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Page 1 of 36 mc About Your Heart-Catheter Procedures About Your Heart-Catheter Procedures Page 2 of 36 mc About Your Heart-Catheter Procedures Page 3 of 36 mc About Your Heart-Catheter Procedures Table of Contents Introduction... 2 Before Your Catheter Procedure Diagnostic Procedures... 9 Coronary angiogram... 9 Right heart catheterization Heart biopsy Catheter-Based Treatments Balloon angioplasty Stent Other treatments Risks After Your Catheter Procedure What you need to know before receiving sedation Discomfort Medications Activity restrictions When to call your physician Follow-up appointments Frequently Asked Questions Research Summary Word List Page 4 of 36 mc About Your Heart-Catheter Procedures Introduction A heart catheterization (also called cardiac catheterization or heart cath) is done to diagnose and/or to treat problems in your heart. If you have symptoms of a heart problem, your health care provider will do several tests, such as blood tests, a chest X-ray, electrocardiogram (ECG), etc. Depending on the results, a heart catheterization may be needed. Catheterization refers to any procedure in which a catheter (a long, thin, flexible tube) is inserted into your body. During a heart catheterization, a catheter is inserted into a blood vessel and guided to your heart (figure 1). Catheters can be inserted in your neck, arm or leg in an artery or a vein. The right or left side may be used. Often, more than one insertion site is used. Catheterization can be used both to diagnose and treat heart problems. 2 Page 5 of 36 mc About Your Heart-Catheter Procedures Internal jugular vein Radial artery Brachial artery Femoral artery or vein Figure 1. Insertion sites for a cardiac catheterization. Dotted lines show possible path of catheters to heart. Angiography refers to the injection of contrast material (dye) through a catheter. The contrast material allows your physician to better see the arteries and heart chambers on the X-ray image. 3 Page 6 of 36 mc About Your Heart-Catheter Procedures Coronary angiography is a procedure that visualizes the blood vessels of the heart. However, catheters can be used to do more than inject dye for X-rays. Catheters can: Measure oxygen in the blood Measure pressure and blood flow in your blood vessels and heart Take samples of your heart tissue (biopsy) Treat some heart problems This material is meant to tell you about: Different kinds of tests and treatments that may be done during a heart catheterization What happens before a heart-catheter procedure What happens after a heart-catheter procedure Words in bold are defined in a word list beginning on page 32. If you have questions about this information or about your procedure, ask a member of your health care team. 4 Page 7 of 36 mc About Your Heart-Catheter Procedures Before Your Catheter Procedure Preparations for all heart-catheter procedures are similar no matter which procedure you have. If you have any questions about preparation instructions before your heart-catheter procedure, talk with a member of your health care team. Usually, you go to the hospital the morning of your heart-catheter procedure. To prepare for the procedure, regardless of which procedure you have: Do not eat or drink anything after midnight. On the morning of your procedure, bring with you a current list of all medications (prescription, over-the-counter medications, herbal supplements, vitamins, etc.) that you take, including dosages and how often you take them. If you take nitroglycerin, bring your medication with you. If you have diabetes, contact your primary health care provider before your test, procedure or surgery for instructions on taking insulin and other diabetes medications. If you take a blood thinner (anticoagulant) medication (such as Warfarin, Coumadin ) or antiplatelet medication, (such as Plavix, Aggrenox ) or aspirin, ask the health care provider managing these medications if you should stop taking them before the procedure and for how long. 5 Page 8 of 36 mc About Your Heart-Catheter Procedures You may rinse your mouth or brush your teeth as long as you do not swallow anything. If you are already in the hospital, members of your health care team will guide you through the preparations for your heart-catheter procedure. Before your procedure, the nurses will ask you questions about your health and check your vital signs (temperature, pulse, blood pressure) and check the pulses in your arms and legs. You will be asked to empty your bladder and change into a gown. The nurses may ask you to remove contact lenses, jewelry or hairpins. An intravenous (IV) line may be started in a vein in your arm. The IV is used to give you a sedative to help you relax, as well as other medications you may need during the procedure. If you need help while you are waiting for the procedure to begin, ask any member of the staff. You will be taken on a cart to the procedure area where a nurse or technician will make sure you are ready. A small amount of hair may be shaved off at the place(s) where the electrodes are placed and the catheter inserted. 6 Page 9 of 36 mc About Your Heart-Catheter Procedures When the physician is ready to start the procedure, you are moved into a room similar to an operating room with X-ray equipment. When you arrive in the room, you will be moved from the cart onto the X-ray table. Because the table may be tilted during the procedure, safety straps are fastened across your chest and legs. These straps allow you to roll to the left and right. A technician will put electrodes on you to monitor your heart during the procedure. A blood pressure cuff will be placed on your arm. Though you may be sedated to help you relax, you will be awake during the procedure and able to talk with the staff if you wish. Personnel in the procedure room wear sterile gloves, gowns, caps and masks to make the area as germ-free as possible. You may notice that staff also wear lead gowns to protect them from daily exposure to X-rays. The area around the artery or vein (catheter insertion site) will be washed with a disinfectant soap and you will be covered with a sterile sheet. Once this sheet is in place, it is important that you keep your hands under it at all times. 7 Page 10 of 36 mc About Your Heart-Catheter Procedures The physician will inject an anesthetic to numb the area into which the catheter will be inserted. A short plastic tube called a sheath is then put into your artery or vein. You may be given medication to help prevent your blood from clotting, to relax your heart arteries, and to make you comfortable. A long, thin, flexible plastic tube called a catheter is inserted through the sheath and placed in the correct position in the heart. Once the catheter is in place, the physician can do the necessary test and/or treatment. 8 Page 11 of 36 mc About Your Heart-Catheter Procedures Diagnostic Procedures Coronary angiogram Coronary angiograms are X-ray pictures of coronary arteries, the blood vessels that carry nutrients and oxygen to your heart muscle (figure 2). To see the arteries, a dye is injected into them. Physicians study the angiogram to learn about blockages in the arteries. Main left coronary Left circumflex Left anterior descending Right coronary Posterior descending Obtuse marginal Left anterior diagonal Figure 2. Coronary arteries carry blood to the heart muscle. Dotted lines show arteries on the back of the heart. 9 Page 12 of 36 mc About Your Heart-Catheter Procedures After your physician places the catheter in your heart, dye is injected through the catheter to make the heart chambers and blood vessels easier to see. There may be parts of the procedure during which the dye makes you feel warm. A special X-ray camera will photograph your heart and coronary arteries. During this procedure, at certain times you may be asked to do certain activities, such as taking deep breaths, holding your breath or placing your arms in different positions. Do not be alarmed if you feel your heart skipping beats; this is normal during angiograms. Your heart rate and blood pressure are continuously monitored to tell your physician about your heart s status. Tell your physician if you feel heart pain or discomfort. Depending on what the physician learns during the coronary angiogram, you may also have other studies or one of the catheter-based treatments mentioned below. 10 Page 13 of 36 mc About Your Heart-Catheter Procedures Right heart catheterization Right heart catheterization usually is done to measure the pressures and blood flow through the right heart chambers and the lungs (figure 3). Catheters with tiny built-in sensors make it possible to measure how much blood your heart is pumping. Usually the catheter is inserted through a neck vein or a vein in the groin for a right heart catheterization. Insertion site into internal jugular vein Figure 3. Right heart catheterization 11 Page 14 of 36 mc About Your Heart-Catheter Procedures Heart biopsy Catheters also may be used to get small amounts of heart muscle to look at under a microscope. This procedure is called a biopsy. To get the tissue sample, a special catheter with small jaws on the tip usually is inserted into the right ventricle through a vein (figure 4). These jaws can be opened and closed by the physician doing the procedure. You will not feel the catheter as it removes the tissue sample. Biopsy catheter inserted through internal jugular vein Figure 4. Heart biopsy 12 Page 15 of 36 mc About Your Heart-Catheter Procedures Catheter-Based Treatments Balloon angioplasty Balloon angioplasty may be done to open a blocked artery. During the procedure, the cardiologist passes a special catheter containing a small, inflatable balloon through a guide catheter. The catheter is placed at the blocked area in your artery and the balloon is inflated (figure 5). As the balloon expands, it enlarges the inside of the artery wall. After the balloon is deflated, the physician looks at an X-ray picture of the artery to see if the artery remains blocked. Sometimes a blockage will open with one or two inflations, but several inflations may be needed. This is done during the same procedure. 13 Page 16 of 36 mc About Your Heart-Catheter Procedures A Guide catheter Aorta Area of blockage Coronary artery B Catheter inserted into artery Guide catheter Balloon catheter Blockage C Inflated balloon enlarges wall and unblocks artery Balloon catheter D Balloon catheter removed Guide catheter Figure 5. Balloon angioplasty 14 Page 17 of 36 mc About Your Heart-Catheter Procedures Stent A stent is a metallic mesh coil that can be placed inside an artery if other procedures do not open the artery enough. One or more stents may be placed. The stent(s) is coiled around a deflated balloon and passed through the guide catheter. When the catheter arrives at the blocked area, the balloon is inflated, expanding the stent. The stent works to keep the blood vessel open (figure 6). Catheter inserted into artery Balloon catheter Inflated balloon enlarges wall and unblocks artery Stent remains to hold artery open Balloon catheter removed Figure 6. Balloon angioplasty with stent 15 Page 18 of 36 mc About Your Heart-Catheter Procedures The balloon is deflated and removed, leaving the stent in place. Stents are used in most catheterrelated procedures because they reduce the need for repeat procedures. Stents may be coated with a medication to prevent repeat blockage. These are called drugeluting stents. Most of the stents now used are drug eluting. Other treatments Closing an ASD (atrial septal defect) or PFO (patent foramen ovale) An atrial septal defect is a hole in the wall (septum) between the right and left atria. A patent foramen ovale usually is a small opening in the wall between the right and left atria that should have closed after birth but has remained open. In some people, an ASD or PFO can be closed during heart catheterization, a nonsurgical procedure, using a special device that is designed to close an ASD or PFO. Thrombectomy To remove blood clots, a special catheter is threaded through the blood vessels to the area of the blockage. When it gets to the clot, different methods are used to break up the clot and remove it. 16 Page 19 of 36 mc About Your Heart-Catheter Procedures Peripheral vascular/carotid interventions To treat blocked peripheral arteries (in the legs) or carotid arteries, balloon angioplasty with or without a stent can be done. Other procedures can be done in the heart cath laboratory, such as balloon valvotomy (using a balloon to open up a blocked valve), septal ablation (using a catheter to decrease muscle obstruction), and others. Talk to your health care provider about your specific procedure. 17 Page 20 of 36 mc About Your Heart-Catheter Procedures Risks Risks involved in all catheter-based procedures are similar, although some treatments may have risks specific to that procedure. Talk to your health care provider about your specific risks. Coronary angiograms are relatively safe, with little discomfort. Your physicians and nurses can discuss all aspects of the procedure with you, including possible complications such as the following: Hematoma A bruise around the puncture site that usually disappears in a few days or weeks. A pseudoaneurysm (swelling of a vessel at the catheter insertion site that looks like an aneurysm) may appear after a catheter-based procedure. Chest pain Tell a member of your health care team if you have any chest pain during the procedure. You may feel a type of chest pain called angina that requires medication for relief. Contrast dye reactions You may feel a temporary sensation of warmth or a hot flash from the dye. This hot flash is not an allergic reaction. Sometimes the dye causes allergic reactions that may be treated with medication. Tell a member of your health care team about any past allergic reactions to dyes used in X-ray procedures. 18 Page 21 of 36 mc About Your Heart-Catheter Procedures Artery blockage Rarely, a coronary artery will suddenly become blocked. Need for emergency surgery. Infection An infection may occur at the puncture site. Heart attack, stroke, death Risk of heart attack, stroke or death associated with a coronary angiogram is very low. While opening blocked arteries, balloon angioplasty and stenting can dislodge blood clots and cause them to travel to another part of the body, possibly causing a heart attack or stroke. Important: Women who are pregnant or those who think they may be should tell their health care provider before having the procedure. 19 Page 22 of 36 mc About Your Heart-Catheter Procedures After Your Catheter Procedure After your catheter-based procedure, you will go to a recovery area for observation. When your condition is stable, usually after about an hour, you will return to your room on a cart. If you received an anticoagulant (medication to help prevent blood clots) during the procedure, the plastic sheath may not be removed immediately. While the sheath is in place, it is very important that you do not move the limb in which the sheath is placed and that you do not lift your head from the pillow. Moving the limb can result in serious bleeding complications. You have to lie flat, but for your comfort, your bed may be tilted, your back rubbed and medications and pillows may be used. Your physician determines how long the sheath must stay in place. The amount of time the sheath is left in depends in part on the procedure done. After the sheath is removed, a member of your health care team will apply pressure to the puncture sites to prevent bleeding. The amount of time pressure is applied depends on the puncture site and on the procedure done. After the sheath is removed, you must lie flat for approximately one to six hours to let your artery begin to heal. This is absolutely necessary to avoid bleeding. How long you lie flat depends 20 Page 23 of 36 mc About Your Heart-Catheter Procedures on the procedure done. Ask your health care provider if you have questions. During this time, you may receive medication to help your muscles relax and to keep you comfortable. You will be told when you can get up. Activity restrictions depend on whether you had a venous or arterial puncture. Closure devices may be used to help seal the artery after a catheter procedure. The closure device is placed under your dressing. Tell your health care provider if you have had a closure device in the past and ask for information about closure devices. When you are back in your room, your blood pressure and pulse will be checked frequently, along with the catheter insertion sites. You may eat and are encouraged to drink plenty of fluids. The amount of fluid you drink and the amount of urine emptied from your bladder may be measured. If you have an IV, it may be removed when you are able to drink fluids. Depending on your medical condition, your physician will decide how long you should stay in the hospital. You may be discharged from the hospital the same day as your procedure, or you may be hospitalized and discharged one or more days after your procedure. 21 Page 24 of 36 mc About Your Heart-Catheter Procedures If you leave the hospital the same day as your procedure, you must stay within 30 miles of the hospital for one night. Someone should stay with you for the first 24 hours after your procedure. If you had a catheter-based treatment, you will probably stay in the hospital overnight. What you need to know before receiving sedation If you receive intravenous (IV) sedation, for the first 24 hours after being sedated it is common to have lapses of memory, slowed reaction time and impaired judgment. Therefore: Arrange for someone to accompany you to and from your appointment. Do not drive or operate motorized vehicles or equipment. If you will be going home after a procedure that requires sedation, make arrangements for someone to drive you home. You may wish to have a responsible adult stay with you for the remainder of the day. Rest for the remainder of the day. Do not return to work. Do not assume responsibility for small children or anyone dependent on your care. Do not ride a bicycle or use in-line skates. 22 Page 25 of 36 mc About Your Heart-Catheter Procedures Avoid rough play and participation in sports. Do not drink alcoholic beverages. You may wish to avoid making important decisions or signing legal documents. Discomfort Normally the puncture site is slightly tender and swollen. There may be a small area of discoloration or a small knot in the area of the puncture. Tenderness at the puncture site may persist for 24 to 48 hours. You may take a nonaspirin pain reliever containing acetaminophen such as Tylenol in the recommended dose as needed for discomfort. Medications Take all your previously prescribed medications, including aspirin, as you normally do unless your physician tells you otherwise. You may be prescribed new medications after your procedure, especially if you have a stent. Activity restrictions Activity restrictions depend on the procedure you had and whether you had a venous or arterial puncture. 23 Page 26 of 36 mc About Your Heart-Catheter Procedures It is common to have activity restrictions for up to three days after your procedure. For three days after your procedure, avoid strenuous activities and do not participate in sports. Do not: Lift or move heavy (weighing more than 10 pounds) objects. Do strenuous exercise (biking, weight lifting, aerobics, golfing). Strain. Climb stairs. Participate in sexual activity. Ask a member of your health care team about returning to work. Do not shower until the morning after your procedure. At that time, you may remove the bandage. Do not soak in a tub for three days. Keep the site clean and dry. Do not use powders or creams on the site. When to call your physician Call your physician if any of the following symptoms occur. Bleeding or inflammation at the puncture site New
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