TESTS: CARDIAC CATHETERIZATION

What Is Cardiac Catheterization?

Cardiac catheterization is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart. Through the catheter, doctors can perform diagnostic tests and treatments on the heart. Cardiac catheterization is usually performed in a hospital by heart doctors (called cardiologists) that specialize in the treatment of heart diseases.

To diagnose some heart conditions, doctors may put a special dye into the catheter to make the inside of the heart and blood vessels show up on X-rays. Doctors may take samples of blood and heart muscle through the tube. They also can treat certain heart problems during this procedure.

Why Is Cardiac Catheterization Done?

Often a doctor does a cardiac catheterization to find out why a patient is having chest pain. The procedure can reveal blocked or narrowed places in the heart's arteries that can cause this pain. During the cardiac catheterization, a doctor might be able to open up the blocked arteries by doing another procedure called angioplasty.

Most people who have heart attacks have arteries that are partly or completely blocked. That is why doctors often do cardiac catheterizations after patients have heart attacks. The procedure can tell them if there are blocked arteries that can be treated with angioplasty or surgery.

Another reason doctors may do cardiac catheterizations is to see the overall shape of the heart and the four large spaces (heart chambers) inside it. That way they can:

· Find any likely problems in people about to have open heart surgery

· See heart abnormalities in children or adults

Sometimes doctors do cardiac catheterizations to see how well the tissue flaps (valves) at the openings and exits of the heart chambers are working. To do this, the doctor will measure blood flow and oxygen levels in different parts of the heart. Cardiac catheterizations also are done to check the functioning of artificial heart valves.

Doctors also may perform cardiac catheterizations so they can do minor surgery on the heart. For example, doctors may do the procedure to remove (biopsy) a small piece of heart tissue to see if there is an infection or tumor, or they might repair holes in the heart or other heart defects.

What Are the Risks of Cardiac Catheterization?

Cardiac catheterization is a common medical procedure that rarely causes serious problems. But complications can include:

· Bleeding, infection and pain where the tube (catheter) was inserted

· Damage to blood vessels

· An allergic reaction to the dye used

Other less common complications of the procedure include:

· An irregular heartbeat

· Damage to the kidneys caused by the dye used

· Blood clots that can trigger strokes, heart attacks or other serious problems

· Low blood pressure

· A buildup of blood or fluid in the sac that surrounds the heart; this fluid can prevent the heart from beating properly

As with any procedure involving the heart, complications can sometimes, although rarely, be fatal.

The risk of complications with cardiac catheterization is higher in:

· People with diabetes

· People with kidney disease

· Older people (ages 75 and older)

· Women

· People having emergency catheterization for serious heart symptoms

How to Prepare for a Cardiac Catheterization

Before having a cardiac catheterization, it is a good idea to meet with your doctor to learn about the procedure and how to prepare for it. In that meeting, you might discuss things such as:

· Any medicines you are taking and whether you should stop taking some of these drugs before the procedure

· Whether you have diabetes, kidney disease or other conditions that may require taking extra steps during or after the procedure to avoid complications

Patients are not usually allowed to drive the same day they have a cardiac catheterization. If you don't have to stay overnight after this procedure, you should arrange for a ride to and from the hospital.

What Happens During a Cardiac Catheterization?

During a cardiac catheterization, you are kept on your back and awake. That way you can follow your doctor's instructions during the procedure. You are given a drug to help you relax. This drug may make you sleepy.

Your doctor or nurse will numb the area where the small plastic tube (catheter) will enter the blood vessel through a small cut or needle in the arm, upper thigh (groin) or neck. The doctor then threads the tube through the vessel and into the large spaces (chambers) of the heart. Special X-ray movies are taken of the tube as it is threaded up into the heart. This helps the doctor see where to put the tube.

Once the catheter is at the right spot, your doctor can use it to conduct several tests or treatments. Often, special dye is put in the tube to make the inside of the heart's arteries and other structures show up on an X-ray. Your doctor may use a procedure called angioplasty to open up the blocked arteries. He or she also may take blood samples from different parts of the heart or do minor heart surgery.

Once your doctor does all of the needed tests or treatments, the catheter will be taken out. The opening in the blood vessel that the tube went through will then be closed up and bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply more pressure. This will help prevent major bleeding from the site.

What Happens After a Cardiac Catheterization?

After a cardiac catheterization, you will be moved to a special care area where you will stay for several hours or overnight. While you recover in this area, your movement will be limited to avoid bleeding from where the tube (catheter) was inserted. Nurses will check your heart rate and blood pressure regularly. They also will check to see if there is any bleeding from the tube insertion site.

Eventually, a small bruise will appear where the tube was put in. That area may feel sore or tender for about a week. Be sure to let your doctor know if:

· You have a constant or large amount of blood at the site that cannot be stopped with a small bandage.

· You have any unusual pain, swelling, redness or other signs of infection at or near the insertion site.

You doctor may tell you to avoid certain activities, such as heavy lifting, for a short time after the procedure.

Source: National Heart, Lung, and Blood Institute, National Institutes of Health

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