IN THIS ISSUE

From the Spring 2005 Issue

Learning Center

Cardiac Catheterization: What to Expect

Many people with a heart condition may at some point have a cardiac catheterization—"cath" for short. We tell you why you might need this common and important heart procedure, then let an experienced cardiac nurse explain what you can expect—before, during, and after the procedure.

Diagnosing Blood Vessel Problems

A cardiac catheterization is a procedure used to diagnose or treat a blood vessel problem. During the procedure, a thin, flexible tube called a catheter is inserted into and gently pushed through an artery. The catheter is usually inserted in the groin (upper thigh) area. It can also be inserted in your arm or neck. The catheter allows your doctor to reach the part of the vessel where there may be a problem (Figure 1).

Figure 1

Catheter

Click to enlarge

Cardiac catheterization is always done with a procedure called angiography. Dye is injected through the catheter during angiography, allowing your doctor to see your arteries on a special x-ray called an angiogram. The dye makes your blood vessels show up as dark lines, like roads on a map. A vessel might look narrow on the x-ray or even appear to end abruptly—meaning the dye couldn't get through because of a blockage.

A cardiac cath and angiography may be needed when your doctor wants to know:

• If you have a narrowed or blocked artery
• Why you have chest pain that medications can't control
• The extent of damage to your heart after a heart attack
• If you have heart valve disease that might need surgery later

Treating Blood Vessel Problems

If a vessel is blocked, your doctor may decide to treat the blockage with an angioplasty and/or a stent implant. (If your doctor decides that surgery is needed instead of a procedure, a coronary artery bypass graft [CABG] may be done at a later time.)

Angioplasty
In this procedure an expandable balloon on a catheter is used to help unblock arteries. The balloon expands and presses the plaque blockage against the artery wall (Figure 2). The procedure opens the artery and allows better blood flow.

Figure 2

Angioplasty

Click to enlarge

Stent Implant
A catheter is used to deliver a small metal mesh tube (stent) to a blockage in an artery (Figure 3). A stent, which helps keep the artery open, is often implanted after angioplasty.

Figure 3

Stent

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An Expert Explains What to Expect and Why

Now that you know why you might need a cardiac cath, we want you to know what to expect if your doctor recommends the procedure for you. LifeBeat Online spoke with Mary Jane Rasmussen, RN, a cardiac nurse who worked at the Mayo Clinic in Rochester, Minnesota. Rasmussen has helped many patients through the procedure over the years. Below she shares common patient comments and concerns and explains what to expect and why.

Before the Procedure

I wasn't sure why the nurse asked if I was allergic to iodine or certain foods.
We inject a dye, or contrast, into the arteries to make them visible like bones in an x-ray. The most commonly used dye contains iodine. We can use a different contrast for people who:

• Have diabetes or kidney disease
• Are allergic to iodine or x-ray dye
• Have food allergies (be sure to tell the doctor about any food allergies)

I was asked to bring a list of all of my medications with me.
It helps us to know if you have other medical conditions (for example, diabetes) and which medications you're taking.

We also make sure that your medications won't affect the procedure. For instance, you should avoid taking a blood thinner like Coumadin for a few days beforehand. Blood thinners can make it harder for your blood to clot and "seal" the artery afterwards.

And we ask male patients about Viagra or similar drugs, because a medication like nitroglycerine might be given. (Nitroglycerine enlarges the blood vessels.) If you have taken Viagra within 48 hours, you can have a serious reaction to the nitroglycerine.

During the Procedure

I expected the room to be like a regular exam room, but it was a lot different.
A cardiac cath lab is a large room with lots of equipment. It's similar to an operating room (OR), but smaller. We wear gloves, masks, and surgical gowns like in the OR. We also use the cath lab for implanting heart devices such as pacemakers and defibrillators.

I knew I would have an incision in my groin, but I didn't know I needed an IV tube in my arm, too. Plus I felt very warm at one point.
We deliver fluids and medications through the IV. For example, we give you a sedative to make you relaxed, but it doesn't make you unconscious.

When the dye is injected, you might notice a:

• Warm flushing feeling, and maybe nausea, for a minute or so
• Metallic taste when the dye reaches the blood vessels in your mouth
• Camera rotating around you to get x-rays of your heart from different angles

You may be asked to lie still to avoid blurring the images on the monitor. And you might be asked to hold your breath or cough. Coughing helps circulate the dye in the arteries.

I didn't expect to have ECG (electrocardiogram) wires put on my chest, or have my groin area shaved.
ECG wires (leads) are put on your chest, arms, and legs to allow us to check your heart rhythm. To attach the leads to your skin, we use small sticky pads. You may also have a clip on your finger to check your pulse and the oxygen levels in your blood.

To make sure the skin at the incision site is as clean as possible we shave the area, apply antiseptic, and cover the nearby skin with a sterile cloth.

I thought it would be painful.
That's rare, because we give you an injection that numbs your skin before the doctor makes the incision. The incision is usually less than 1/2 inch long—just big enough to let the catheter enter your artery. We ask you to let your doctor know if you feel any pain at any time.

There were people in the room and more in the room next door, watching through a window.
There are usually several people in the cath lab:

• The cardiologist performs the procedure.
• The anesthetist monitors the medication that makes you relaxed.
• Technicians and/or nurses assist the doctor.
• Staff in training sometimes observe.

The people behind the window are technicians talking through headphones to the doctor. They assist the doctor to be sure the images are clear. The doctor will review the images after the procedure and then discuss the results with you.

After the Procedure

I had a weight on my groin, and I couldn't really move for several hours.
Pressure is applied at the incision site and then a weighted bandage is put on. Both steps help reduce bleeding until a clot forms and seals off the small incision in the artery.

If you need to sneeze or cough, hold the bandage firmly in place to avoid loosening the clot. It's important to lie on your back with your leg (or arm, if the catheter was put in your arm) extended and held still for several hours. You can wiggle your toes, but avoid bending your leg (or arm).

I felt fine after the procedure and was ready to get back to my routine.
Most people have a short and trouble-free recovery after a cardiac catheterization. Always follow your doctor's advice about avoiding heavy lifting or strenuous activities. And contact your doctor or nurse if you have questions about your medical condition, your catheterization, or any lifestyle changes they have suggested.

Note: Individual symptoms, situations, and circumstances may vary. Please consult your physician or qualified health provider regarding your condition and appropriate medical treatment. The information provided is not intended to be used for medical diagnosis or treatment or as a substitute for professional medical advice.

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