This page describes the procedure known as cardiac catheterization. If you or a family member has any additional questions, please feel free to discuss them with your doctor or nurse at any time.

The purpose of cardiac catheterization

A cardiac catheterization is a diagnostic test that will give your doctor detailed information about your heart and coronary arteries. Your doctor will be able to evaluate any blockages in your coronary arteries, the overall health of your heart and valves, the presence of aneurysms, and abnormal blood flow in your heart. Based on this information, your doctor will make a diagnosis and recommend a plan of care. The doctor will usually discuss the results of your test with you the same day.

Words you should know

• Anesthetic: a medicine applied to an area to numb it.
• Aneurysm: abnormal bulge in the wall of the heart or an artery.
• Antiseptic: a disinfectant used to kill germs.
• Catheter: a small, thin, flexible line.
• Electrocardiogram or ECG: computerized recording of the electrical activity of the heart.
• IV: intravenous needle used for administering medication.

Testing instructions:

Do not eat or drink after midnight the day of the test until the test is over. Take all medications as prescribed with a small sip of water unless directed otherwise by your doctor. Be sure to tell your doctor if:

• You have an allergy to seafood, x-ray dye or iodine.
• You know or suspect that you are pregnant.
• You are taking blood thinners.
• You have a history of bleeding problems.
• You are diabetic.

Prior to your procedure, blood tests, x-rays and an electrocardiogram (ECG) will be ordered by your doctor. Family members will be taken to a waiting room where the doctor will speak with them after your procedure. You should make arrangements to have someone drive you home after the procedure.

The cardiac catheterization procedure

The procedure is performed by a physician who is specially trained in performing cardiac catheterization. You will be awake during the entire procedure and your doctor and nurses will explain each step as it occurs. You will wear a hospital gown and you may wear your eyeglasses, hearing aid and dentures. At the start of the procedure, a nurse will give you a sedative to help you relax. If you don't already have an intravenous needle (IV), one will be started. Your blood pressure and electrocardiogram (ECG) will be monitored constantly throughout the test.

The procedure will begin by administration of an anesthetic to the site where the catheter will be inserted - usually in the groin or arm. You may feel a slight "stinging" sensation during the injection. A small incision is made in the skin and a special catheter is then inserted. The catheter will then be advanced through a blood vessel into your heart. Since blood vessels do not have nerves, you should experience no pain while the catheter is threaded into your heart.

Once the catheter is in place, several injections of dye will be made into the arteries and chambers of your heart. You may experience some discomfort for 20 - 30 seconds as dye is injected into your heart. This sensation may give you a "hot flash" or the feeling that you've urinated, but you will not lose control of your bladder. An x-ray camera will be moved around the table to take pictures of your heart from a number of different angles. You may be asked to cough, hold your breath or take a deep breath to help the doctor get more detailed pictures. The procedure usually takes 30 - 60 minutes.

It is unusual to experience any pain during the procedure. If you do, report it to your doctor immediately. After the procedure, the catheter will be withdrawn and a nurse may apply pressure to the site for about 20 minutes. If the catheter was inserted in your arm, you may be given stitches to that area.

Complications

Complications during cardiac catheterization are rare. The most common complication is bleeding at the site of the blood vessel where the catheter is inserted. If this occurs, it usually results in minor bruising. Sometimes a small lump occurs at the site, but this will go away in a week or so. The possibility of a heart attack, stroke, sudden closure of a blood vessel, or death is very rare. Your doctor will discuss your risks and answer any questions you may have. Experienced personnel are prepared to act immediately in the event of any complication.

What to expect following surgery

Your doctor will decide when you will be able eat and drink after the test. You will remain in bed for about 4 - 6 hours, with the head of the bed either flat or slightly raised. The nurse will check your catheter insertion site and take your blood pressure and pulse rate. Once the doctor allows you to have liquids, you will be asked to drink frequently in order to flush the x-ray dye out of the body.

The IV will remain in place for 2 - 3 hours and the nurse may place a small weight on the catheter insertion site to prevent bleeding. It is not uncommon to have swelling, bruising and a small lump at the catheter insertion site. The dye you received may temporarily cause you to urinate more than usual. The nurse will help you use the bedpan or urinal. The leg below the catheter insertion site will be monitored for bleeding. Movement of your leg will be restricted for several hours. Please tell your nurse if you experience any pain or discomfort including warmth, wetness, numbness or tingling, or if you develop a fever over 100°F.

Your doctor will decide, based on your concerns, whether you will be discharged to your home or transferred to another unit in the hospital. Discharge usually takes place within 4 - 6 hours of the procedure. Exercise and driving may usually resume after 1 - 2 days with the permission of your doctor.

Returning Home

• Avoid heavy activity for seven days, including pushing or pulling heavy objects or lifting more than 10 pounds.
• Stop exercising before you become tired or short of breath. If you experience chest pain during exercise, stop immediately, call your doctor and follow all instructions given. If you cannot reach your doctor and are still in pain, call 911.
• Avoid rubbing the lump at the catheter insertion site.
• Avoid driving for two days after the procedure.
• Keep all follow-up appointments with your doctor.

Call your doctor if:

• Your arm or leg becomes numb or painful, or if there is redness or a yellow discharge at the catheter insertion site. It is normal to have soreness at the catheter insertion site.
• You have pain or numbness below the catheter insertion site (leg, toes, arm, fingers).
• The catheter insertion site swells or bleeds. If this happens, lie down immediately on a firm surface and have someone apply pressure to the catheter insertion site for 10 minutes by pressing the heels of both hands over the lump and pushing down. If the swelling and/or bleeding don't stop, call your doctor or go to the emergency room while continuing to hold pressure to the site. Seek emergency medical care immediately if you have chest pain like the pain before or during your catheterization.

Medications

You may be placed on medications following your catheterization to prevent blood clots from forming. Report all side effects from medications to your doctor. Do not stop taking any medicine unless directed by your doctor.

Follow-up

Be sure to contact your cardiologist for a follow-up evaluation and final discussion of the results of your catheterization within 7 - 10 days of the procedure.