Cardiac conditions are one of the prime reasons for deaths, along with accidents, diabetes, and various cancers, all over the world.Cardiac Catheterization is a critical procedure doctors use to diagnose and treat various heart disorders. It plays a vital role in assessing various heart conditions and developing appropriate treatment plans. In many cases, doctors employ coronary angiography as a part of the cardiac catheterization procedure. This process involves capturing X-ray images of various arteries inside the heart (known as coronary arteries). The images obtained through this process are called arteriograms or coronary angiograms.
This page provides information on the life-changing procedures of cardiac catheterization and coronary angiogram. From the way it is done to how it helps diagnose vital coronary disorders, you can understand the medical test in detail.
Understanding Cardiac Catheterization
The therapeutic diagnostic procedure of cardiac catheterization is known for its minimal invasiveness. This technique is considered a revolutionary advancement in the field of cardiology, as it helps your healthcare provider gather valuable insights and study the arteries and veins that pass through the heart. Cardiovascular conditions such as heart valve disorders and coronary artery disease are just a few of the conditions that can be easily diagnosed with a coronary angiogram, which is often a part of cardiac catheterization.
How is Cardiac Catheterization Carried Out?
Cardiac catheterization is often referred to as a cardiac cath. In this process, the medical practitioner introduces a hollow, narrow, and flexible tube called a catheter inside the blood vessels of the groin, neck, or arm to reach the aorta and eventually the heart. When the catheter reaches the desired position, various tests and procedures can be carried out. During cardiac catheterization, your physician utilises the catheter to assess the heart’s pressure and other vitals. Plus, they can also collect blood samples from the region to check for the level of oxygen in the circulating blood. Additionally, the injection of a contrast dye through the catheter helps visualise and understand the blood flow within the heart and its vessels.
Procedures Done During or After Cardiac Cath
During or after cardiac catheterization, several procedures may be performed to diagnose and treat heart conditions. Some of these procedures include:
Stent Placement
While going through this procedure, your doctor will expand a small metallic mesh coil at the catheter’s endpoint inside the artery. This is done to keep the artery open.
Angioplasty
This is a minimally invasive procedure where a balloon-like device is inflated to widen blocked or narrowed blood vessels. This process helps improve blood flow in the affected blood vessels.
Fractional Flow Reserve (FFR)
It is a diagnostic process to assess the severity of blockage in the coronary arteries. It acts as a guide for designing treatments such as the requirement for angioplasty or stenting.
Sampling of Heart Tissue
Also, popular as biopsy, a cardiologist recommends this to examine a tissue sample to look for abnormalities under a microscope.
Intravascular Ultrasound (IVUS)
It is an imaging technique used during heart cath and similar procedures to obtain a detailed image of the coronary arteries. It is helpful to visualise and measure various blood vessels inside your heart.
Why Do You Need to Undergo a Cardiac Cath? Symptoms to Watch Out for
There are certain symptoms that might be signs of specific cardiac issues. Below are the most vital symptoms you should address immediately.
- Angina or chest pain
- Frequent dizziness
- Shortness of breath
- Extreme fatigue
If initial screening tests, such as an electrocardiogram (ECG) or stress test, indicate the possibility of a heart condition that requires further investigation, your doctor may request a coronary angiogram or cardiac cath to obtain more detailed information.
Conditions that Cardiac Catheterization can Diagnose
Cardiac cath is an effective diagnostic tool that can detect numerous cardiovascular conditions. It provides crucial information for determining appropriate treatment strategies for the following conditions:
Cardiomyopathy
This condition is characterised by heart enlargement, where the muscles of the heart thicken and their performance weakens with time.
Atherosclerosis
Patients with atherosclerosis are diagnosed with clogged arteries, potentially due to the accumulation of fatty substances along with other materials in the bloodstream.
Congenital Heart Disease
Abnormalities in the structure of the heart that occur during foetal development are called congenital heart diseases. One example of such a disease include ventricular septal defect, in which infants have a hole in the walls of one of the heart chambers, predominantly in the lower two chambers.
Heart Valve Disease
This is a malfunctioning of heart valves that significantly affects blood flow inside the heart.
Heart Failure
This is a serious condition where the heart muscles are unable to pump enough blood, causing fluid congestion around the lungs and blood vessels. The condition can cause oedema in various parts of the body, including the ankles and feet.(4)
Risks Associated with Cardiac Catheterisation
Even though cardiac cath is a commonly performed procedure, it does have the potential for certain risks for patients. Below are some of the potential risks related to a heart cath.
- When the catheter is inserted into the body from the neck, groin, wrist, or arm, the area of the wound has a high chance of bruising. Bleeding is also possible in the area of insertion.
- The patient can feel a sharp pain in the area of catheter insertion.
- If the procedure is not performed accurately, there is a possibility of a blood clot. It can even damage the nearby blood vessels.
- Temporary heart rhythm issues are seen among patients.
- Infection at the insertion site is also sometimes possible.
There are more serious complications that have been observed among patients. However, these are rarely seen. These include.
- Abrupt coronary artery blockage
- Chest pain resulting in a heart attack
- Ischemia (reduced flow of blood in the tissues of the heart)
- Tear in the artery lining
- Kidney failure resulting from the dye used in the process
- Stroke
Besides these risks, you may have an allergic reaction to the dye used in cardiac catheterization if you have previously been diagnosed with allergies associated with medicines, iodine, latex, or contrast dyes.
People with pre-existing kidney issues are at high risk of kidney failure post-cardiac cath. Keep your doctor informed regarding any kidney issues and take precautionary measures before undergoing a coronary angiogram.
Pregnant women or individuals planning to become pregnant should notify their physician before going through this procedure, as it can injure the growing foetus. Furthermore, exposure to radiation can potentially lead to abnormalities in the unborn child.
There can be other risks associated with various medical issues. Please discuss your case with the healthcare practitioner in detail before agreeing to go through this procedure.
Ways to Prepare for Cardiac Catheterization
Preparing for heart catheterization involves a set of steps. The following preparative measures can help you remain well-informed and ready for the procedure ahead.
- You will need to fast for around 2 hours before undergoing heart catheterization. Some individuals may even require overnight fasting, which will be advised by your doctor.
- You will be asked to sign a consent form and give the healthcare facility permission to perform the procedure on you. Read every point carefully before agreeing to sign the form.
- Do not forget to discuss your allergies with your doctor prior to the test.
- If you take medicines regularly, you may have to stop taking them for a certain period of time. Please discuss the same with the doctor to know if you need to stop any medication.
- Furthermore, individuals with bleeding disorders should talk to their physician. Even if they are on blood-thinning (anticoagulant) medication, discuss it with the doctor.
- Pregnant women should avoid going through this procedure, even if it is inevitable. Talk to your physician and explore potential alternative options.
- Notify your doctor if you have any implants, such as pacemakers, in your body.
What to Expect During the Cardiac Catheterization Process?
A heart cath is usually an outpatient procedure. However, your specific condition determines the length of your stay. Before going to the procedure table, make sure you follow the steps below.
- Remove all jewellery and metallic accessories, as they can cause interference during the procedure.
- You need to empty your bladder before entering the procedure room.
- After emptying your bladder, change into the gown provided by the healthcare facility.
- A caregiver may shave the area where the catheter will be inserted if necessary.
- Before injecting the contrast dye, your healthcare practitioner will insert an intravenous (IV) line in your arm if necessary. Moreover, before the IV, you will be administered a sedative to keep calm and stay relaxed. The insertion site will be numbed with an anaesthetic before introducing the catheter.
- ECG monitoring will be done throughout the procedure to monitor your heart’s vital signs.
- Under the catheter insertion site, your pulse will be marked. This step is required to help check the circulation of blood in your limb post-procedure.
- After the local anaesthesia has taken effect, your physician will carefully introduce a sheath into a chosen blood vessel. This serves as a pathway for threading the catheter into your blood vessel and progressing towards your heart. In some cases, especially when using the arm as an access point, a small incision may be made for blood vessel exposure and to facilitate the placement of the sheath.
- Furthering the process, your physician will skilfully guide the catheter inside the aorta toward your heart’s left. Throughout this process, you may have to perform simple actions like coughing, holding your breath, or making slight head movements. You can watch the whole procedure on a screen.
- After the catheter has been properly positioned, your doctor will administer a contrast dye injection. This dye serves the purpose of enhancing visibility, allowing for clear visualisation of both the heart and the coronary arteries.
- Following the injection of contrast dye, a sequence of rapid X-ray images will be taken to capture detailed images of the coronary arteries and the heart.
- Upon completion of the procedure, your doctor will carefully extract the catheter and proceed to close the site of insertion. Several techniques can be employed for this purpose, including the use of collagen to seal the arterial opening, sutures, a clip to secure the artery, or applying pressure to prevent bleeding. The method chosen by your doctor will be based on your specific circumstances.
- When using a closure device, a sterile dressing is usually applied over the site to promote healing. Alternatively, if manual pressure is employed, the healthcare professional will apply pressure to the site, facilitating the formation of a clot to stop the bleeding. When the bleeding stops, the wound will be secured with a tight bandage.
Post-Cardiac Catheterization Events
Inside the Health Facility
Following the cardiac catheterization procedure, you will be transferred to a recovery room. During this time, it is important to remain flat in bed for a few hours. A dedicated nurse will closely monitor your vital signs, monitor the insertion site, and assess circulation in the affected leg or arm.
It is essential to promptly inform your nurse if you experience chest pain or discomfort or any sensations of warmth, pain, or bleeding at the insertion site. The duration of bedrest can vary, typically between 4 and 12 hours. However, if your doctor used a closure device, your bedrest period may be shorter, as determined by your specific circumstances.
At Home
After getting discharged from the healthcare facility, closely monitor your wound at home. Swelling, unusual pain, or discolouration should be reported to the doctor immediately.
It is normal to experience a small bruise in the area. However, if you observe continuous bleeding at the insertion site that cannot be managed with a dressing, you should promptly contact your physician for further evaluation.
