General information
Other namesFIGURE 5.8 FIGURE 5.9
| Where It's Done | Who Does It | How Long It Takes | Discomfort/Pain |
| Hospital catheterization lab or special diagnostic center. | Doctor. | 2-3 hours plus at least 6-8 hours of rest and observation afterward. In selected cases, the patient may go home the same day; in many instances, you may have to stay in the hospital overnight. | Minor discomfort from IV and anesthetic injection. Dye may cause flushing or burning. Holding position for imaging may be uncomfortable. You may have to remain in bed overnight with your weight on your groin. |
| Results Ready When | Special Equipment | Risks/Complications | Average Cost |
| A few hours. | X-ray and fluoroscopic equipment, IV line, catheter, and dye. | Possible clot, bleeding, or blood vessel damage at site of catheter insertion. Dye may cause an allergic reaction, especially in people allergic to iodine or shellfish. Rarely, test may provoke heart attack, stroke, or cardiac arrest. | $$$ |
Coronary arteriography or cardiac cath.
Purpose- To evaluate blockage of coronary arteries; to evaluate function of bypass grafts, heart valves, and other heart structures; and to assess coronary circulation and overall heart function.
- To study congenital heart defects.
- To take tissue samples (biopsies) and study heart muscle disorders such as myocarditis, or transplant rejection.
- A thin catheter is inserted into a blood vessel, usually an artery in the leg or arm, and passed through the blood vessel to the heart.
- Dye is injected to make the coronary arteries and other structures visible on X-rays.
- Fluoroscopy and X-rays provide images of the coronary arteries and other heart structures.
- Do not eat or drink for 12 hours before the test.
- An IV line will be inserted before the test, and a mild sedative may be administered to ease anxiety.
- If the catheter is introduced from the le.g., the groin is shaved to help prevent infection.
- You lie on an examination table under the X-ray monitoring equipment, and remain as still as possible throughout the test unless you are told to shift your position.
- Anesthetic is injected into the leg (or arm).
- A small incision is made in the leg (or arm) to permit insertion of the catheter (see figure 5.8).
- The doctor threads the catheter through the blood vessel to the heart while watching its progress on the video monitor.
- Contrast dye is injected through the catheter, and the doctor views the heart function on the monitor.
- Moving and still X-ray pictures (angiograms) are made for later study and interpretation (see figure 5.9). If a biopsy is needed, a special tweezerlike instrument is inserted through the catheter to collect tissue samples.
During cardiac catheterization, the catheter is inserted into a vein in the leg and then threaded upward to the heart. (In some instances, the catheter is inserted into a blood vessel in the arm.) A contrast dye is then injected through the catheter to make the coronary arteries and other heart structures more visible on X-rays.
In this angiogram, the coronary arteries are shown in white. The arrow points to an area of significant narrowing of the left anterior descending coronary artery due to fatty plaque, or atherosclerosis.
- After the catheter is removed, pressure is applied to the incision site until bleeding stops, and a bandage is applied.
- A small sandbag is usually placed over the incision for a few hours to prevent bleeding.
- During the recovery period, your blood pressure and other vital signs are monitored periodically.
- If you have the test as an outpatient, you rest in a recovery room for six to eight hours. Otherwise, you stay in the hospital overnight.
- In the first few hours after the test, you will be given apple juice, water, or other clear fluids. Drink as much as you can to speed the kidney's removal of the dye from your body.
- For the first few hours, you are checked every 30 minutes by a doctor or nurse. During this time, you should avoid moving your leg (or arm), and summon help immediately for bleeding or other symptoms.
- If your condition remains stable and there is no bleeding, you can sit up, stand, and walk for a short distance five or six hours after the test. Outpatients can usually leave the testing center seven to eight hours after the test.
- Before you go home, a doctor or nurse should show you how to apply pressure to stop any bleeding at the incision site. If continuous bleeding (not stopping within a few minutes) or other symptoms develop at home, call for an emergency medical crew to take you to the nearest hospital.
- Obesity may obscure X-rays.
- Severe arteriosclerosis in the blood vessels of the arms or legs may limit access of the catheter to the heart.
The films are studied for narrowed or blocked arteries and other abnormalities.
AdvantagesThe test is reliable, providing the most accurate information about heart structures.
Disadvantages- It's invasive.
- It carries a risk of a clot (embolism), bleeding, or blood vessel damage at the incision site.
This is usually the definitive diagnostic test that confirms or rules out earlier findings. If the results point to the need for surgical treatment, the next step may be balloon angioplasty, coronary bypass surgery, a heart valve operation, or some other intervention.
DID YOU KNOW?
- The German scientist who did the first human cardiac catheterization actually did the procedure on himself, with the help of his office nurse.
- Each year, more than one million Americans undergo cardiac catheterization and angiography.
- Of these patients, about 300,000 later undergo balloon angioplasty, while 265,000 later have coronary bypass surgery to improve blood flow to their heart muscle.
PATIENT TIPS
- Be sure to tell the doctor of any allergies, especially to seafood or iodine. Otherwise, you may suffer an adverse reaction to the dye.
- About 1 in 10 patients has an adverse reaction to the dye when it is injected, becoming nauseated and possibly vomiting.
