cardiac cath lab angiogram

Cardiac Catheterization

What is it and what should you expect

Cardiac catheterization

Is a procedure that focuses on assessing the functional level of the chambers, valves, and blood vessels of the heart. The most common procedure performed during a cardiac catheterization is the coronary angiogram, which involves taking pictures of the coronary arteries. A coronary angiogram is performed to look for and treat coronary artery disease.

Coronary arteries are the vessels on the outside of your heart that supply your heart muscle with the necessary oxygen and nutrients needed to pump blood to the rest of your body. Chest pain and heart attacks can be caused by one of these arteries getting clogged from a clot, plaque, or calcium causing a reduced amount of blood flow to an area of heart muscle. This lack of blood flow is called an infarction and can often cause chest pain, jaw or arm pain, or heaviness in your chest.

The procedure

Is fairly simple. The patient lays on a narrow table and  the chosen access location is prepped with a sterile solution or scrub. A sterile drape is then laid down covering the patient and table. Supplies are set up and an x-ray camera is moved into position over the patient. A local anesthetic is injected into the skin around an artery usually in the front of your hip to access the femoral artery or your wrist to access the radial artery. A needle is then inserted into the artery, which is exchanged for a sheath that maintains access to the artery allowing catheters, balloons, and stents to be passed through. This sheath is about the size of the tube of ink inside a typical pen.

A guide catheter, which is a shaped plastic tube, is advanced into the aorta and directed into the coronary arteries. Dye is pushed through this catheter and into the arteries. X-ray is used to see the coronary arteries opacify and gives the practitioners the ability to see if there are blockages in the arteries and if there is something that needs to be fixed.

When a blockage or significant narrowing is discovered in an artery a small balloon is often used to push the lesion open. A stent may be placed to hold the area open allowing blood to flow more easily through the artery. A stent looks a lot like a very small tube made of chicken wire. Improved flow of blood allows the heart muscle to retrieve the oxygen and nutrients it needs to work. The quicker the artery is opened the better chance of the heart muscle coming back alive after having been deprived of oxygen. Most hospitals have a goal of 90 minutes or less to open a blocked artery from the time a patient arrives at the hospital with a heart attack.

A cardiac catheterization can also be done to evaluate the efficiency of the valves in the heart and how well the heart is pumping. To determine how well the heart is working practitioners take pressure measurements or inject large amounts of dye into the main pumping chamber of the heart and watch it squeeze while watching on x-ray.

After the procedure

If access was through the femoral artery by the hip then the patient may be expected to lay flat for several hours after the procedure to prevent bleeding. If the access site was in the wrist then a pressure band is usually applied and then removed after several hours. Strong blood thinners are administered during the cardiac catheterization if a stent is placed to prevent the body from rejecting the stent and to prevent further clot from forming in the artery. These clot preventing medications are important to prevent the vessel from re-occluding but occasionally can cause bleeding issues after the procedure. Generally you can return to daily activities in a few days after having the heart cath.