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Cardiac Catheterization - The Cardiac Catheterization Procedure

How do I prepare for a cardiac catheterization?

3You should not eat or drink anything for about eight hours before a scheduled cardiac catheterization. If you have diabetes, you should discuss dietary concerns for the day of the test with your healthcare provider to control your blood sugar levels. Talk to your doctor about any medications or dietary supplements that you are taking because they may affect the accuracy of the test. You may have to stop taking or reduce the dosage of certain medications, particularly blood-thinning medications (such as aspirin or warfarin).

What does the test entail?

You will change into a hospital gown. The test will take place in a specialized catheterization lab; the staff wear hospital gowns and masks, and the lights are dimmed. Before the procedure, you will be asked about your medical history and you will be given blood thinners to prevent blood clots during the procedure. The physician will insert an intravenous (IV) line into your arm, so that a mild sedative and other necessary medication can be given without further injections. You may feel the needle prick when the IV is inserted. You will be hooked up to an ECG so that your heart rate can be monitored-- small sticky patches with wires attached will be taped to your body. Your blood pressure will also be monitored.

Usually, the catheter is inserted via the femoral artery in your groin, but sometimes an artery in the elbow or wrist is used. The area will be cleaned, shaved if necessary, swabbed with antibacterial solution, and then numbed with a general anesthetic, which may cause a brief period of discomfort. A small cut will be made and an introducer sheath will be placed in the opening. The sheath is a short hollow tube through which the catheter is fed through the artery and into the heart. You will probably feel a warm sensation when the contrast dye is injected into the catheter. A series of X-ray pictures are taken. At times, the physician or other medical staff may ask you to cough, turn your head, or take a deep breath. You may feel some discomfort, but you should let someone know if you feel any pain. You will be awake for the entire procedure.

How long will it take?

2Approximately 30 minutes to an hour. If a significant blockage is detected in the arteries of your heart that requires balloon angioplasty with or without stent treatment, you may have this procedure at the same time as your cardiac catheterization. In this instance, the procedure can take up to three hours (see Balloon angioplasty).

What happens after cardiac catheterization?

After the procedure, you will be transferred to a cardiac recovery room. You may feel groggy from the sedative, and the catheter insertion site (arm or groin) may be bruised and sore. If the groin was used as the point of catheter insertion, you will be instructed to lie in bed with your legs out straight. There are two techniques for removing the introducer sheath that was placed at the beginning of the procedure when the catheter was inserted. The more traditional method is to wait four to six hours for the effects of the blood thinners to wear off, then to apply pressure while removing the sheath. A newer technique uses a hemostatic device, such as the Angio-Seal or Perclose. These small devices are inserted to make a tiny seal or stitch in the artery to close it off. If the arm was the insertion point, you should keep your arm straight for at least one hour and you can get out of bed sooner.

Throughout the postprocedure monitoring, the point of insertion will be checked for bleeding, swelling, or inflammation, and your vital signs will be continuously monitored. You should drink plenty of fluids to flush out the contrast dye. If you feel any pain in your chest or see any bleeding at the point of insertion, tell the hospital staff immediately. You may be released on the same day or the next day with instructions from your doctor. These instructions include limiting physical activity for 24 to 48 hours, and you will be advised against driving for at least two days. Numbness and soreness are possible during the first week, and bruising can take as long as three weeks to heal.

What do the results mean?

If the angiogram shows a significant blockage in the arteries of your heart, you will need to have a procedure to clear the blockage such as angioplasty with or without stent placement or even bypass surgery. Sometimes the angioplasty and stent placement can be done at the same time as the catheterization. In other cases, it is scheduled for a future date.


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