Health Topics for Cardiovascular Health

UI Heart and Vascular Care

Cardiovascular Diseases

Cardiac Catheterization

This booklet will acquaint you with what to expect before, during and after your cardiac catheterization. Your physician and nursing staff will be happy to answer any questions you have regarding your care.

Contents

• Introduction
• Before the Procedure
• Hospitalization
• Laboratory Setting
• The Procedure
• After the Procedure
• Other Tests
• Glossary

Introduction

Cardiac catheterization is a diagnostic procedure for evaluating certain problems with the heart and its blood supply. The procedure involves the placement of a long, thin tube (called a catheter) into the heart to measure pressures, inject dye, and take x-ray pictures. This procedure normally takes two to three hours.

Cardiac catheterization provides information about (1) the blood flow through the heart and coronary arteries (blood vessels that supply blood to the the heart muscle) or other major blood vessels that carry blood to and from the heart; (2) pressure within the heart chambers; (3) the detailed structure of various parts of the heart and vascular (blood vessel) system; and (4) the heart's pumping ability.

Your doctor has decided that this information is needed to plan appropriate treatment for you.

The Normal Heart

Information about the normal heart may help you to better understand any problem involving your heart or vascular system that may be found during cardiac catheterization.

The heart is a hollow, muscular organ that lies in the center of the chest under the breastbone. It has four chambers. The two upper chambers (atria) receive blood, and the two lower chambers (ventricles) pump blood. A wall (septum) divides the heart into a right and left side. Four valves in the heart serve as one-way gates to keep blood flowing in the proper direction.

Blood from all parts of the body returns through veins to the right atrium (grey arrows). This blood has had most of its oxygen removed by the body's tissues. From the right atrium, blood goes to the right ventricle, which pumps it to the lungs where it is replenished with oxygen. From the lungs, oxygen-rich blood (red arrows) returns to the left atrium of the heart and into the left ventricle, the most muscular portion of the heart. When the left ventricle contracts, it sends blood into the largest artery, the aorta. Blood then passes into smaller arteries until it reaches its various destinations throughout the body.

The heart, like all body organs, requires oxygen to perform its work. This oxygen is supplied by a system of arteries, called the coronary arteries, which branch off the aorta soon after the aorta arises from the left ventricle. Although there is great individual variation, most people have three major coronary arteries: the right coronary artery, left anterior descending branch and left circumflex branch.

These arteries run along the surface of the heart and divide into smaller branches that penetrate the muscular walls of the heart to nourish it with oxygen.

Before the Procedure

Insurance

At least one to two working days prior to your cardiac catheterization, you should contact your insurance representative to inform them of your anticipated procedure. Many policies require pre-certification, or prior approval for coverage of elective procedures. The clerical staff of the Cardiac Catheterization Lab will assist your if you have further questions. A social worker is also available for information on other funding sources.

Admission to the Hospital

Unless your medical condition requires prior hospitalization, many patients are admitted to the hospital the same day as the cardiac catheterization, then go home the following morning. In this case, the necessary blood tests, chest x-rays, and ECGs (electrocardiograms) will be obtained at a clinic visit the day prior to the procedure or the morning of the procedure.

The nursing staff will review the procedure with you and your family to clarify any information and answer any questions. In addition, a member of the catheterization team will explain more specifically what you can expect during the actual procedure.

Hospitalization

Allergies

Tell your physician at least one day before the procedure if you have a history of allergies to any of the following: medications, shell fish, and/or x-ray dye.

Consent

A catheterization team physician will explain why the procedure is necessary and what risk is involved. The degree of risk is related in part to your health condition and varies with each patient. The procedure requires written consent.

Skin Preparation

The day or evening before the catheterization, your skin will be prepared for the procedure. This involves scrubbing your skin and shaving body hair from potential catheter insertion sites. The most commonly used site is the inside part of your thigh (groin area), but occasionally the forearm is used. Skin preparation helps ensure a clean site and reduces the chance of infection where the catheter enters the skin.

Intravenous (IV) Lines

A small catheter is inserted into a vein to provide an access site in case medicatons need to be given or intravenous solutions are required.

Eating, Drinking

You must not eat or drink after midnight of the evening before the test, except to drink small amounts of water when taking medications. If the catheterization is not scheduled until the afternoon, your physician may allow you to have clear liquids for breakfast, after which you must not eat or drink.

Final Preparation

Before you go to the Catheterization Laboratory, you should use the bathroom because it will be a couple of hours before you return to your room. You will not be able to use the urinal or bedpan during the procedure.

You will wear a hospital gown without pajama bottoms to permit easy access to the catheter insertion site. You may wear your glasses, and if you have dentures, please wear them.

Before you go to the Catheterization Laboratory, you will be given medication to help you relax. The medication does not put you to sleep, becuase you need to be awake during the test to follow instructions.

Your family members should wait in your room or in a nearby visitors' lounge. They will be notified when you return to your room.

Laboratory Setting

Environment

The Catheterization Laboratory is similar to an operating room. Sterile technique prevents infection. The physicians who perform the procedure wear gowns, masks, and gloves.

Equipment

Once you are in the Catheterization Laboratory, you lie on a special table and a camera rotates around you. The purpose is to obtain pictures of the heart from different angles.

The pictures are taken by an x-ray movie camera located above your chest. During the procedure, you can see the pictures on a special television screen.

Monitoring

During the procedure, your electrocardiogram (ECG) and pressures in the heart chambers are monitored.

The Procedure

Site Preparation

The entry site (forearm or groin) for the catheter is scrubbed with a soap solution and covered with a sterile drape, which you should not touch during the test.

Insertion of the Catheter

When the physician numbs the insertion area with a local anesthetic, you will feel an initial needle prick, then burning from the anesthetic. After that you should not have significant pain. You may have a pressure sensation when catheters are exchanged.

The physician uses a needle to enter the blood vessel. A guide wire is passed through the needle and the needle is removed. Next, a small plastic tube (catheter) is threaded over the wire and guided through the vessel and into the chambers of the heart.

An x-ray confirms the desired location of the catheter tip, and the guide wire is removed. The catheter is connected to special equipment that records pressures in the different heart chambers.

Once the catheter is in place, you might have a clear plastic hood placed over your head for approximately five minutes. The purpose of this is to analyze the air that you exhale. By doing this, the physician can determine the pumping efficiency of your heart. During this part of the test, you should not talk--just relax and breathe normally.

Blood samples may also be drawn through the catheter. After this, contrast material (dye) is injected, while x-ray motion pictures are taken. During the injection of dye, you might feel a warm sensation that spreads from head to toe and lasts 30 to 60 seconds. You may be asked to cough or hold your breath at certain times during the procedure.

When the test is finished, the physician removes the catheter (from the forearm or groin) and pressure is applied for about 15 minutes. The insertion site is usually covered with a small dressing. You are returned to your room, or if necessary, you may be moved to a special care area where your heart's rhythm can be carefully monitored.

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After the Procedure

When you return to your room, you are required to lie flat on your back for a minimum of six hours. The head of the bed may be elevated slightly after 2 hours, if there has been no bleeding. It is important to keep the leg that was used in the procedure straight and immobile during this time to minimize the chances of bleeding. A sheet may be placed over the knee of the affected leg to remind you not to bend that knee. After six hours, if there has been no bleeding from the catheter insertion site, the staff will assist you in turning onto your side. Most patients are allowed out of bed the next morning.

If the procedure was done through an entry site in your forearm, you will be permitted to get out of bed with assistance in one to two hours. Your arm, however, will be kept straight on a stiff armboard.

Nursing Care

After you return to your room, a nurse frequently checks your blood pressure, pulse, and catheterization site for signs of bleeding.

The pulse and temperature of your feet are checked, too. You are instructed to apply firm pressure to the catheter insertion site when moving or coughing. You may have difficulty with urination because of lying flat during the six hours of recovery. If so, a Foley catheter can be placed in your bladder until the following morning.

Eating, Drinking

An intravenous solution may be given to ensure that you have adequate fluid intake. Your physicians will determine when you can eat or drink. Your initial meal is all liquids. Unless you are advised otherwise, you are encouraged to drink plenty of fluids.

Discomfort

If you experience any pain or discomfort (backaches may occur during bedrest after catheterization), ask your nurse for pain medication. If you should experience any chest discomfort or note any bleeding at the catheterization site, you should notify a nurse immediately.

Results

Your physician will discuss your test results either on the afternoon of the procedure or the next day. A plan for your therapy will be discussed.

Day After the Procedure

The following day you may be up and about as you were before the test. It is important that a nurse be present to assist you when you first get out of bed, because you may feel light-headed. You are encouraged to drink fluid freely. If you have any more questions or concerns, please ask your physician or nurse.

Other Tests

Although you may not need additional tests, other diagnostic tests that require specialized x-ray recording equipment can be performed in the Catheterization Laboratory:

• Pulmonary Angiography - looking for blood clots in the blood vessels supplying the lungs.

• Aortography - visualizing the aorta, the major blood vessel arising from the heart.

• Coronary Bypass Graft Angiography - determining the diameter and function of bypass grafts.

• Pericardiocentesis - removing fluid from the sac surrounding the heart.

Glossary

Aorta - the large artery that receives oxygenated blood directly from the heart.

Atrium (plural "atria") - the two small upper chambers of the heart. The right atrium receives oxygen-poor blood from the body. The left atrium receives oxygen-rich blood from the lungs.

Cardiac - pertaining to the heart.

Cardiac Catheterization - the process of introducing a thin, flexible tube into an artery or vein and guiding it into the heart.

Catheter - a thin, flexible tube that can be inserted into a vein or artery (usually in the forearm or groin) and guided into the heart.

Contrast Material (dye) - a substance injected into the blood during cardiac catheterization. It allows heart structures to be shown on x-ray film.

Coronary Angiography - a catheterization procedure for assessing the diameter and function of the coronary arteries.

Coronary Arteries - arteries that arise from the base of the aorta and arch over the outer surface of the heart. They supply heart muscle with oxygen-rich blood.

Coronary Arteriogram- x-ray motion pictures of the dye-filled coronary arteries.

Dye - (See Contrast Material)

ECG (electrocardiogram) - a record of the electrical activity of the heart.

Heart Chambers - the four compartments of the heart: two atria and two ventricles.

Valves - tissue flaps at the entrances and exits of the heart chambers. The valves open and close to direct blood through the heart.

Ventricles - the two large lower chambers in the heart. The right ventricle pumps blood throughout the circulatory system via the aorta and is the major pumping chamber of the heart.

Ventriculogram - x-ray motion pictures of the ventricles showing contraction of the heart muscle.

Last Reviewed 2005

Source: University of Iowa Department of Internal Medicine

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.