Cardiac Catheterisation

What Is Cardiac Catheterisation?

Cardiac catheterisation is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart. Through the catheter, doctors can perform diagnostic tests and treatments on the heart. Cardiac catheterisation is usually performed in a hospital by heart doctors (called cardiologists) that specialize in the treatment of heart diseases.

To diagnose some heart conditions, doctors may put a special dye into the catheter to make the inside of the heart and blood vessels show up on x rays. Doctors may take samples of blood and heart muscle through the tube. They can also treat certain heart problems during this procedure.

Why Is Cardiac Catheterisation Done?

Often a doctor does a cardiac catheterisation to find out why a patient is having chest pain. The procedure can reveal blocked or narrowed places in the heart's arteries that can cause this pain. During the cardiac catheterisation, a doctor might be able to open up the blocked arteries by doing another procedure called angioplasty (AN-jee-oh-plas-tee).

Most people who have heart attacks have arteries that are partly or completely blocked. That is why doctors often do cardiac catheterisations after patients have heart attacks. The procedure can tell them if there are blocked arteries that can be treated with angioplasty or surgery.

Another reason doctors may do cardiac catheterisations is to see the overall shape of the heart and the four large spaces (heart chambers) inside it. That way they can:

• Find any likely problems in people about to have open heart surgery
• See heart abnormalities in children or adults

Sometimes doctors do cardiac catheterisations to see how well the tissue flaps (valves) at the openings and exits of the heart chambers are working. To do this, the doctor will measure blood flow and oxygen levels in different parts of the heart. Cardiac catheterisations are also done to check the functioning of artificial heart valves.

Doctors may also perform cardiac catheterisations so they can do minor surgery on the heart. For example, doctors may do the procedure to remove (biopsy) a small piece of heart tissue to see if there is an infection or tumour, or they might repair holes in the heart or other heart defects.

What Are the Risks for Cardiac Catheterisation?

Cardiac catheterisation is a common medical procedure that rarely causes serious problems. But complications can include:

• Bleeding, infection, and pain where the tube (catheter) was inserted
• Damage to blood vessels
• An allergic reaction to the dye used

Other less common complications of the procedure include:

• An irregular heartbeat.
• Damage to the kidneys caused by the dye used.
• Blood clots that can trigger strokes, heart attacks, or other serious problems.
• Low blood pressure.
• A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.

As with any procedure involving the heart, complications can sometimes, although rarely, be fatal.

The risk of complications with cardiac catheterisation is higher in:

• People with diabetes
• People with kidney disease
• Older people (ages 75 and older)
• Women
• People having emergency catheterisation for serious heart symptoms

How To Prepare for a Cardiac Catheterisation

Before having a cardiac catheterisation, it is a good idea to meet with your doctor to learn about the procedure and how to prepare for it. In that meeting, you might discuss things such as:

• Any medicines you are taking, and whether you should stop taking some of these drugs before the procedure
• Whether you have diabetes, kidney disease, or other conditions that may require taking extra steps during or after the procedure to avoid complications

Patients are not usually allowed to drive the same day they have a cardiac catheterisation. If you don't have to stay overnight after this procedure, you should arrange for a ride to and from the hospital.

What Happens During a Cardiac Catheterisation?

During a cardiac catheterisation, you are kept on your back and awake. That way you can follow your doctor's instructions during the procedure. You are given a drug to help you relax. This drug may make you sleepy.

Your doctor or nurse will numb the area where the small plastic tube (catheter) will enter the blood vessel through a small cut or needle in the arm, upper thigh (groin), or neck. The doctor then threads the tube through the vessel and into the large spaces (chambers) of the heart. Special x-ray movies are taken of the tube as it is threaded up into the heart. This helps the doctor see where to put the tube.

Once the catheter is at the right spot, your doctor can use it to conduct several tests or treatments. Often, special dye is put in the tube to make the inside of the heart's arteries and other structures show up on an x ray. Your doctor may use a procedure called angioplasty to open up the blocked arteries. He or she may also take blood samples from different parts of the heart or do minor heart surgery.

Once your doctor does all of the needed tests or treatments, the catheter will be taken out. The opening in the blood vessel that the tube went through will then be closed up and bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply more pressure. This will help prevent major bleeding from the site.

What Happens After a Cardiac Catheterisation?

After a cardiac catheterisation, you will be moved to a special care area where you will stay for several hours or overnight. While you recover in this area, your movement will be limited to avoid bleeding from where the tube (catheter) was inserted. Nurses will check your heart rate and blood pressure regularly. They will also check to see if there is any bleeding from the tube insertion site.

Eventually, a small bruise will appear where the tube was put in. That area may feel sore or tender for about a week. Be sure to let your doctor know if:

• You have a constant or large amount of blood at the site that cannot be stopped with a small bandage.
• You have any unusual pain, swelling, redness, or other signs of infection at or near the insertion site.

You doctor may tell you to avoid certain activities, such as heavy lifting, for a short time after the procedure.

Key Points

• Cardiac catheterisation is a procedure in which a thin tube (catheter) is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart to do tests or treatments on the heart.
• Cardiac catheterisations often are done after a heart attack or to find out why a patient is having chest pain.
• Cardiac catheterisation is a common medical procedure that rarely causes serious complications. The risk of complications is higher in people with diabetes and kidney disease, and in older people and women.
• Before having a cardiac catheterisation, it is a good idea to meet with your doctor to learn about the procedure and how to prepare for it.
  • You may have to stop taking certain medicines before the procedure.
  • Patients are not usually allowed to drive the same day as the procedure. If you don't have to stay overnight after the procedure, you should arrange for a ride to and from the hospital.
• You are kept awake during a cardiac catheterisation. Afterwards, you will be moved to a special care area where you will stay for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the tube was inserted.
• The area where the tube was put in may feel sore for about a week. You need to let your doctor know if you have an excessive bleeding from that area or signs of infection. You may have to avoid doing certain activities, such as heavy lifting, for a short time after the procedure.