This is an invasive procedure done in the hospital to identify blockages within the arteries of the heart. The doctor inserts a thin plastic tube (catheter) into an artery or vein in the arm or leg. The catheter is advanced into the chambers of the heart or into the coronary arteries. Measurement of the pressure in the heart chambers, pictures of the heart pumping, and images of the arteries supplying blood to the heart are obtained. If no blockages are identified, the procedure is complete, and the patient returns home the same day.
When a blockage is severe enough to warrant treatment, the doctor will recommend the option that provides the best outcome based on current medical literature, available technology, and an understanding of the patients individual circumstances. PTCA (Angioplasty) and Stent placement are the most commonly recommended and typically immediately follow a heart catheterization. The majority of patients who receive a PTCA or stent will require an overnight hospital stay.
Bypass surgery is recommended to those patients whose blockages cannot be fixed by a catheter-based procedure. A cardiothoracic surgeon, who has specialized training in the surgical treatment of heart vessels and valves, performs bypass surgery. As this is major surgery, it requires an in-patient hospital stay.
What to Expect: Cardiac catheterization is performed in the hospital. You will be required to disrobe. A hospital gown will be provided. You will be administered medication for relaxation; however, you will NOT be under general anesthesia. Small electrode pads will be placed onto your chest to monitor your heart rate and rhythm (similar to an EKG) throughout the procedure. A blood pressure cuff will be placed on your arm to monitor your blood pressure throughout the procedure. An IV (intravenous) catheter will be inserted, most likely into a vein in your arm. Your groin area or wrist (depending on approach) will be cleansed with a sterilized wash and some may require the area be shaved. You will also receive local anesthesia to the groin or wrist area, so the insertion site will be numb. A small plastic tube called an introducer sheath, and a special guide wire will be thread into the artery. Once the catheter is in place, your physician will inject x-ray dye through the catheter. Cineangiography, a type of move x-ray, will provide clear pictures of your arteries so that your doctor can evaluate for any problems. Once the physician has obtained adequate pictures and it is determined that no invasive therapy is required, you will be transferred to the recovery area. You will need someone to drive you home. You will be asked to monitor your groin site or wrist for any swelling, tenderness, bruising, or bleeding, which would require immediate notification to your physician. You will be scheduled for a follow-up visit with your physician within one to 2 weeks. The procedure takes approximately two to three hours for preparation and performance of the test. However, plan to be at the hospital a full day, and occasionally over night.
Preparation: If your procedure is scheduled in the morning, you will be asked not to eat or drink anything after midnight. If your procedure is scheduled in the afternoon, you will be asked not to eat or drink anything for four hours prior to testing. Patients are instructed to take their cardiac medications the morning of the procedure with a few sips of water. It is very important that you take your aspirin the morning of the procedure and Plavix if you are prescribed Plavix. If you are on Coumadin, you will be instructed to hold your Coumadin for five days prior to your procedure. If you are on other forms of blood thinners ( Pradaxa, Xarelot, Eliquis) you will need specific directions from your managing doctor on when to stop prior to the catheterization. If you are an insulin dependent diabetic and your procedure is before noon, take only half of your morning dose with juice. If your procedure is after noon, take the whole dose with a light breakfast. Glucophage should be held the day of the procedure and will be held for 48 hours after the procedure due to potential interaction with the dye. Other oral diabetic medications, such as Micronase and Glucotrol, should be held the day of the procedure. It is always best to review all of your medications with your cardiologist prior to your procedure. It is essential that you notify your physician of any allergies to shellfish, iodine, or IV dye. Lab testing is usually required within a couple weeks of the procedure.
Locations: Catheterization is performed at the hospital.