Cardiac Catheterization
Introduction
Cardiac catheterization is a procedure of passing a thin flexible tube (catheter) into the right or left sided chambers of the heart, usually from the groin or the arm.
Indications:
Catheterization is done for getting information about heart and large vessels around the heart. Definitive procedures can also be done by the surgeon. There are two types of indications for cardiac catheterization- diagnostic and therapeutic.
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1. For diagnosis of
1. 1. Coronary artery disease.
1. 2. Congenital heart diseases present since birth
1. 3. Etiology of congestive cardiac failure
1. 4. Cardiomyopathy
1. 5. Cardiac amyloidosis
1. 6. Diseases of the heart valves
1. 7. Pulmonary hypertension or high blood pressure in the lungs
2. Cardiac catheterization is indicated in following therapeutic procedures:
2. 1. Repair of heart defects
2. 2. Treatment of narrowed valve or stenotic valve
2. 3. For angioplasty or grafting in the coronary arteries
Before the Test:
Cardiac catheterization has a slightly higher risk than other heart tests. But in hands of experienced cardiology team, it is safe.
Patient is advised not to eat or drink for 6 – 8 hours before the test. The test is done in mostly operation rooms in a hospital and patient is asked to wear a hospital gown. Sometimes the patient is admitted a day before the test in the hospital.
Make sure to ask the cardiologist about the entire procedure, steps involved and risks of the same. A written, informed, signed consent of the patient for the procedure is obligatory.
Before the surgery:
1. A proper history, examination and few lab tests are done to determine the general health. 2D echo, ECG and X-ray chest are done as a part of evaluation of cardiac disease.
2. Patient should stop anti-inflammatory drugs like aspirin at least a week before surgery.
3. Medications being taken for other conditions like diabetes, heart disease, blood pressure should be continued with advice from the treating doctor.
4. History of smoking or alcohol drinking should be told to the surgeon.
5. Recent history of cough, cold, fever, viral infections, or other illnesses should be informed.
6. Any allergy to medications or sea food should be informed.
7. Past reaction to any contrast dye or iodine contrasts should be informed.
8. Any medications for erectile dysfunction being taken should be told.
9. Possibility of pregnancy should be ruled out.
Procedure:
1. Medications for allaying anxiety are given before the test to make the patient relax. Patient is awake throughout the procedure and can follow the commands. Pediatric patients may need a strong sedative.
2. The cardiologist or surgeon cleans the site of puncture on the arm, neck or groin and inserts a line in a vein at that site. This is the intravenous (IV) line. The patient can have some discomfort when the lines or catheters are inserted.
3. A sheath or a larger plastic thin tube is then inserted in a vein or artery depending on the procedure in the arm or leg.
4. After this, longer plastic tubes called catheters can be moved into the heart upward under continuous fluoroscopic guidance.
5. Then, the surgeon can:
• Measure pressures and flows in various heart chambers and in the large vessels of the heart.
• Measure the oxygen saturation in different heart chambers
• Collect blood samples from heart
• Take heart muscle biopsy
• Examine the arteries for any abnormality
6. If there is a block in coronary arteries, definitive angioplasty and stenting can be done.
7. The test takes about 30 to 60 minutes or longer depending on whether any special procedure is to be done. The catheter is removed after the procedure and pressure is maintained on the point of insertion for at least 10 to 15 minutes to prevent bleeding.
8. Patient can go home or is admitted in hospital depending on the procedure.
Risks:
Cardiac catheterization has a slightly higher risk than other heart tests. But in hands of experienced cardiology team, it is safe.
The risks are:
1. Irregular heartbeat
2. Sudden lowering of blood pressure
3. Reaction to the contrast dye used.
4. Cardiac temponade
5. Heart attack on table
6. Stroke risk
Possible complications of any type of invasive catheterization are:
1. Bleeding
2. Infection
3. Injury to blood vessels
4. Blood clots
5. Kidney damage as a side effect of contrast dye. Patients with diabetes or existing kidney disease are predisposed to this condition.