Cardiac Catheterization & Balloon Angioplasty/Coronary Stenting

Why are you being sent for a cardiac catheterization?

A cardiac catheterization is a test that directly looks at the coronary arteries (those that supply blood to your heart).  For patients that have a high suspicion of blocks or obstructions in these very important vessels, it may be necessary to directly visualize the inside of your coronary arteries.  Some patients may have had non-invasive testing (stress testing or Cardiac CTA) that suggests blocks in the arteries or come to the hospital with a heart attack or unstable cardiac condition requiring this procedure.  In the setting of a heart attack, this procedure can be life saving by opening up an acutely obstructed vessel.  In situations of angina, the obstructed vessel may be able to be opened with the goal of eliminating or improving symptoms.  Additionally, a cardiac catheterization is requested prior to planned heart valve surgery so that the surgeon can know whether to “fix” the heart vessels at the same time as the valve surgery.

	Angiogram 1: Tight stenosis (blockage) in the LAD.
	Stent image: Stent placement.
	Angiogram 2: Successful angioplasty (opening) of the artery with stent placement.

What else can be learned?

At the same time as the standard cardiac catheterization, both valvular and heart function can be assessed.  Other times a “right heart” cardiac catheterization is performed to evaluate intracardiac pressures (pressures in your heart) to attempt to explain certain symptoms such as shortness of breath or swelling in your legs.

How does the standard cardiac catheterization work?

You will be given intravenous medication (similar to Valium) to make you comfortable and relaxed during the procedure. The area where the catheter will be inserted is anesthetized. A small puncture is made in the artery and a small tube or introducer sheath is placed in the artery. The catheter passes through the sheath and is guided to the heart. X-ray dye is injected through the catheter and x-rays of the heart and coronary arteries are taken. Angiogram 1 demonstrates a tight stenosis (blockage) in the left anterior descending artery (LAD).  In an angioplasty, a balloon tipped catheter is inserted into the artery until it reaches the blockage. The balloon is then inflated to compress the fatty deposits. When a stent is placed (see stent image), it is placed at the area of blockage generally after a balloon tipped catheter has opened the vessel.  After the stent is fully expanded, the balloon tipped catheter is removed and normal blood flow is restored (Angiogram 2). The stent remains in the artery permanently.

How does this procedure get set up?

When your doctor decides with you that you need to have a cardiac catheterization, a time is scheduled at the hospital for the procedure.  Our office schedulers will try to arrange a time at the hospital that is convenient for you. 

How to prepare for the cardiac catheterization?

• We ask that you consume nothing by mouth (NPO) after midnight prior to the procedure other than prescribed medication with a small quantity of water. 

• Diabetic patients:  If on insulin: Take ½ dose of prescribed dose night before and morning of the test. If taking oral (by mouth) diabetic medications: No oral diabetic medications on the day of the procedure.  After the completion of the procedure, you will be able to eat and drink, and at that point diabetic patients can return to normal doses of your diabetic medications except Metformin (Glucophage) or combination medication that includes Metformin, as this medication must be restarted 2 days later. 

• We ask that you come with someone that can drive you home or at least have someone prepared to pick you up without planning on driving yourself home because of the effect of sedative medication that you will receive. 

• Report all allergies to your doctor before you come. Since contrast contains iodine it is important to report any allergies to x-ray dye or shellfish. If you are allergic, the catheterization can be safely performed but additional medications may need to be given prior to the test to decrease the chance of any reaction.

• Standard blood tests will be sent prior to the test.

• Please remind us if you have any kidney problems that we should know about.

• The test is performed in the cardiac catheterization suite at the hospital.

After the Procedure

After the catheterization, you will either go on to have a stent or angioplasty or you will have the catheter removed in the cath lab and a small seal will be inserted in the leg to help close the hole made in the artery. Direct, firm pressure may also be applied to the puncture site.

You will be watched for bleeding and discharged home the same day if no “intervention” or stent is placed. If a stent has been placed, you will be observed over night in the hospital and likely discharged the next day.  You may notice a bruise or small lump in the groin or arm area where the puncture was made. This is normal unless the area increases in size or you experience progressive discomfort.

IF YOU EXPERIENCE ANY OF THE FOLLOWING CALL IMMEDIATELY:

• Numbness or pain in the arm or leg where the procedure was done
• Difficulty breathing
• Chest or back pain
• Palpitations or irregular heart beat
• Bleeding at the insertion site
• A fever with temperature > 101.5 F
• Warmth, tenderness or redness around the incision

You may return to usual activities in 1-2 days. Do not push or lift more than 10 pounds for at least 1-2 weeks after the procedure unless told otherwise. Ask the doctor if you have further questions.