Cardiac Catheterization

Alternative Name: Catheterization – cardiac; Heart catheterization

Definition:
Cardiac catheterization with coronary angiogram takes pictures of the blood vessels in your heart, to evaluate the health of your heart and detect any narrowing of the blood vessels or other problems. The catheterization is performed by a cardiologist (or sometimes a radiologist) who is a specialist in doing this type of test.
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This process involves passing a catheter (a thin flexible tube) into the right or left side of the heart. In general, this procedure is performed to obtain diagnostic information about the heart or its blood vessels or to provide treatment in certain types of heart conditions.

Cardiac catheterization can be used to determine pressure and blood flow in the heart’s chambers, collect blood samples from the heart, and examine the arteries of the heart with an x-ray technique called fluoroscopy. Fluoroscopy provides immediate (“real-time”) visualization of the x-ray images on a screen and provides a permanent record of the procedure.
Why the Test is Performed ?
Cardiac catheterization is usually performed to evaluate heart valves, heart function and blood supply, or heart abnormalities in newborns. It may also be used to determine the need for heart surgery.

Therapeutic catheterization may be used to repair certain types of heart defects, open a stenotic heart valve, and open blocked arteries or grafts in the heart.
How the Test is Performed:
You lie on your back as a medical technician connects you to a heart monitor. An intravenous (IV) line is inserted into one of the blood vessels in your arm, neck, or groin after the site has been cleansed and numbed with a local anesthetic.. You may be given a sedative through the IV so that you are relaxed during the test.

First, the doctor injects a local anesthetic into the skin. This might sting momentarily. After the skin is numb, the cardiologist inserts a catheter (a thin, hollow plastic tube) into a large artery-usually in your groin but possibly in your arm or wrist.

Using live x-rays displayed on a video monitor as a guide, your doctor moves the catheter along the artery until it reaches your aorta (the large blood vessel that carries blood from your heart to the rest of your body). The tip of the catheter is pushed up the aorta until it reaches the heart and then gently pushed into the coronary arteries that supply blood directly to your heart muscle.When the tip of the catheter reaches one of the coronary arteries, the doctor injects contrast dye through the catheter. The dye illuminates the artery, allowing the doctor to see if it is blocked or narrowed. The procedure is repeated to visualize the other coronary arteries.

X-ray pictures are taken while the dye travels down the arteries. The arteries look like thick lines on the x-ray; a narrowing or blockage in an artery appears as a thinner line (see Figure 1). Your doctor might also inject some contrast medium into the left ventricle of your heart to show how forcefully your heart is pumping. The entire procedure usually takes from one to several hours.

How you Prepare for the Test:
Food and fluid are restricted 6 to 8 hours before the test. The procedure takes place in the hospital and you will be asked to wear a hospital gown. Sometimes, admission the night before the test is required. Otherwise, you will be admitted as an outpatient or an inpatient the morning of the procedure.

Your health care provider should explain the procedure and its risks. A witnessed, signed consent for the procedure is required.

Tell your doctor if you are allergic to seafood, if you have had a bad reaction to contrast material in the past, if you are taking Viagra, or if you might be pregnant.

During this procedure, local anesthetics (numbing agents) are used to minimize pain. Tell the cardiologist if you have ever had an allergic reaction to a local anesthetic or to contrast dyes. Also let your doctor know if you could be pregnant, since the x-rays used during this procedure can damage a fetus.

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. Tell the cardiologist if you’re taking a nonsteroidal anti-inflammatory drug (NSAID) or other medicines that affect blood clotting and could increase the chance of bleeding from the procedure. You should also tell your doctor if you take insulin shots or blood sugar-lowering pills so that you can take steps to avoid dangerously low blood sugar, or hypoglycemia.

How the Test Will Feel?
The study is carried out in a laboratory by a trained cardiologist or radiologist and technicians or nurses.

You will be awake and able to follow instructions during the catheterization. A mild sedative is usually given 30 minutes before the procedure to help you relax. The procedure may last from 1 to several hours.

You may feel some discomfort at the site where the IV is placed. Local anesthesia will be used to numb the site, so the only sensation should be one of pressure at the site. You may experience some discomfort from having to remain still for a long time.

After the test, the catheter is removed. You might feel a firm pressure at the insertion site, used to prevent bleeding. If the IV is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.

Risk Factors:
There are several potential risks. First, the catheter can irritate the heart, in rare cases causing a disturbance in the heart rhythm. Should this happen, the doctor can immediately use devices and medicines to restore a normal heart rhythm. The catheter occasionally can cause the coronary artery to go into spasm, temporarily reducing the blood flow and causing chest pain. For this reason, alert the doctors and nurses if you develop any chest discomfort, trouble breathing, or any other problem during the test.

In addition, the contrast medium can sometimes impair kidney function. This effect is almost always temporary, but some people have permanent damage. Another possible complication is bleeding at the place where the catheter was inserted. If blood collects under the skin, it can form a large painful bruise called a hematoma. This usually resolves on its own, without requiring additional treatment. Occasionally, people are allergic to the contrast dye and develop a rash, hives, or difficulty breathing after the dye is injected. If this should occur, the medical staff in the catheterization laboratory have medicines available to treat the allergic reaction.

The amount of radiation from this test is too small to be likely to cause harm.
Cardiac catheterization carries a slightly increased risk when compared with other heart tests. However, the test is very safe when performed by an experienced team.

Generally, the risk of serious complications ranges from 1 in 1,000 to 1 in 500. The risks include the following:
*Cardiac arrhythmias
*Cardiac tamponade
*Trauma to the artery caused by hematoma
*Low blood pressure
*Reaction to contrast medium
*Hemorrhage
*Stroke
*Heart attack
Must you do anything special after the test is over?
You should lie flat for a few hours after this procedure. Often, a small plug or stitch is used to prevent bleeding from the artery that was entered to perform the catheterization. If you received a sedative, you might feel sleepy and shouldn’t drive or drink alcohol for one day after the catheterization.

What Abnormal Results Mean

The procedure can identify heart defects or disease, such as coronary artery disease, valve problems, ventricular aneurysms, or heart enlargement.

The procedure also may be performed for the following:
*Primary pulmonary hypertension
*Pulmonary valve stenosis
*Pulmonary embolism
*Tetralogy of Fallot
*Transposition of the great vessels
*Tricuspid regurgitation
*Ventricular septal defect

How long is it before the result of the test is known?
Your doctor will have your results as soon as the test is completed. In particular, the doctor can tell you if you have any blockages in the coronary arteries, how many and how severe they are, and the best way to treat them. In some cases, your doctor is even able to remove any blockages immediately by performing an intervention known as a coronary angioplasty, a procedure that uses a tiny inflatable balloon to reopen the artery.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/cardiac-catheterization.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003419.htm

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