Heart Catheterization Diagnosis and Interventions

Cardiac Catheterization – A Guide for Patients

This web page has been designed for patients who are about to undergo cardiac catheterization, also called a “heart cath.” It will tell you all you need to know before you come to the hospital. Our aim is to make you and your family as comfortable as possible with your procedure and ease any anxiety about what might happen to you while you are here.

There are a variety of reasons why you may need a heart catherization. You may have experienced shortness of breath, chest pain (angina), dizziness or irregular heartbeats. Even if you've had no symptoms, your physician may have detected other signs of heart problems. Cardiac catheterization is a diagnostic procedure for evaluating certain problems with the heart and its blood supply.

About the Heart

The heart is a four-chambered muscular organ that pumps blood to all parts of the body. A wall, called a septum, divides the heart into a right and left side. Each side is further divided into an upper chamber (called the atrium) and a lower chamber (called the ventricle). These chambers are separated by valves that open and close to direct blood flow through the heart.

Blood is pumped throughout the body delivering oxygen and nutrients to all cells and organs. The blood then returns to the right side of the heart. From there, the blood is pumped to the lungs where it receives a fresh supply of oxygen. The left side of the heart receives this blood from the lungs and pumps it through arteries to your heart muscle and all other parts of the body. This process continues thousands of times a day with each heartbeat.

Reasons For Catheterization

Coronary artery disease is the most common problem that requires a catheterization or what's known as a “heart cath.” Coronary artery disease occurs when the arteries that bring blood to the heart muscle are narrowed by a build-up of fats or cholesterol. Blood cannot flow freely throughout the vessels. This may result in episodes of chest discomfort (angina) or in a heart attack (myocardial infarction). In some cases a heart cath is also needed to check on how well the heart muscle is pumping and how well the valves are opening and closing.

The procedure involves an injection of dye to see how the blood flows through the vessels of the heart. X-ray pictures are taken of your heart and its arteries to determine if there are any blockages. It is very important that you tell your doctor if you have ever had any x-ray contrast dye allergy. The doctor then can prescribe medication to prevent any allergy symptoms (e.g. rash, difficulty breathing, nausea and vomiting.)

The Week Before

You may need to go to your doctor’s office to review your health history and have a physical exam. Blood tests and an EKG will be collected at this time. If you live outside the Boston area, your doctor will do the required tests and will send us the results. Patients that are on blood-thinning medications such as coumadin or lovenox should contact their doctor or us (617) 525-7339 five days before their procedure date for instructions on how to take their blood-thinning medication. Most patients are asked to stop coumadin or be changed to a different medication until their Heart Cath is complete. Patients who have been taking blood-thinning medications will need another blood test just prior to their Heart Cath to make sure that blood clotting has returned to normal.

The Night Before

• Do take all your usual medications including a full dose aspirin (325mg) unless you have been instructed otherwise.
• Do not eat or drink anything after midnight except a small sip of water with your morning medications.
• If you are a diabetic, take your usual medications at night, including Lantus insulin (usual prescribed dose), but do not take ORAL diabetic tablets, and if you take Morning INSULIN only take HALF of your usual dose. Our Nursing staff will check your blood sugar on your arrival.

Planning Your Travel To and From the Hospital

• It is important that you arrange for someone to drive you to and from the hospital. You will not be allowed to drive your self home, take public transportation or a Cab.
• After your procedure is completed, you may be discharged (usually several hours later) or be admitted to the hospital overnight, depending on the outcome of your test. Your doctor will tell you and your family the discharge plan immediately after the test.

Your family is welcome to accompany you and remain with you in the Recovery Room before your procedure, and to visit with you in the Recovery Room after the procedure. During the procedure itself there are several waiting areas nearby where they will be asked to wait. Your doctor will meet with them immediately after your procedure.

Arrival in the Catherization Laboratory

On the day of your heart catheterization you should go to the Admitting Office, next to the Information Desk at the 75 Francis street entrance (where the large revolving door is located). You will then be brought to the Cardiac Recovery Waiting Room on floor L2. A nursing staff member will call for you and escort you to the Recovery Room. Your family will be asked to wait in the waiting room initially until the nursing staff has had time to prepare you for you procedure. They may then rejoin you in the Recovery Room until it is time for your procedure to begin.

Once in the Recovery Room you will be asked to use the restroom and change into a hospital gown. All of your personal belongings will be placed in a hospital “personal belongings bag” identified with your name and medical record number. The personal belongings bag will be placed in a locked secure area during your procedure. Please remember to wear no jewelry and to leave valuables such as money and credit cards at home or with your family.

On the working day before your procedure, please call Cardiology at (617) 732-7226 between 12:00 and 3:00 p.m. to confirm the time you need to arrive at the hospital.

Preparing for Your Heart Catheterization

In the Recovery Room you will have an intravenous (IV) line started in your arm or hand. The IV will be used for giving you fluids and medications before, during, and after your procedure. The nursing staff will interview you, asking questions to complete your medical history.

In preparation for the Catheterization an arterial site will be prepped. The site, either your groin or wrist area, will be shaved. Removing the hair from the area decreases your risk for infection. Please remember no jewelry on your arm or hand.

• A member of the Catheterization team, either a doctor or a Physician Assistant, will explain the procedure and ask you to sign a consent form before the heart catheterization.
• The doctors at Brigham and Women’s are on the faculty of Harvard Medical School. Many participate in research studies of new techniques for studying or treating heart disease not yet available elsewhere. A member of the Catheterization Laboratory Research team may speak with you about opportunities to participate in a research study. Participation in research is completely voluntary. Your care will not be affected in any way whether or not you decide to be a part of a study.

During Your Heart Catheterization

• A cardiac nurse will be assigned to you and will be with you during your procedure. The nurse will meet you in the Recovery Room, briefly discuss your procedure, and answer any remaining questions you may have prior to entering the procedure room. Along with your doctor and nurse, other important members of the catheterization team include: A Radiology Technologist, who assists in moving the X-Ray table and with other specialized equipment; A Cardiovascular Technologist who assists with the monitoring equipment; and a Physician Assistant or cardiology fellow (cardiologist-in-training) who will assist your doctor during the procedure.
• The procedure room is cold, because the equipment used for your catheterization requires a cool environment.
• Warm blankets will be provided.
• The team will request that you verify your name, and the procedure you are scheduled for. This is required for all medical procedures, and ensures safety to our patients.
• Once you are on the X-ray table, you will lie on your back with a pillow under your head. The nurse may administer medications called “conscious sedation” through your IV line. This combination of medications helps you relax and become drowsy, while still being able to talk, answer questions, and follow instructions (such as holding your breath, etc). A member of the team will then begin to prep your skin with a special sterile soap.

We ask that you please keep your hands by your side as the area is sterile and your hands could contaminate the area being prepped, increasing your risk for infection. A large sterile sheet will then cover you, to provide warmth and to maintain a sterile area.

• Next you will receive some local anesthetic similar to what your dentist may use, to numb your skin. After the anesthetic is given, you should only feel pressure at the site of the procedure in your wrist or groin. Please let the team know if you have any significant discomfort. The catheters the doctor uses are similar to a large IV catheter. You should not feel pain once the catheter is placed, and you will not feel the catheter moving inside your body. When the catheter is in position, measurements will be taken, and contrast dye will be injected. At this time the doctor and radiology technologist may ask you to move your head from side to side, or take a deep breath as the table and camera move to take pictures of the heart from different angles. It is not unusual for you to feel some warmth in your chest, arms, or elsewhere for a few seconds as the dye is injected.
•  A full heart catheterization is usually complete in 30-40 minutes. When the Catheterization is complete, your doctor will discuss with you the results and will contact your regular cardiology doctor. At that time a treatment plan will be discussed and further treatments or procedures explained below will be recommended. Sometimes these procedures are then done immediately in the same procedure room.

Angioplasty and stenting

If you need an angioplasty to open up a blocked artery, it will usually be done immediately. A different doctor might come into the room to assist with the procedure. During Percutaneous Transluminal Coronary Angioplasty (PTCA) a very thin wire and then a small balloon are passed across the blockage in your heart vessel. The balloon is inflated to compress the plaque (cholesterol buildup). The balloon is then deflated and the blockage is improved. While the balloon is inflated, you may feel some chest pain much like angina. This pain is only temporary and will go away once the balloon is deflated.

Most patients who undergo angioplasty also have a metal tube, or stent, placed within the artery to hold it open. These stents remain permanently within the artery after the procedure. Most stents now have a medication on their surface which is gradually released from the stent during the first few days or weeks. This medication greatly reduces the scarring that follows stent placement, and therefore keeps the stent open better and longer. Special medications to prevent blood clots within the stent will be started before or right after your procedure, and continued for at least several months. These mild blood-thinners are of great importance to take regularly. Every effort should be made not to miss or skip even a single dose.

The total time needed for your procedure and hospital stay will depend on what procedure is done. If you do have a coronary intervention (such as PTCA, stent or atherectomy) you will be transferred to a cardiology ward and must lie flat on your back for 4-12 hours, depending how long then entry site takes to heal and whether or not a “closure device” is used. Your doctor may choose to use a stitch or collagen plug to seal the artery in the leg. If such a “closure device” is used, the time you must lie on your back will likely be shortened.

If the procedure is done through the radial artery in the wrist, a device called a “hemoband” is applied to hold pressure and prevent bleeding at the site and will remain on for 2 to 4 hours. If the procedure is done through the wrist or arm, you may sit up shortly after the procedure but must keep the arm still for at least 4 hours.

Rotational Atherectomy – With some blockages, a special drill can be used to soften the plaque before a balloon or stent is used to stretch the plaque. This procedure is named rotational atherectomy. The drill is called a "roto-rooter" and sounds like a dentist drill.

Embolic Protection – During some stent procedures your doctor may use one of several special devices (generally referred to as “filters”) to keep small fragments of the plaque from breaking off from your vessel during stent placement and causing injury to the heart. These are most often used if you have had previous bypass surgery and have developed a blockage in one of your bypasses.

After Your Catheterization

After your catheterization you will either return to the Recovery Room, or be taken directly to an inpatient cardiology floor. Your doctor will meet with your family immediately so that they know where you will be and can see you right away. If your doctor did not use a plug or stitch to close the artery in the procedure room, the catheter will be pulled out of the artery in the Recovery Room. This part of the procedure is not usually painful but you might find it uncomfortable. You then will have to lie flat on your back for six hours after the procedure and the nurses will monitor you carefully. They will check your blood pressure and check the pulse in your feet and legs often.

If the catheterization was done from the leg artery, you must remember not to bend the leg at the hips. That means you cannot bend your knees to try to sit up, but the head of the bed can be raised a little so you can eat and drink. If you need to go to the bathroom during this time you will have to use a bedpan or urinal. If the procedure was done through the wrist or arm, you may not use them to eat, drink or hold anything and you will be given further instructions to care for that site at time of discharge. When the procedure site is sealed, you will be asked to walk to make sure you do not have any bleeding or swelling. If there are no complications, you will be allowed to go home.

You will also meet with different members of the staff to review in detail your medications and treatment plan before you leave. It is very important for you and your family to understand these instructions to prevent any problems at home. That night we ask that you relax and have a quiet evening at home either lying down or reclining in a comfortable chair. The next morning you can shower and go back to your normal routines, but do not start any vigorous activity for another full day. The area where the catheter was inserted will sometimes feel and look bruised. There will be a small cut in the skin that feels sore. You can wash this with soap and water and leave it open to air or cover it with a bandage if that’s more comfortable. You will notice a small bump under the skin. This may last for weeks but it will eventually disappear. If you notice any other swelling, redness, bruising or pain in the area call your doctor or go to your local emergency room.

We want to know that you are well and safe after your procedure and return home. Please use the telephone numbers and names we provide you at discharge to call back with any questions or concerns.

Learn more about Interventional Cardiology and Cardiac Catheterization at Brigham and Women's Hospital.