INVASIVE AND INTERVENTIONAL PROCEDURES
CARDIAC CATHETERIZATION
(ANGIOGRAM)
What is cardiac catheterization?
 |
|
BHG Doctors in action
|
A cardiac catheterization or "heart cath" is an examination
that is done in the cardiac catheterization laboratory to detect
heart disease and evaluate the condition of your heart. During
the test, x-ray movies and pressure recordings of the arteries
and chambers of the heart are made. The status of your heart's
arteries as well as its main pumping chamber is assessed. Additionally,
the function of some valves within the heart can be assessed.
This information will help your doctor decide which form of therapy,
if any, is best for you.
Following the diagnostic portion of the test, your doctor may decide
to treat one or more blockages found within your heart arteries.
This entire procedure can take one to three hours to complete.
 |
|
BHG Doctors in action
|
What happens during the procedure?
After you arrive in the cardiac catheterization laboratory (cath
lab), the cath lab staff will review the proposed procedure with
you. They will ask you about the medications you are currently
taking and when you last took your medications. You will be asked
when you last ate. A small intravenous line (IV) will be placed
in a vein in your arm to enable the administration of medications.
You will be moved to a special table in the cath lab. Adhesive
patches will be attached to your arms and legs so your electrocardiogram
(ECG) can be monitored. You may be given a sedative to help you
relax. Your groin or arm will be scrubbed with a special antiseptic
solution and you will be covered with sterile drapes. This is
done to prevent any infection at the puncture site.
 |
To perform the catheterization study, a catheter (small hollow
plastic tube) will be inserted into an artery and/or vein in either
the groin or arm. Before the procedure begins, your doctor will
numb your groin or arm with an anesthetic. This will cause a slight
sting or burning sensation which only lasts a few moments. As
the catheter is inserted, you may feel some discomfort, although
most people feel only pressure. If you have pain, please let your
doctor know.
Using a special x-ray unit (fluoroscopy), the catheter will be
directed to the heart. You will not feel the catheter as it moves
through the blood vessels or heart chambers. As the catheter enters
your heart, you may feel some extra heart beats. Pressures within
the heart chambers will be measured, blood samples may be taken
and x-ray dye (which makes the arteries and chambers of your heart
visible on x-ray) will be injected. When the dye is injected,
a warm flushing sensation may be felt over most of your body.
This sensation will last for about thirty seconds. X-ray dye will
be injected into each of your coronary arteries to look for blockages
within these vessels. While these x-ray pictures are being taken,
you may be asked to take a deep breath and hold it for about five
seconds. You may be occasionally asked to cough, as coughing helps
clear the dye from your coronary arteries. If the study does not
show significant blockages or if proceeding with intervention
is not elected at this time, the catheter(s) will be removed (see
Post Procedure Care below).
If the diagnostic portion of the study shows blockages(s) within
your coronary artery(ies), your cardiologist may choose one or
a combination of methods to open the blockage(s). A description
of the method that your doctor may use to open the blockage(s)
can be found on the following page. In general, all of the methods
involve placing small devices into your coronary arteries. A hollow
tube or catheter is positioned at the opening of your coronary
artery or bypass graft and through this a small wire can be steered
across the blockage. This wire acts as a rail over which various
devices can be placed. At times these devices may temporarily
interrupt the flow of blood through the artery being worked upon
and chest pain can result. If you experience any chest pain or
other discomforts during the procedure, please tell your cardiologist
or the cath lab staff. We will make every effort to minimize your
discomfort.
POST PROCEDURE CARE
At the end of the procedure, the catheters are removed from the
body but the sheaths through which the catheters are introduced
into the body are often left in place. This is because blood thinners
are used during the procedure to minimize the risk that clots
will form. Until the blood thinners have worn off, the sheaths
cannot be safely removed. The sheath(s) may be removed in the
cath lab or later in your room depending upon the status of the
blood thinners. Alternatively, special blood vessel closure devices
can be used to enable the sheaths(s) to be removed immediately.
If the catheterization was done from your arm, your doctor may
close the artery and the skin with several stitches and a pressure
dressing will be applied. Stitches are not usually needed when
the groin or wrist is used. Pressure will be held for a variable
amount of time depending on the dose of blood thinners used and
whether or not a coronary intervention occurred.
After sheath removal, you will be required to lie flat in bed
with your leg straight for a variable amount of time. If an artery
closure device is used, this may require minimal bed rest. If
pressure is used , you will remain at bed rest for about six hours.
You may have your head raised about fifteen degrees and you may
roll from side to side. Your blood pressure and dressing will
be checked frequently for the first three to six hours. If you
feel a warm wet sensation in the groin area, apply pressure and
call your nurse. The skin around the puncture site or incision
may look bruised or slightly swollen. If you notice coldness or
discoloration of your leg or arm, notify your nurse. It is common
to feel some numbness along the inside of your thigh due to the
local anesthetic that is used. You may have pain medication to
relieve any discomfort that you may have.
PREPARATION FOR CARDIAC CATHETERIZATION WITH INTERVENTION
 |
|
BHG Doctors in action
|
Because it is possible that you may experience nausea during
the procedure, you will be required to fast (have nothing to eat
or drink) for several hours before the test. If your test is in
the morning, you will begin your fast the evening before. If your
test is in the afternoon, you may have a light (tea and toast)
breakfast in the early morning on the day of the procedure and
then have nothing further to eat or drink until your catheterization
is completed. In either case, take your usual medications with
a small amount of water the morning of the procedure. If you are
a diabetic, question your doctor as to wether or not you should
take your diabetic medicatiom.
If you smoke, do not smoke after your evening meal. This will
help your coronary arteries to return to their normal state of
relaxation. It is recommended that you empty your bladder before
going to the catheterization laboratory.
Prior to entering the hospital, notify your cardiologist if you
have ever had a reaction to x-ray dyes, antiseptics, anesthetics,
or any drugs. It is also important to tell the doctor if you have
any history of bleeding tendencies or if you have been on anticoagulant
medication (coumadin, ticlid, persantine, aspirin, or arthritis
medications).
[FOLLOW-UP INSTRUCTIONS]
A bruise or lump may develop at the puncture site and remain
for a week or more. If there is extensive bruising, some discoloration
and tenderness may last for several weeks. Notify your doctor
if you notice new bleeding, increased tenderness, redness or drainage
from the catheterization site, fever, or change in color, temperature,
or sensation in the limb used for the catheterization.
There may be changes in your medications following this procedure,
especially if an intervention was done. Your cardiologist or his
associate will go over this with you before discharge. If you
have any questions about medications, your post procedure visit
or any instructions, please ASK! If you were provided medications
at the time of discharge and will run out before your next office
visit, please call the office.
© Copyright 1999 Dialog Medical, Inc. All rights reserved.
Top
BALLOON ANGIOPLASTY
(PTCA
or Percutaneous Transluminal Coronary Angioplasty)
The method by which a small balloon tipped catheter is placed
over a guide wire into the narrow segment of the coronary artery.
The balloon is then inflated several times, compressing the fatty
material (plaque) against the wall of the artery. This opens the
narrowed section increasing blood flow to the heart muscle.
Top
STENT IMPLANTATION
© Copyright 1999 Dialog Medical, Inc. All rights reserved.
The method by which a small metal slotted or coil tube is placed
against the artery wall to hold the artery open. Balloon angioplasty
is done before and after the stent is placed. The stent is a permanent
implant that stays in the artery.
© Copyright 1999 Dialog Medical, Inc. All rights reserved.
WHAT IS A STENT?
A stent is a wire mesh tube that is used to help hold open an
artery. It is usually used in combination with angioplasty (using
a balloon to open a clogged artery).
Stents are used to hold open diseased coronary arteries (the arteries
that supply blood to the heart), as well as diseased arteries
of the peripheral vascular system (the arteries that supply blood
to the rest of the body).
There are a variety of stents currently available. Some are compressed
onto the outside of an angioplasty balloon catheter, and delivered
by inflating the balloon in the desired location. Some are "self-expanding"
spring-loaded devices, which expand automatically upon deployment.
Stents remain in arteries permanently. The tissue lining the
arteries actually grows over the metal mesh to cover the inner
lumen of the stent.
When are stents used?
Stent procedures have become very common. Stents are sometimes
used as an alternative to coronary artery bypass surgery. Stents
are often used in combination with balloon angioplasty. Typically,
stents are used for lesions that do not respond to angioplasty
alone. Stents are often used in cases of "restenosis",
which refers to the re-closing of arteries after balloon angioplasty.
In carefully selected patients, the use of stents can dramatically
reduce restenosis following balloon angioplasty or other catheter-based
procedures. Stents are also used frequently to hold open arteries
that have been damaged, torn, or dissected by balloon angioplasty
or other catheter-based procedures.
Stents allow angioplasty to be done in patients with severe and
long-segment obstruction of coronary arteries. As soon as the
initial part of the block is widened, a stent is placed, which
holds it open allowing further opening to proceed. Stents have
also allowed angioplasty to be performed in patients with blocks
of multiple vessels, and in multiple blocks in a single artery.
What are the risks associated with a stent procedure?
Risks include the standard risks of an interventional, catheter-based
procedure, which should be specifically discussed with your doctor.
Lesions treated with stents can "restenose" (renarrow
within weeks to months after the procedure) similar to restenosis
associated with angioplasty.
Follow-up Instructions:
Your doctor will recommend blood thinning medications following
your stent procedure. Agents such as plavix or ticlid are usually
given for one month post procedure along with aspirin. Aspirin
in then continued indefinitely. Your doctor may also prescribe
antibiotics for a period of time after the stent procedure, to
be taken any time you have a medical or dental procedure. MRI
tests should not be done for at least eight to twelve weeks without
your doctor's approval. Metal detectors do not present a problem.
Stents appear to be safe in the long-term; there are no long-term
complications associated with a permanent stent.
© Copyright 1999 Dialog Medical, Inc. All rights reserved.
Top
ATHERECTOMY
The method by which a small mechanically driven cutter shaves
the plaque from the artery wall. The catheter is placed over a
guide wire to the narrowed segment. Balloon angioplasty may be
done before and after the atherectomy. The different types of
atherectomy catheters that may be used:
- Rotational Atherectomy uses an abrasive diamond coated burr
at the tip of the catheter. The catheter is rotated rapidly (like
a dental drill) to grind or sand the plaque into tiny particles
that float away in the blood stream.
- Extraction Atherectomy uses a rotating blade inside the tip
of the catheter to cut the plaque. The plaque is then vacuumed
into the catheter and removed.
- Directional Coronary Atherectomy (DCA) uses a catheter with
a windowed chamber over a rotating blade. The window is placed
over the blockage. The rotating blade shaves the plaque and collects
it in the catheter tip.
© Copyright 1999 Dialog Medical, Inc. All rights reserved.
Top
|
