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STEP BY STEP THROUGH CARDIAC CATHETERIZATION AND ANGIOPLASTY Produced by the Irish Heart Foundation This booklet is one of the publications in our patient information series. Funding
STEP BY STEP THROUGH CARDIAC CATHETERIZATION AND ANGIOPLASTY Produced by the Irish Heart Foundation This booklet is one of the publications in our patient information series. Funding This booklet is sponsored by AstraZeneca (Pharmaceuticals) Ireland Ltd. Acknowledgments We would like to thank Sister Carmel O Callaghan and Dr Vincent Maher for preparing this booklet. The Irish Heart Foundation The Irish Heart Foundation is the national charity fighting heart disease and stroke. More people in Ireland die from these causes than from cancer, road deaths and suicide combined. We work to bring hope, relief and a better future to Irish families. We support pioneering medical research, campaign for improved patient care and provide vital support and information for patients. In hospitals, schools and workplaces, we support, educate and train people to save lives. As a charity we depend on your ongoing support - through your donations or by giving of your time as a volunteer or on a training course. For more information or to donate, visit our website: Heart and Stroke Helpline: Locall (Monday to Friday 10.00am to 5.00pm) Irish Heart Foundation, 50 Ringsend Road, Dublin 4. Phone: Fax: Contents Introduction 3 What is cardiac catheterization? 4 Your heart 4 Your coronary arteries 5 Atherosclerosis 6 Heart attack 6 Coronary artery spasm 6 Heart valve problems 6 Getting ready for a cardiac catheterization 7 The cardiac catheterization (angiogram) 9 After cardiac catheterization 12 Right heart study 15 What is an angioplasty? 16 Stents 19 After the angioplasty 20 Helpful hints 23 An explanation of medical terms used in this booklet 25 2 Introduction This booklet has information about two medical procedures, the cardiac catheterization test (or angiogram) and angioplasty. We have written it for people who are going to have one of these procedures to help you understand why you need to have this procedure, what happens during the process and how you will feel. It adds to the information that you have already from your doctor. It does not replace the advice of your doctor, consultant or nurse. The booklet explains how your heart works and the problems that can happen to your heart and its arteries. It explains cardiac catheterization which is a test to find out if you have any of these problems. It also explains about angioplasty which is a similar procedure, but one that can treat some of the problems. 3 What is a cardiac catheterization? Your doctor feels that you need to have a test called a cardiac catheterization. An angiogram is another name for cardiac catheterization. You may never have heard of it, or if you have, you probably have a lot of questions. A cardiac catheterization is a test using dye and x-ray to see if there are any problems in your arteries, valves or the chambers of your heart. Your heart Your heart is a hollow muscular organ about the size of your fist that is slightly to the left of the centre of your chest. Its main job is to pump blood through arteries and veins to all parts of your body. There are two sides to your heart, a right side and a left side, which are separated by a muscular band known as the septum. On each side there are two chambers, an atrium and a ventricle, with a valve separating them. The chambers collect blood, the valves keep it flowing in the correct direction through your heart and your heart s muscular walls squeeze to pump blood to all parts of your body. Vein Aorta To lungs Right Atrium Left Atrium Right Lung Left Lung Vein Left Ventricle Right Ventricle Septum 4 Veins carry blood that has already been pumped around your body and from which some oxygen has been removed. This blood returns to the right side of your heart to the chamber called the right atrium. It then passes through the tricuspid valve into the chamber called the right ventricle. The right ventricle then pumps the blood through the pulmonic valve into your lungs. The blood gets oxygen in your lungs and then returns to the left side of your heart to the chamber called the left atrium. It passes through the mitral valve into the chamber called the left ventricle. From here the blood is pumped through the aortic valve into your main artery, the aorta, which carries the blood to all parts of your body. Your coronary arteries Heart muscle is called myocardium, and like every other muscle in your body, it needs to get the oxygen and nutrients in blood to be able to work properly. So, your heart pumps blood to itself through the coronary arteries. These arteries come from the aorta and spread out over the surface of your heart like the branches of a tree. A: Right coronory artery B: Posterior descending artery C D Left coronary artery C: Left Main D: Circumflex Artery (Cx) E: Intermediate Marginal F: Left Anterior Descending (LAD) A E F B 5 There are two large arteries. The right coronary artery mainly brings blood to the right side and lower surface of your heart. The left coronary artery divides into two large branches, the circumflex branch and the left anterior descending branch. These mainly supply blood to the left side of your heart. Atherosclerosis These arteries can become damaged over time by atherosclerosis (pronounced ath-er-o-scler-o-sis). Atherosclerosis comes from the Greek language and means hard porridge. This condition happens when fatty material builds up on the inside wall of your coronary arteries. This fatty material hardens into what is called atherosclerotic plaque, which narrows the artery and reduces the flow of blood to your heart muscle. This is what is commonly called, hardening of the arteries. It can cause angina. Angina is a tightness or pain in your chest, jaw or arm which is brought on by doing an activity that needs some effort. Your arteries can become very narrow due to the growth of this plaque. The plaque may tear away from the wall of the artery and cause a blood clot. This narrowing of your arteries reduces the flow of blood to your heart muscle and, in some cases, stops the blood from getting through completely. Heart attack If heart muscle does not get a supply of blood, it becomes damaged and can die. When an area of heart muscle dies, it is called a heart attack. The medical term for heart attack is myocardial infarction or MI. Coronary artery spasm Some people s coronary arteries can go into spasm. The reason for this is not fully understood. If the spasm lasts for long enough, blood flow to your heart muscle will be reduced and the muscle may be damaged. Heart valve problems The valves in your heart can be damaged by certain conditions such as rheumatic fever or infection. This can make the valves narrow or cause them to leak. A cardiac catheterization will let your doctor see if you have any of the problems mentioned above. You and your doctor will then decide on the best treatment for your condition. 6 Getting ready for a cardiac catheterization Some people have a cardiac catheterization during a stay in hospital. Most of the time, a cardiac catheterization is done as a day patient. The preparation is the same. What about food? Sometimes your doctor will ask you to have nothing to eat or drink for about 4 hours before the cardiac catheterization. This will stop you feeling sick or getting sick. You can eat and drink as much as you want after the test. If you have diabetes, be sure to discuss this with your doctor before the day of your test. What about tablets? If you are taking any type of medicines, you will need to know the name and the amount of each medicine you take. It would be a good idea to take your medicine bottles or an up to date list of your medicines with you to the hospital. Anticoagulants are medicines that thin your blood and prevent blood clots. Warfarin is a blood thinner and you must stop taking it a few days before the test. Again you should discuss this with your doctor as soon as you get your appointment date for the test. Aspirin is also a blood thinner, but it is safe to take as usual before the cardiac catheterization. Will I have to have any other tests? Before a cardiac catheterization you will need to have blood tests and an ECG (electrocardiogram) and sometimes a chest x-ray. Your medical history At the hospital you will be asked about your past and present health. It is very important that you tell the doctor or nurse if you have any allergies to 7 medicines or food. If you are waiting to have surgery carried out in the next year, be sure to tell hospital staff before you have the test. A cardiac catheterization is considered to be a safe procedure, but any work done inside your blood vessels carries a small risk of problems. These include bleeding and rarely heart attack and stroke. Your doctor will discuss any risk that cardiac catheterization might have for you and ask you to sign a consent form giving your permission for the procedure. Clothes To get ready for the test, you have to take off all your clothes, including underwear, and jewellery and put on a hospital gown. The nurse will tell you if you can wear your glasses and false teeth. If you have a hearing aid, leave it in. Preparing your skin The doctor will be putting a small tube into a blood vessel in your groin or your wrist during the test. So before the test, the nurse will shave any hair in your groin area and clean your skin with a special soap. Before the test starts, the doctor or nurse will put a small tube into a vein in your arm. This is called an IV and through the IV any medicine you need during the test can be given into your blood stream. You should go to the toilet before the test. You are now ready for your cardiac catheterization test. The cath lab Cardiac catheterization tests are carried out in a specially designed room called the cath lab or the angio suite. Who are the people in the lab? A number of people are needed for the cardiac catheterization test: A doctor performs the test A nurse helps A radiographer works the x-ray equipment A cardiac technician monitors your heart rate and blood pressure. 8 Cardiac catheterization When you arrive in the lab you will be asked to lie on the procedure table. The x-ray camera will be over the table and you will be able to see x-ray screens to the side. The cardiac technician will attach sticky pads to your body so he or she can monitor your heart rhythm (this is called an ECG). You may be able to see it on the screen. Sometimes you will be given medicine before the test to help you to relax. This can make you sleepy, but won t put you to sleep. Although a cardiac catheterization is a test not an operation, the doctor and nurse may be wearing gowns and masks. This helps the equipment to stay germ free. Your groin or wrist area will be cleaned with an antiseptic soap. You will be covered with a sterile cloth. Your groin or wrist will be injected with local anaesthetic to make the area numb. This injection might sting a little. When the area is numb, the doctor will put a needle into the artery in your groin or wrist. Through this needle, a tiny guide wire will be placed into your artery. A sheath (a long thin plastic tube open at each end) is threaded over the guide wire. Through the sheath a thin tube called a catheter will be passed into your artery and guided up to your heart. Once your groin or wrist is numb, you shouldn t feel the catheter as Catheter blood vessels have no pain cells. 9 At this point, if the tube is in your groin, you will be asked to put your hands behind your head. The x-ray camera will move close to you and will move around as the doctor carries out the test. The doctor uses an x-ray to see the catheter and move it to the opening of your coronary artery. The doctor will then inject dye into the arteries. The x-ray camera takes moving pictures of the flow of dye through the arteries. If there is any plaque in the arteries, the dye will show it. When all of the arteries have been examined, a catheter will be placed into your heart s main pumping chamber, called the left ventricle and more dye will be injected. The dye will fill up the chamber and the x-ray camera will take moving pictures of the dye as it is pumped out of the chamber into the aorta, which is your main blood vessel. This part of the procedure is called a ventriculogram. Aorta Dye enters the heart s left chamber Catheter 10 You will feel warm all over after that injection. This feeling will last for about 20 seconds. Some people may have a sensation that they have passed urine. You may also feel a few extra heart beats or feel slightly sick. These feelings will also pass quickly. TR Band The cardiac catheterization usually only takes about 30 to 45 minutes. What about the tubes? After all the pictures have been taken, the catheter will be taken out. If your procedure has been done through your wrist, the doctor will put a small band on your wrist. This band presses on the puncture site and should stay on for at least 2 hours and sometimes longer. If your procedure was done through your groin, firm pressure will be applied to the puncture site for about 10 to 20 minutes. This allows a seal to form over the puncture site in your artery. Some doctors use a little device that plugs the puncture site. This device cuts the amount of time you will need to stay in bed after the test. If your doctor uses this, he or she will explain more about it to you. Closure device Suture Collagen Bioabsorbable Anchor 11 After cardiac catheterization Wrist If your procedure was done though your wrist, you can sit up straight away and get out of bed after 1 hour. It is important that you rest your arm for the next few days. Groin If you have a closure device in your groin, you can get out of bed after 1 hour. If you don t have a closure device, you will have to rest in bed for up to 4 hours to let the puncture site seal fully. Your movements will be limited during this time. You may wiggle your ankle or toes on the leg that was used for the test. You don t have to keep your leg stiff, just straight. The head of the bed will be raised slightly, but you may not sit up, lift your head off the pillow or turn on your side. If you need to cough or sneeze, put your hand over the puncture site and press it firmly. If you need to go to the toilet you must use a bedpan or urinal (bottle), at this time. The nurse will help you with this. It is important that you empty your bladder whenever you need to. While you are in bed The nurse will check your heart rate and blood pressure regularly and also check the puncture site on your groin or wrist, and leg or arm pulses. Please tell the nurse if you have any discomfort in your chest, neck, jaw or arm. If you have any pain, numbness, tingling or pins and needles in your leg or hand, tell the nurse straightaway. As the numbing medicine wears off, your groin or wrist might be a little sore and bruised, but it shouldn t be swollen. Let the nurse know, as you may be able to get some medicine to relieve the pain. 12 Important. You must tell the nurse immediately if you feel sudden pain or swelling at the puncture site or notice a warm, sticky or wet feeling on the leg or wrist that was used. Remember Do not bend your leg and do not sit up. Time to get up The nurse must be with you when it is time for you to get out of bed. He or she will take your blood pressure and help you to sit and then stand. You have been in bed for a little while and you may feel a little light-headed, so take it easy. The nurse will also make sure that there is no oozing or bleeding from the puncture site. If you are a day patient, you can go home when your doctor has seen you. 13 Leaving hospital Your doctor will see you before you go home. He or she may discuss the results of your cardiac catheterization with you at that time, or they may wait until your next appointment. The nurse will give you information on what to expect after you leave hospital. You may feel a little tired, but unless your doctor tells you otherwise most people return to their normal routine within 2 to 3 days. Your groin or wrist may have a bruise and be a little sore for a few days. What did the cardiac catheterization test show? If the cardiac catheterization test shows that there is disease in your heart or coronary arteries, or both, your doctor will discuss treatments with you. Heart disease can be treated successfully with one or a combination of: medicines changes in lifestyle an angioplasty or a stent; and surgery. If the cardiac catheterization showed that your heart and arteries are normal, it is up to you to keep them healthy. You can do this by not smoking, controlling your blood pressure, monitoring your cholesterol level, taking regular exercise, keeping your weight down and reducing your stress. Ask your doctor for some help with this. For more information see the Irish Heart Foundation s leaflets covering these topics or contact the National Heart and Stroke Helpline on Right heart study A right heart study as the name suggests, means that your doctor is looking specifically at the right side of your heart. From shortly after birth, your heart is divided into two halves by a partition called the septum. Normally, there is no communication or link between these two halves. As mentioned earlier the right side of your heart pumps blood from which some oxygen has been removed to your lungs, while the left side of your heart pumps blood that is rich in oxygen and nutrients to the rest of your body. Aorta Balloon Pulmonary artery Left atrium Right atrium Catheter Right ventricle Left ventricle Septum To look at the right side of your heart, the doctor will put a small tube into the vein in your groin, at the top of your leg. This tube has a small balloon on its tip. Using x-ray, the doctor will guide the tube through the right side of your heart into the pulmonary artery. As the tube moves through your heart, oxygen levels and pressure readings may be taken. By injecting small amounts of fluid through the tube the doctor can tell how much blood is pumped from your heart over a certain period of time. A right-sided heart study is carried out to diagnose disease of your heart valves and lungs, or poor pumping function of your left ventricle. This test takes about 30 minutes. After the procedure the tube is removed from your groin and pressure is applied to the area for 5 to 10 minutes. This allows the puncture in the vein to seal. You then need to rest in bed for a short time. 15 What is an angioplasty? Your cardiac catheterization has shown that there are fatty build-ups, called atherosclerotic plaques in your coronary arteries. Angioplasty is a treatment used to unblock the arteries and increase blood flow to heart muscle. The angioplasty procedure is very similar to a cardiac catheterization. It is not surgery. Getting ready for angioplasty is the same as for cardiac catheterization. The procedure is carried out in the same room, the cath lab or angio suite. You will be awake during the procedure. Angioplasty takes about 45 minutes to 1½ hours. You will stay in hospital at least 1 night after the procedure. Angioplasty is a treatment used to unblock the arteries and increase blood flow to heart muscle. 16 17 Preparation You will be asked not to eat or drink anything for 4 hours before your angioplasty. Bring your medicine bottles or a list of your medicines with you to the hospital. You may not need to have another chest x-ray or ECG, so be sure to bring any recent results to the hospital with you. It is a good idea to make a list of questions you want to ask the doctor about the procedure or what happens afterwards. You may have some blood taken before the angioplasty. Remind the doctor of any allergies that you might have. You may be given some blood-thinning medicine before your angioplasty. But if you are taking warfarin, it is likely to be stopped a day or two before the procedure. When you get your appointment for this procedure, tell your doctor that you
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