help you relax. When the skin is numb, a guide wire is passed through a needle inserted into the artery in the leg or arm. A short introducer tube called a sheath is then placed over the guide wire through which the coronary catheters can be passed. There is no pain after the skin is numbed.
When the x-ray pictures have been taken, the catheters are removed. The sheath may be left temporarily in place. It will be removed after you are moved back into your bed. The entire procedure generally takes less than one hour. If an angioplasty is necessary, it can usually be done at the same time as the cardiac catheterization.
Angioplasty is one of the most widely used interventional therapies for opening blockages in the arteries of the heart. During the angioplasty, the cardiologist guides a small balloon to the site where the artery is blocked. Once the balloon is inflated, the plaque material that is clogging the artery is compressed to the side, creating a wider channel for blood to flow. Often a metal stent is placed to reinforce the opened channel and help prevent the artery from closing back down. With any angioplasty, there is a small risk of the artery closing down at the time of the procedure, which can lead to a heart attack. Therefore, an operating room and a cardiac surgeon are always available, should urgent open-heart bypass surgery be necessary. Patients who have an angioplasty done should expect to stay in the hospital overnight, but can usually be discharged home the following morning.
After the Cardiac Cath
Once you are back in bed, the sheath will be removed. After the sheath is pulled, firm pressure is immediately applied to the artery by hand or with a C-clamp device for 20 to 40 minutes. This will allow the puncture site in the artery to seal over with a small blood clot. A sandbag will then be applied over the groin site for 4 to 6 hours to make sure the artery heals properly. Bedrest will also be needed for these 4 to 6 hours after the procedure. In some cases, the artery can be sealed with a mechanical plug. In these cases, the sandbag is not usually necessary and patients need only a few hours of bed rest. After a period of time, you will be asked to get up and walk. If there are no problems, you will be discharged home at that time. Your cardiologist will review the results of the cardiac cath with you and your family, and future treatment plans will be discussed. You should leave the hospital with a complete understanding of the test results and any follow-up instructions. Your primary care physician will be notified of the test results as well.
Unless you need other treatment right away, you can go home after the cath. You will need a ride since you cannot drive with the arm or leg used for the cath. Also, some of the medicines used to help you relax may leave you feeling a little lightheaded.
As soon as you arrive home from the hospital, you should remain at rest except to use the bathroom. You can return to your normal routine the following day unless otherwise instructed by your doctor. The bandage may be carefully removed the next day. You may shower or take a bath at that time. Do not plan to do any heavy lifting (greater than 20 pounds) or exercise for two full days after the test. You should not plan to drive for one to two days after the test.
Fatigue is common for a day or two after the procedure. You may have a small lump or bruise at the catheterization site. The area may be sore for a few days. Generally, all these types of symptoms resolve in a few days or weeks. In the unlikely event that you have any bleeding from the catheter site, you should apply manual pressure immediately and have someone contact your cardiologist. If serious problems develop, you should be transported to the nearest hospital by ambulance.
Finally, be sure to call your doctor if you have any of the following problems:
- Numbness or severe pain in your arm or leg
- Bleeding or redness at the catheter site
- Fever greater than 100 degrees
- Hives, or swollen lips or tongue
- Shaking, sweats, or chills
- Shortness of breath or chest pain
- Difficulty voiding or blood in the urine
We hope this information has been helpful, but should you have any further questions or concerns, please feel free to call our office at (203) 265-9831 and ask for the Cath Coordinator.
Dr. Lee provides useful information on cardiac catherization. Click below to watch his video.