Heart Catheterization
Testing For Coronary Heart Disease

Cath surgery on the heart

Cath Diagram

Cather is threaded from the groin to the heart

Heart Catheterization

Contents

What Is A Heart Catheterization?
Coronary Angiography
Ventriculography
Left and Right Catheterization
Electrophysiology (EP) Study
How Is A Heart Cath Performed?
What Preparation Is Necessary?
What Do The Test Results Show?
When Is It Used For Treatment Purposes?
Are There Any Dangers Or Complications?
How Much Does It Cost?


Cath Operation
Cath Procedure

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Heart Disease in Women

 

What Is A Heart Catheterization?

Cardiac or heart catheterization (also called cath or cardiac cath) is a technique doctors use to perform many procedures on the heart and blood vessels. Catheterization is an invasive procedure which involves inserting a long thin tube through the body. It is usually inserted through a small puncture made in the arm or groin area. The cath is then guided through the blood vessels towards the heart. A number of tests can be completed once the cath reaches its destination. For example, a dye can be introduced which allows the doctor to visualize the structure of the heart and arteries (this procedure is known as a coronary angiography). Or an instrument can be inserted through or attached to the cath tube for treatment purposes (an angioplasty for example). Although other less invasive heart disease tests such as echocardiogram (echo) and electrocardiogram (ECG/EKG) can provide a great deal of information, only a cardiac cath can detect certain problems such as blocked arteries. It is worth mentioning that occasionally other structures of body besides the heart can be catheterized.

Coronary Angiography

This is the most common procedure (image) carried out by cardiac catheterization. A coronary angiography is considered the gold standard for diagnosing coronary heart disease (CHD) or coronary artery disease (CAD). In fact when many people talk about a 'cath' they are referring to this procedure. It is usually performed if an exercise stress test or chemical stress test indicates blocked arteries. It may also be carried out on patients where the stress test came back negative (a false negative) but the doctor still suspects heart disease. To perform an angiogram the doctor will insert the cath, positioning it at the opening of the coronary arteries or left heart ventricle. Once in place an iodine dye is injected so that the doctor can follow the blood flow through the structures via X-ray. If there is a blockage it will clearly show up on the angiogram.

Ventriculography

This procedure involves the use of a cath to inject contrast dye into the ventricular cavity - that is the internal space inside the heart's two ventricles (the pumping chambers). The dye is then tracked as the heart pumps blood in and out. This can be a useful test for patients suspected of having weak heart muscle or valve problems.

Interesting: Risk Factors for Heart Disease and Heart Disease Statistics

Left and Right Catheterization

For some heart conditions doctors may perform a left or right catheterization (it is sometimes used for diagnosis of heart failure). A cath will be inserted to measure pressure, take a sample of tissue or to directly view the spaces (cavities) within the heart itself. All these procedures are called heart-catheterization procedures. A right-heart cath usually involves inserting the cath through a vein in the neck or the groin. Once inserted a balloon is inflated at the end of the cath which floats, dragging the cath along with the blood flow. As it moves along the veins and arteries, blood pressure readings can be taken. These readings can be used to gauge how strong the heart muscles and valves are. A right-heart cath can also be used to take a heart biopsy. The cardiologist (heart specialist doctor) uses a tiny tool which is fed through the cath and essentially removes a tiny snip of heart muscle. Patients who have had a heart transplant need to have regular heart biopsies to check for signs of rejection. Finding a rejection early is important because medicines can be given to the patient to protect the transplanted heart. A left-heart cath is essentially the same as an angiography. When it reaches the heart it is guided towards the left ventricle so that blood pressure can be measured. If there are signs that the left ventricle has become thick and stiffened, it will make it difficult for the heart to 'relax' and fill with blood. This means there will be problems pumping blood around the body. This is known as hypertrophic cardiomyopathy. Many people with hypertrophic cardiomyopathy show no symptoms, the first time a diagnosis is given is when an autopsy is performed. Evidentially, an earlier diagnosis is beneficial. Occasionally a cardiologist will perform a left and right heart cath at the same time.

Electrophysiology (EP) Study

Heart arrhythmia are usually diagnosed with regular ECG tests. However some heart rhythm problems may be more difficult to diagnose and require invasive tests. An EP study involves the use of a cath (usually a left-heart cath). The cath is inserted into the left ventricle and is used to stimulate the heart's muscle. The resulting electrical activity will be recorded and a computer program uses the results to create an electrical map of the heart. This procedure is used for diagnosing complex heart rhythms and may even be used for treatment.

How Is A Heart Cath Performed?

If you are having a heart cath for diagnostic purposes (such as an angiogram) or for non-urgent reasons, this is known as an elective procedure (as opposed to it being performed for emergency reasons). The test is normally carried out in hospital as an outpatient procedure. A chest X-ray, some blood tests and an ECG will be carried out first. Next the patient is moved to a catheterization laboratory or cath lab, a room with special facilities (although not all hospitals have this facility). You will be asked to lie on a flat table under a large X-ray guidance machine. Electrodes (sticky patches) will be attached to your chest and their wires are inserted into an ECG machine. This will monitor the heart. A blood pressure cuff will also be attached to your arm. An IV line is inserted into the arm and a mild sedative is injected. If the cath is to be inserted through the groin, the area will be cleansed and shaved if necessary. A local anesthetic is injected into the area which means you will not feel pain but will still be awake throughout the procedure. Next the doctor will puncture the skin and insert a catheter with a specialized needle into a vein or artery. He will thread it through the veins until it reaches the heart, guided by images from the x-ray machine which are displayed on a nearby monitor. The patient should not feel any pain. Depending on which procedure is being performed (angiogram, EP study, left or right heart cath, heart biopsy), different tools will be used next. You may feel a sensation such as flushing or nausea, this is quite normal. If you experience any chest pain, inform your doctor immediately. When the procedure is completed, the cath and IV is withdrawn. A bandage is placed on the point of incision. The procedure takes about an hour in total.

Recovery
The patient is moved to the recovery room where pressure is applied to the insertion wound for 15 minutes. They will need to remain for several more hours after this and will be told to lie still and to keep the leg straight. If bleeding continues stitches may be necessary. The patient should be driven home and rest for another 6 to 8 hours before attempting to walk.


What Preparation Is Necessary?


1. The patient will need to inform the doctor about any medications they are taking. They may be told to stop taking blood thinners or anticoagulant medications for a few days before the procedure.
2. Inform your doctor if you have asthma or have ever had a serious allergic (anaphylaxis) reaction to any substance including a reaction to an insect bite or venom from a bee sting.
3. Avoid eating or drinking after midnight before the procedure. Diabetics will need specific advice regarding food and insulin.
4. Completely empty your bladder just before the test.
5. Remove any jewelry and nail or toenail polish.
6. Patients who are allergic to iodine dyes will need to take steroids on the day of the test and another medication just before the test.

What Do The Test Results Show?

The purpose of a cardiac cath is find out if a person has CHD - that is disease in the coronary arteries (atherosclerosis). Atherosclerosis (image) is the buildup of fat and calcium deposits in the arteries which gradually restrict blood flow and cause heart attacks in women (and men). If the patient tests positive for CHD the procedure should be able to pinpoint the exact location of atherosclerosis and how severe (size) it is. Results from the test will help a doctor determine the best course of treatment - whether that is a heart bypass surgery (image) or percutaneous coronary intervention (PCI), such as coronary angioplasty. Specialized cardiac caths can diagnose particular conditions, for example an EP study can diagnose the cause of complex cardiac palpitations. Before a cardiac cath is carried out, a doctor should explain clearly which particular heart problem (but there may be more than one possibility) is being investigated.

Note about Women: Women are less likely to be referred for a cardiac cath than men. Yet, once they undergo the procedure they are just as likely as men to be treated with angioplasty.

When Is It Used For Treatment Purposes?

Heart caths are not only used for diagnosing heart disease, but the procedure may also be used as part of a treatment plan. PCI for example uses cardiac cath technology to reach a narrowed coronary artery - the artery is then stretched with a special tool to improve blood flow. The two most common types of PCI are angioplasty and atherectomy.

Angioplasty: A heart angioplasty (image) involves attaching a balloon to the cath. The balloon is inflated once it has reached the blocked artery. Inflating the balloon has the effect of widening the blood vessel so that blood flow can improve. If a small wire tube called a stent is also inserted, this will keep the artery open for longer than if a balloon alone was used.

Atherectomy: Once a cath has reached a blocked artery, a small whirling blade or laser beam is used to remove the buildup of plaque (atherosclerosis). Very often this procedure is combined with a balloon angioplasty or stenting.

Are There Any Dangers Or Complications?

Complications are rare but if they do occur they can be life-threatening. This is why the benefits versus risks will need to be weighed carefully by a doctor, particularly if the patient is ill or advanced in age. Serious complications include:

• Heart attack or stroke in women.
• Blockage of blood flow to the leg or arm or leg below the area where the catheter was inserted.
• Heart palpitations.
• Kidney damage caused by a reaction to the contrast dye.
• Abnormal collection of fluid in between the heart and the sac that surrounds it (known as cardiac tamponade).
• A build up of air in space between the chest wall and lungs (called pericarditis).
• Allergic reaction to the dye material including hives, itching and rarely shock, fever or shortness of breath.
• Blood vessel puncture, if this happens immediate open heart surgery is required.

Less serious complications include:
• Pain, swelling or continued bleeding at the site of cath insertion.
• Difficult urinating for a few days.

When To Call The Doctor

1. If you experience chest pain, dizziness, extreme shortness of breath, difficulty swallowing or talking. See: Chest pain in women.
2. If any part of the body becomes paralyzed.
3. If the legs or arms become cold, painful to touch or numb.
4. You have a fever or the site where the cath was inserted starts swelling or oozing a discharge.

How Much Does It Cost?

The average cost of cardiac catheterization is between $1,500 and $4,000 depending on what other procedure it is performed with.

Other Heart Tests
Holter Monitor
Event Monitor
Nuclear Heart Scan

  Related Articles on Heart Disease Testing

For more on heart problems, see the following:

UK Heart Disease Statistics
Cardiac Rehab Exercise Program
Heart Disease in Pregnancy

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