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Cardiology Associates of Central CT, LLC
Cardiac Catheterization Test ...
(Coronary Angioplasty)

Last updated:  Friday, May 19, 2006 04:31 PM

Cardiac Catheterization (Coronary Angioplasty) Test ...

A cardiac catheterization, or "cath" for short, is a test that determines if there are any blockages in your heart arteries. You may have already had a stress test that showed there was a heart artery problem. The cardiac cath, also called an angiogram, will show precisely where the blockages are, how severe they are, and how many of the heart arteries are involved. Sometimes the angiogram proves there is not a significant problem with the heart, even though noninvasive tests suggested there was an abnormality. Based on the result of the cardiac cath, the cardiologist will decide the best way to treat your heart condition. A cardiac cath is generally a safe procedure, but as with any invasive procedure there is a small amount of risk. Your cardiologist will discuss the risks of the procedure before you sign a consent form.

During the procedure, a long, thin plastic tube called a catheter is passed through the blood vessels of the body to the heart. The entry site for the catheter is usually in the groin area of the leg, but the arm can be used as well. The procedure is relatively painless since there are no nerve endings inside the blood vessels to feel the catheters being moved back and forth. The only significant discomfort is the local anesthetic injected into the skin before the catheters are placed. Through the catheters, contrast agents, or "dye", can be injected into the heart arteries while x-ray pictures are 
taken. Patients are given as much sedation as they need to be relaxed during the test. The entire procedure usually takes under one hour to complete.

Before the Cardiac Cath 

You will be asked some questions regarding your health, including any allergies to food, medicine, or x-ray dye. If you are pregnant or think you may be, tell your doctor or nurse. You will need blood tests and an electrocardiogram (ECG) before the test. You will need to sign a consent form indicating that you understand the procedure and any risks that might be involved. 

Please bring a list of the names and dosages of your current medications. Alternatively, you may bring your pill bottles with you. If you are taking blood thinners such as Coumadin, you will probably be told to stop taking them several days prior to the test. Please do not stop taking anti-platelet medications such as aspirin or Ticlid unless specifically asked to do so by your doctor. If you take insulin or pills for diabetes your dose may be reduced the morning of the test. If you take Glucophage (Metformin) you will probably need to stop this medication three days before the test. Do not eat or drink anything after midnight the day of the angiogram. You may take your usual medications the morning of the test with water unless otherwise directed. If you have any questions do not hesitate to ask your doctor.

On the day of the test, please remove any hairpins, earrings, or nail polish. You may wear hearing aids or glasses during the procedure. At the hospital you may be given medication to help you relax before the procedure. Your nurse will insert an intravenous line, or IV, in your arm that will be used during the procedure. 

During the Cardiac Cath 

In the catheterization laboratory you will lie on a table under an x-ray camera. You will see television monitoring screens and a moving x-ray tube or camera. You may be able to see the pictures taken of your heart during the test. Small pads, called electrodes, will be placed on your chest to monitor your heartbeat. The hair at the groin site where the catheter is inserted will be shaved and the skin cleaned with a special soap. A large drape will then be placed over your body to create a sterile field for the doctor to work. The doctor will then numb the skin in the arm or the leg. Additional medicine may be given in your IV to help you relax. When the skin is numb, a guide wire is passed through a needle inserted into the artery in the leg or arm. A short introducer tube called a sheath is then placed over the guide wire through which the coronary catheters can be passed. There is no pain after the skin is numbed. 

When the x-ray pictures have been taken, the catheters are removed. The sheath may be left temporarily in place. It will be removed after you are moved back into your bed. The entire procedure generally takes less than one hour. If an angioplasty is necessary, it can usually be done at the same time as the cardiac catheterization.

Angioplasty is one of the most widely used interventional therapies for opening blockages in the arteries of the heart. During the angioplasty, the cardiologist guides a small balloon to the site where the artery is blocked. Once the balloon is inflated the plaque material that is clogging the artery is compressed to the side creating a wider channel for blood to flow. Often a metal stent is placed to reinforce the opened channel and help prevent the artery from closing back down. With any angioplasty there is a small risk of the artery closing down at the time of the procedure. To help prevent a heart attack under such circumstances, an operating room and a cardiac surgeon are always available should urgent open heart bypass surgery be necessary. Patients who have an angioplasty done should expect to stay in the hospital overnight, but can usually be discharged home the following morning. 

After the Cardiac Cath 

Once you are back in bed the sheath will be removed. After the sheath is pulled, firm pressure is immediately applied to the artery by hand or with a C-clamp device for 20 to 40 minutes. This will allow the puncture site in the artery to seal over with a small blood clot. A sandbag will then be applied over the groin site for 4 to 6 hours to make sure the artery heals properly. Bedrest will also be needed for these 4 to 6 hours after the procedure. In some cases, the artery can be sealed with a mechanical plug. In these cases, the sandbag is not usually necessary and patients need only a few hours of bed rest. After a period of time, you will be asked to get up and walk. If there are no problems, you will be discharged home at that time. Your cardiologist will review the results of the cardiac cath with you and your family, and future treatment plans will be discussed. You should leave the hospital with a complete understanding of the test results and any follow-up instructions. Your primary care physician will be notified of the test results immediately. 

Going Home 

Unless you need other treatment right away, you can go home after the cath. You will need a ride since you cannot drive with the leg used for the cath. Also, some of the medicines used to help you relax may leave you feeling a little lightheaded.

As soon as you arrive home from the hospital, you should remain at rest except to use the bathroom. You can return to your normal routine the following day unless otherwise instructed by your doctor. The bandage on your groin may be carefully removed the next day. You may shower or take a bath-at that time. Do not plan to do any heavy lifting (greater than 20 pounds) or exercise for two full days after the test. You should not plan to drive for one to two days after the test. 

Fatigue is common for a day or two after the procedure. You may have a small lump or bruise at the catheterization site. The area may be sore for a few days. Generally, all these types of symptoms resolve in a few days or weeks. In the unlikely event that you have any bleeding from the groin site, you should apply manual pressure immediately and have someone contact your cardiologist. If serious problems develop, you should be transported to the nearest hospital by ambulance. Finally, be sure to call your doctor if you have any of the following problems: