About cardiac catheterisation and cardiac angiography

 Non-invasive tests can provide a lot of valuable information about the heart. However, sometimes it is not possible to make important decisions about a patient’s treatment unless a test called cardiac catheterisation is performed.

Cardiac catheterisation, also known as coronary angiography gives vital information about the blood pressure inside your heart, and how well the pumping chambers and valves are working. Most importantly, it shows whether there are any narrowing in the coronary arteries and demonstrates their position and severity. This information can be used to help plan further treatment.

Intended benefits

 To provide valuable information about how your heart is functioning which then helps us to plan further treatment.

Who will perform my procedure?

This procedure will be performed by a consultant cardiologist or cardiology specialist registrar.

Before your procedure

 Most patients attend a pre-admission clinic, where you will meet a member of the nursing staff. At this clinic, we will ask for details of your medical history and carry out any necessary clinical examinations and investigations. The procedure will be explained to you. Please ask us any questions about the procedure, and feel free to discuss any concerns you might have at any time.

We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring any packaging with you.

This procedure involves the use of local anaesthesia. We explain this at the end of this leaflet.

Most people have the test as a day case.

You should not eat or drink anything for at least three hours before the test. However, on the morning of the procedure please take the medication as advised by staff.

When you arrive, you will meet your nurses who will prepare you for the procedure.

Please inform medical or nursing staff if there is any possibility that you may be pregnant.

You will be taken to the X-ray room (catheter lab) for the test.

You may be asked to shave the groin or wrist area prior to your procedure, however this can be done by nursing staff on the day.

During the procedure

• The test usually takes between 20 minutes and an hour.
• You will change into a gown before your procedure and a nurse will prepare you by going through a check list. When it is your turn for the procedure you will be transferred to the cath-lab where the staff will check your name, personal details and confirm the procedure you are expecting.
• Once that is complete, the nursing staff will make you comfortable on the X-ray table. Monitoring devices may be attached to you, such as a heart monitor (ECG) and a monitor to check your oxygen levels (a pulse oximeter).
• A catheter is a long, flexible, hollow plastic tube, about 2mm in diameter. It is passed into a vein or artery either in the groin or, sometimes, the arm.
• You will be given a local anaesthetic by the person carrying out the procedure, using a small needle to numb the area where the catheter is put in. A local anaesthetic is a drug which numbs a specific area of the body for an operation. It stings for a few seconds when injected and then the area becomes progressively more numb. You will be fully awake during the procedure although you should feel no pain. The numbness usually fades after a few hours but occasionally it may last longer.
• Following the injection of local anaesthetic, a small incision will be made over the groin or wrist, and a fine sheath will be inserted. The operator will then pass a series of catheters through the blood vessels and into the correct position in the heart. You will not feel the catheter moving around inside your chest, but you may be aware of the occasional missed heartbeat or extra beat. You can watch the procedure on the video screen if you want to. Feel free to ask questions about what is going on.
• While you are having the test, you will be linked to an ECG recorder which records your heart rate and rhythm. This will be checked continuously. The blood pressure at the tip of the catheter will also be monitored.
• X-ray pictures of your coronary arteries are taken by injecting a special fluid (contrast) through the catheter into the coronary arteries. A further picture of the left ventricle of your heart may be taken by rapidly injecting contrast. The contrast sometimes causes a hot, flushing sensation which lasts a few seconds. This sensation may pass to your groin and give you the impression that you have wet yourself, even though you have not. You will be warned when to expect this. People occasionally feel a short-lived, mild chest pain during the test. This does not necessarily mean anything is going wrong, but you should tell the doctor about the pain

After the procedure

 You will be brought to the Recovery area of the Cardiac Catheterization Lab on your stretcher bed. Depending on the type of procedure that was performed, your sheath (the catheter that was put in your blood vessel through your skin) will be managed with one of these options:

• Removed right after the procedure with a closure device put in. There are different types of closure devices. They are a seal or plug for the tiny hole in your artery.
• Removed right after the procedure and a special band/brace will be put around your wrist.
• Removed after you are transferred back to the Cath Recovery area
• In place for a few hours
• In place overnight

If you have a sheath in your groin, the nurses will place a special clamp over your groin to stop the bleeding after they remove it (unless you have had a closure device). This clamp will apply pressure for about 20 – 45 minutes. The nurses will check your pulse, blood pressure, pulses in your feet or wrist and the puncture site often.

You must rest in bed for a few hours after the procedure. It is very important to keep your head on the pillow and your leg (the one that held the catheter/sheath) straight to prevent bleeding from the puncture site. If your back becomes sore, please let your nurse knows. You may be given some medication to help lessen your discomfort or your nurse may reposition you. During this time you may sleep, read, or rest. You will be given a snack.

If the doctor used your arm (radial artery) you will have a clamp applied to your arm after the procedure before you leave the lab to prevent bleeding. You will be on bed rest for approximately one hour after the procedure. It is important to keep your arm on the pillow. Do not twist or bend your wrist. You may move your fingers but please do not use your hand. Your nurse will be available to help you while the clamp is in place.

It is important to drink a lot of fluids for the dye to flush out through your kidneys. Ask your nurse for help as soon as you feel the need to empty your bladder because you will not be able to sit up. Once your bed rest is complete, your nurse will help you to stand. You will be encouraged to walk.

When the test is completed, the catheter and sheath are removed. If the catheter was inserted in your groin, pressure is applied to your leg for about 15 minutes. If the catheter was inserted into your wrist a pressure band will be applied and worn for about two to three hours to prevent bleeding. Some people feel washed out for a few hours after the test. A nurse will examine your groin or arm several times after the test, to check for any possible bleeding.

The site where the catheter was inserted may be tender for a few days. Most people return to normal after a day or two, but can vary from one person to another.

Eating and drinking. After this procedure, you should not have anything to eat or drink until advised – this is usually for about one to two hours.

Getting about after the procedure. We will help you to become mobile as soon as possible after the procedure. This helps improve your recovery and reduces the risk of certain complications.

Leaving hospital. Generally most people who have had this procedure will be able to leave hospital the same day generally three to four hours after the procedure. However, the actual time that you stay in hospital will depend on your general health, how quickly you are recovering from the procedure and your doctors recommendations.

Resuming normal activities including work. Usually you can resume normal activities after 48 hours. Your doctor will advise you on how quickly you can resume normal and more vigorous activity.

Special measures after the procedure we will give you a post procedure leaflet about any special measures you need to take after the procedure.

Check-ups and results:

 Before you leave hospital, the doctor will come and discuss the results of your angiogram. At this time any further treatment needed will be discussed. Depending on the results of your tests, you may be advised to take medication, to have angioplasty with stents, or to have heart surgery. You will be able to discuss this with your cardiologist.

Talking with your doctor about this procedure

The table below lists the most common potential benefits, risks. Other benefits and risks may apply in your unique medical situation. Talking with your healthcare provider is the most important part of learning about these risks and benefits. Dont be afraid to ask questions or discuss your concerns.

Potential benefits

Useful information for diagnosis. Cardiac catheterization gives your doctor more detailed information than other tests.

• Faster recovery. The procedure doesnt require a major incision (cut) or general anesthesia (medication that makes you sleep).

Potential risks /complications

• Leg numbness or weakness for a few hours after (rare)
• Bleeding or infection where the catheter was inserted (rare)
• Bleeding or bruising at the site of the incision
• Haematoma – if there is bleeding from the areas where the catheter was placed, you may have a patch where blood collects under the skin, called a haematoma. This usually clears up on its own.
• False aneurysm – Rarely, a pulsating lump develops in the groin at the siteof the puncture. This is because bleeding occurred when the catheter was removed. The clot produced a small sac on the side of the artery via the hole made in the artery. This sac is called a false aneurysm, and can be treated with a small injection into the sac to block the hole to the artery.
• Infection at the incision site, which may need to be treated with antibiotics
• A mild to moderate allergic reaction to the contrast dye – this can usually be controlled using anti- allergy medication
• Reduced kidney function (kidney failure in rare cases) – tell your doctor or the imaging technician if you have kidney disease or diabetes
• Exposure to x-ray energy, which can slightly increase your lifetime cancer risk (for more information, see Intermountains Guide to Understanding Radiation)
• Damage to the artery or heart muscle (extremely rare) Blood vessel damage requiring further
• Heart attack or stroke (extremely rare, and not typically caused by the procedure itself)
• Death
• Unforeseen complications

Alternative procedures those are available

 There are other tests available to assess the arteries of your heart, although this test gives the most complete information. Your cardiologist has recommended cardiac catheterisation because he/she feels that this is the best test for you. However, if you have any concerns about the procedure, you should discuss these with your doctor/cardiologist. Cardiac catheterization is the best way to get accurate information about your arteries or heart valves. Other tests include:

• Electrocardiogram
• Cardiac stress test
• Cardiac CT scan
• Cardiac MRI

If you have any concerns about your cardiac catheterization, discuss them with your doctor

Anaesthesia

You will be given a local anaesthetic by the person carrying out the procedure, using a small needle to numb the area where the catheter is put in. A local anaesthetic is a drug which numbs a specific area of the body for an operation. It stings for a few seconds when injected and then the area becomes progressively more numb. You will be fully awake during the procedure although you should feel no pain. The numbness usually fades after a few hours but occasionally it may last longer.