Heart Catheterization

About

Inside the catheterization laboratory, the interventional cardiologist and heath care team first make sure the patient is comfortable. During the procedure, the patient remains awake to respond to instructions from the cardiologist, if necessary. Nurses can administer light sedation or other medications, as appropriate.

After numbing the catheter entry site (typically the groin, arm or leg), the cardiologist inserts a very thin, flexible, soft-tipped wire, inside a catheter, into the patient's artery. While watching the special fluoroscopic (X-ray) video screen, the cardiologist continues to thread the catheter and wire up through the artery and into the heart. After it is placed correctly, the cardiologist injects a special contrast dye into the catheter. The dye is visible on the video screen as it enters the heart and reveals any blockages or plaques within the heart's vessels. The catheterization equipment rapidly records views from several angles to get the most accurate diagnostic picture.

When the dye is injected, the patient may feel a warm sensation. Some patients feel some chest pain. A nitroglycerine tablet may be given during the procedure to relieve the pain.

Following heart catheterization, the cardiologist has several options, depending on what was found during the procedure:

• No blockage or plaque — The patient has effectively tested negative for coronary artery disease. No further treatment is needed.
• One or two blocked arteries -- The cardiologist may perform an angioplasty immediately following the catheterization. Because the catheterization has already been performed, opening the artery or arteries with a balloon takes only an extra 30 minutes. Patients should be informed of this possibility prior to catheterization.
• Small blockage — Sometimes the angiogram reveals a small blockage or buildup of plaque, but not enough to warrant intervention. Typically this patient will be prescribed medications to break up the blockage or relieve symptoms.
• Multiple blockages with widespread disease — More complex cases may require coronary bypass surgery.

For blockages and buildup in places accessible to the catheter, intervention can be performed immediately following the angiogram. To perform cardiac angioplasty, the catheter and wire remain in place, and the cardiologist threads other instruments into the heart along the same pathway. Blocked arteries are typically opened by inflating a tiny balloon one or more times. After the blood flow is restored, in many cases a stent is also inserted, expanded and stays in place as scaffolding to keep the artery open. Doctors are often using special stents that are coated with a time-release medication to prevent scar tissue from forming around the stent, reducing the risk that the artery will re-clog.

Because heart catheterization is a minimally invasive procedure, most patients can go home within one or two days. New technologies are being researched and developed that decrease catheterization patients' discomfort after the procedure and shorten recovery time.