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Cardiac catheterization is a diagnostic procedure in which a catheter (a long, thin, hollow, flexible, plastic tube) is inserted into an artery in the groin in order to move it through the arteries and access the heart. Once in place, a variety of tests and procedures can be performed.
Why is it performed?
Cardiac catheterizations are done in order to evaluate heart muscle, coronary arteries, and heart valves. Narrowing or blockages of the arteries restrict blood flow. Leaky or narrowed valves can impair the effectiveness of the heart. An arterial blockage may be treated with procedures during the catheterization (see percutaneous transluminal angioplasty or PCTA, atherectomy, and coronary stenting) or subsequently, coronary artery bypass surgery (CABG). Sometimes patients don’t require any procedure and can be treated with medications alone.
What is experienced?
Prior to the procedure, blood tests, an electrocardiogram, and a chest X-ray are taken. During the procedure, the patient may be asked to take a deep breath, cough, turn his or her head to one side, or not speak for a few minutes while measurements are being taken. There is no pain during the procedure, other than the brief prick of a needle to give a local anesthetic in the groin area (the inside of the upper thigh where it meets the torso). However, during the procedure a sensation of heat flushing through the body may be felt when a contrast material (dye) is released into the arteries. This is normal and lasts about 30 seconds. Some women compare it to a menopausal hot flash. The clicking of the camera as it takes pictures of the heart is also heard. The patient will be asked to keep as still as possible throughout the procedure.
The procedure takes place in the cardiac catheterization suite. In the pre-procedure area, medical personnel review the medical history, including any allergies to medications, dyes and foods (especially shellfish and/or iodine-containing x-ray contrast liquid, in which case a medication will be given to prevent an allergic reaction during the procedure). A mild sedative is given to relax the patient.
The patient changes into a hospital gown and reclines on a raised bed while the groin area is shaved. In the procedure room, a camera suspended overhead and connected to monitors allows the cardiologist to view the coronary arteries during the procedure. At first, the groin is cleansed with Betadine, and the surrounding area is draped. Electrodes are applied to the chest to monitor heart rhythms. An intravenous line is placed in the arm to administer medication, if required.
The groin is injected with a local anesthetic before a small introducer sheath is inserted into the femoral artery. The physician then inserts a long catheter into the sheath. Gradually, it is pushed through the aorta to the heart. There may be some pressure but not any pain. If it is uncomfortable, the physician should be told so that additional medication can be provided.
A contrast material (dye) is then injected into the heart and coronary arteries. A hot sensation may be felt at this time. Immediately, the camera records moving images — like an X-ray video — of the contrast material filling the arteries. The pictures are called coronary angiograms. The camera will make a noise as it records the images on a monitor. The images show the heart’s motion, its pumping function (ejection fraction), and any arterial blockages.
The procedure itself takes about 15 to 20 minutes.
At the end of this procedure, the catheter is removed and firm pressure is applied to the insertion site for 10 to 20 minutes. Then bandages are applied. The patient is moved to a post-procedure area for up to six hours, during which further pressure may be applied to the insertion site to prevent bleeding. During this time, medical personnel will check your vital signs, heart rhythm and groin area. A bruise, pain or any warm, wet or sticky feelings at the insertion site should be reported to the staff immediately. If no further procedures are planned, the patient usually goes home the next day.
If there is any pain or bleeding at the groin puncture site, or the size of the bruise increases, call the cardiologist or hospital immediately. The puncture site and bruise may take a while to heal completely.