What to Expect if You Require a
Cardiac Catheterization

If you or someone you know requires a Coronary Angiogram...or Cardiac Catheterization...what can you expect?

First of all, the terms...

Cardiac Catheterization

Coronary Angiography

Coronary Angiogram

Cardiac Catheter and...

Cardiac Angiogram

...All mean the same thing. Coronary Angiography is now a routine low risk procedure for imaging, diagnosis and the documentation of Coronary Artery abnormalities.

This examination is often performed on a day stay basis in patients who are well enough not to require hospitalization for their condition.

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Cardiac Catheterization simply involves the introduction of a small amount of X-Ray contrast media into your coronary arteries via a long plastic tube called a catheter. A series of moving X-Ray pictures will then be taken.

You would be required to have had nothing to eat or drink for four to six hours prior to the start time of the examination and generally speaking, some premedication to calm any anxiety...pre exam jitters..will be given to you around half an hour before the procedure begins.

Where is Cardiac Catheterization Performed?

The exam itself takes place at a clinic or hospital facility in a room usually referred to as the Cathlab.

The cathlab resembles an operating theatre which has a single narrow bed or couch in the middle of the room with several television monitors usually hanging from an arm attached to the ceiling on one side of the bed.

At the head end of the table you'll see a large piece of equipment either bolted to the floor or the ceiling. This is called the C-Arm gantry. The C Arm gantry supports the X-ray equipment on either end of the C-Arm and will actually rotate around...above and below you during the examination when pictures of your Coronary Arteries are being taken.

Having A Coronary Angiogram

What will happen to me when I first enter the cathlab?

You will be assisted to lie flat on your back with your head on a pillow and your hands usually tucked under your head to get your arms up out of the way. The bed does have a thin mattress for comfort.

Once you are centrally positioned on the table and comfortable, you will have the area on your body where the catheter will be inserted prepared by a Nurse or Cathlab Technician.

The most likely sites for catheter insertion are...

Femoral Artery: Your pre shaved right groin area where you can feel the pulse...at the top of your leg will be 'painted' with a topical solution to clean the area, helping to minimize infection risk at the proposed entry site. Shortly after a small nick or incision will be made in your skin by the attending Cardiologist to allow the catheter to be advanced

Alternatively....

Radial Artery: Your right arm will be extended and angled out slightly from your body...palm facing upwards. A board will be placed under your arm for support. Your hand and arm will likely be taped to the support board to keep it in position. The wrist and palm will be painted as in the above example. The area of your wrist below the thumb...where you can feel your pulse indicates the point that the catheter will be inserted

Monitoring Your ECG During your Cardiac Catheterization

While the surgical site is being prepared, another technician will place some ECG electrodes...also known as ECG dots onto your chest. Three dots are usually sufficient for simple monitoring of your heart rhythm. The technician will clip some thin cables onto the dots. These cables are connected to an ECG machine. Your heart rhythm will be monitored throughout the Cardiac Catheterization procedure for your safety

You'll be the center of Attention in a Surgical and Sterile Zone

Following or during these preparation procedures you will be covered...from neck to toe with a blue or green surgical drape. The only part of your body showing will be your head

The area on top of the drape is called a sterile area and must not be touched by you...The Cardiologist, Technical and Nursing Staff will all be in surgical gowns with sterile gloves and possibly wearing hats and masks as a surgeon would. The wearing of hats and masks does vary from cathlab to cathlab though.

Other technical staff in the cathlab are not 'working' in what is called the sterile field so they will not be dressed in a surgical outfit to quite the same extent. Staff who haven't 'scrubbed in' will be available to come to your assistance if you should require anything...just ask.

Ok...what happens next?

Your Cardiologist will feel for your pulse using finger tips in either of the prepared areas and then administer some local anesthetic to the same place. You will feel a small needle prick...followed by a brief stinging sensation....the area will very rapidly go numb.

Coronary Angiography

Further discomfort at the 'entry site' is unlikely. Please ask for more anesthetic if you still feel pain. Cardiac Catheterization exams are not performed with a general anesthetic as full patient cooperation is required throughout the procedure

Your Cardiologist will now make a small incision in the skin in the same place the local anesthetic was administered. A needle will be advanced through the skin at the point where your pulse is felt. When your Cardiologist sees a small amount of blood...pulsing slightly...coming back through the needle he / she knows they're in the correct place

A wire is now threaded through the needle...the needle is removed...and a short plastic tube...called a sheath...a bit like a drinking straw with a cap on the end of it is advanced into and slightly along your artery...the cap remaining against the outside surface of your skin. Blood will not leak out of your artery while the sheath is in position.

Now that access to your artery has been gained and secured, long catheters....they must be long enough to be threaded through your arterial system to reach your heart...can be advanced with the help of a flexible wire of similar length inside the catheter to stiffen the flexible plastic tube. The wire is removed when the catheter tip is near its target position.

When are Pictures of the Coronary Arteries Taken?

The table you are lying on 'floats' lengthways...and from side to side. You will be floated or positioned underneath the X-Ray equipment so that the Cardiologist can place the catheter tip accurately into the origin(s) of your Coronary Arteries.

On correct placement of the catheter, The C-arm gantry and X-ray equipment will be rotated around you in an arc...from side to side...coming to rest in various positions. You will be asked to take a breath in and hold for a few seconds. While you are holding your breath, moving images are obtained of your Heart's Coronary Arteries

In order for your Coronary Arteries to show up on these X-ray pictures a special drug called X-ray Contrast Media sometimes known as dye is injected through the catheter (it is actually a clear liquid that x-rays have difficulty penetrating). The contrast media flows out the end of the catheter tip and into the coronary artery(s). The contrast media only stays in your coronary arteries for a few seconds and will later be eliminated from your body via the kidneys and urine

X-ray Contrast Media Contrast media such as Omnipaque can sometimes cause side effects. These can include... the rapid appearance of itching spots on your skin nausea and... difficulty with breathing Please alert the medical staff in the cathlab if you start to experience any unusual sensations. Drugs to counter any contrast media side effects can be given to you and may help prevent the worsening of any symptoms. The majority of people do not experience symptoms from the administration of contrast media but ignoring them if they occur can be dangerous as very rarely some people can experience very serious side effects to the drug. If you have any history of Asthma orAllergy or you have experienced symptoms in the past with contrast media your potential for a negative reaction during your procedure could be heightened. Please communicate any relevant medical history to the staff on admission to the clinic / hospital prior to your cardiac catheter exam.

During your Cardiac Catheterization the process of your coronary arteries filling with contrast media will be recorded onto sophisticated hard disc recording media via the X-ray equipment for later analysis comprising of a written and diagrammatic report. This report will assist the health care professional in charge of your care in planning suitable treatment options for you if required.

Obtaining pictures of your hearts pumping chamber may also be required

It is usually desirable during the course of a Cardiac Catheterization procedure to assess the function of the main pumping chamber of your heart…called the left ventricle. This assessment is carried out in a very similar way to coronary artery assessment. The only noticeable difference for you will be a hot flush sensation that will last for a few seconds...most people actually enjoy the way this feels.

The hot flush sensation is the result of injecting...through a catheter sitting in your pumping chamber...a larger volume of X-ray contrast media than was used for your Coronary Arteries. This fills the cavity of your left heart pumping chamber and allows medical staff to see it contracting and relaxing.

How well your pumping chamber is working will be fully evaluated and reported on in the same analysis as that of your coronary arteries

Obtaining a complete set of video sequences of your coronary arteries and your left ventricle will conclude the diagnostic Cardiac Catheterization.

What happens after medical staff have finished taking pictures?

Soon after the conclusion of Cardiac Catheterization Angiography you will be moved across from the examination bed onto a hospital bed or trolley and transported to an aftercare holding area where the small tube (sheath) in your groin or wrist will be removed and firm pressure applied to the spot for fifteen to twenty minutes...

...remember you have had a small incision made to an artery so proper care of the entry site is essential.

Some centers use internal clip or seal devices such as the Angio-Seal vascular closure device to 'pinch' off the small whole in the artery made by the needle and sheath. In this case, you won't need firm pressure to the site as the device takes care of this. These are only used in groin entry sites.

If you came in to the clinic / hospital just for the day...and nothing further needs to be done as a result of your Cardiac Catheterization Angiogram you will be able to go home in a few hours.

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