CARDIAC CATHETERIZATION WITH ANGIOGRAPHY

Other Names: Heart Catheterization, Left and/or Right Heart Catheterization

Description/Test Basics/Reasons for the test: Cardiac catheterization is done in a special operating room called a catheterization lab. Cardiac catheterizations are usually performed with the patient lying flat on a table with an x-ray machine above or on the side of the table. An IV line will likely be placed in your arm and a mild sedative given to relax you.  You will be awake during the procedure.  Just before the procedure, a nurse or technician may shave the hair from the site-arm or groin- where the catheter will be inserted after local anesthetic is applied to numb the area.  A puncture will be made where the local anesthetic was applied and a plastic sheath inserted into the cut to provide access for your physician to insert the catheter, a long thin tube that is inserted in an artery or vein in your groin or arm and threaded to the blood vessels to your heart. The catheter is carefully threaded into the heart using a specially-designed x-ray machine that produces real-time pictures (fluoroscopy).  Once the catheter is in place, what happens next depends on why you’re having the cardiac catheterization:

Test preparation/pre-test guidelines: You will be instructed to not eat or drink anything 8-12 hours prior to the test, bring all your medications with you, inform your physician and the hospital staff if you take any medications for angina, hypertension, high cholesterol, diabetes or blood-thinning medications, notify your physician and the hospital staff of any allergies, particularly to iodine, and if you might be pregnant.  You will also be instructed by the hospital staff to have blood tests, an electrocardiogram, and a chest x-ray taken before the procedure.  Depending on what medications you take, your physician may discontinue some of them prior to the procedure. You'll be asked to use the restroom to empty your bladder. You'll also be asked to remove dentures if applicable and may need to remove jewelry that could interfere with obtaining pictures of your heart.  

Test process/How the test is done: Cardiac catheterization is done in a special operating room called a catheterization lab. Cardiac catheterizations are usually performed with the patient lying flat on a table with an x-ray machine above or on the side of the table. An IV line will likely be placed in your arm and a mild sedative given to relax you.  You will be awake during the procedure.  Just before the procedure, a nurse or technician may shave the hair from the site-arm, neck or groin- where the catheter will be inserted and a local anesthetic will be applied to numb the area.  A cut will be made where the local anesthetic was applied and a plastic sheath inserted into the cut to provide access for your physician to insert the catheter, a long thin tube that is inserted in an artery or vein in your groin, neck or arm and threaded to the blood vessels to your heart. The catheter is carefully threaded into the heart using a specially-designed x-ray machine that produces real-time pictures (fluoroscopy).  Once the catheter is in place, what happens next depends on why you’re having the cardiac catheterization: 

  • Coronary angiography: This is the most common test that is performed in conjunction with cardiac catheterization. During angiography, a contrast dye will be injected through the catheter into the coronary arteries around your heart after taking pressure measurements inside the heart. The physician usually places the catheter in the aorta at the beginning of the arteries that supply blood to the heart.  The contrast dye is then injected through the catheter.  The dye blocks x rays. While flowing  through the coronary arteries surrounding the heart, the physician traces the flow of this dye with an x ray machine to get a 'road map' of the heart's blood vessels.  X-ray images of your heart will be taken.  These x-rays, called angiograms, help your physician find the location and severity of the blockages affecting your heart's blood supply and decide on a treatment course. In a coronary angiogram, the catheter is usually placed in the artery in your groin or wrist. Many patients who have undergone coronary angiography report feeling sensitive to their heartbeats and a warm, flushing sensation when the dye is injected.  This is a normal reaction that lasts for 20 to 30 seconds. The physician may ask the person to cough to help move the dye through the heart's arteries. More than one injection of dye may be used during an angiography. 
  • Right heart catheterization. This procedure measures the blood flow and pressure in the right side of your heart. The catheter has special sensors in it to measure the pressure and blood flow (hemodynamics) in your heart. 
  • Balloon angioplasty, with or without stenting. Percutaneous Transluminal Coronary Angioplasty is used to open a narrowed artery in or near your heart. For this procedure, the catheter likely will be inserted in the artery in your groin. A long, flexible catheter will be thread through your arteries to the narrowed artery. Then, a smaller balloon catheter will be led through the flexible catheter and inflated at the narrowed area to open it. The balloon compresses the blockage (plaque) against the arterial wall, allowing increased blood flow through the coronary artery.  In many cases, your doctor will also place a mesh coil called a stent at the narrowed portion to help keep the artery open.  Drug eluting stents have an anti-platelet coating that further help to reduce the chance of restenosis, or the blockage reappearing. 
  • Closure of heart defects such as a hole in your heart, biopsy of the heart muscle or balloon valvuloplasty, which helps to make the heart valves open more easily.

Throughout the procedure you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions. After the test, the catheter is removed through the sheath at the insertion site. The IV will be removed as well. When the sheath is removed, firm pressure will be applied on the insertion site to allow the puncture area to close and stop any bleeding. You may be asked to raise your leg, or sutures may be used to help close the insertion site.  You’ll need to lie flat for one to six hours after the procedure to avoid serious bleeding and to allow the artery to close. You will also be bandaged.

Post-test guidelines: If there were no complications during the prcedure, most people can resume normal activities within a few days to a week after their catheterization.  Patients will be advised to:

  • Drink plenty of water and other clear liquids for two days;  
  • Avoid heavy lifting more than five or 10 pounds for the first few days;
  • Avoid tub baths for a few days (showers are usually permitted within 24 hours).
  • Given instructions on when they can resume their medication regimen, as well as any changes to their medications if need be; and
  • Instructions to call our office should any complications arise following the cardiac catheterization.


Test location: Cardiac Catheterization will be performed at Denton Regional Medical Center, Texas Health Resources Presbyterian Hospital Denton or Medical Center of Lewisville.  




HOSPITAL PRIVILEGES:   •  Denton Regional Medical Center   •  Texas Health Presbyterian Hospital Denton
   •  Muenster Memorial Hospital   •  North Texas Medical Center


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