Cardiac Catheterisation

cardiac catheterisation

Cardiac catheterisation is a way to find out detailed information about your heart and coronary arteries. Some 'operations' are also possible during cardiac catheterisation. Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.

What is cardiac catheterisation?

A catheter is a thin, flexible, hollow tube. Cardiac catheterisation is where a very thin plastic catheter is passed into the chambers of the heart. The catheter can also be passed into the main blood vessels of the heart (the coronary arteries).

How is cardiac catheterisation done?

You lie on a couch in a catheterisation room. An X-ray machine is mounted above the couch. A catheter is inserted through a wide needle or small cut in the skin into a blood vessel in the groin or arm. Local anaesthetic is injected where the puncture is to be made. The doctor gently pushes the catheter up the blood vessel towards the heart. Low-dose X-rays are used to monitor the progress of the catheter tip which is gently manipulated into the heart chambers and/or coronary arteries. You cannot feel the catheter in the blood vessels or heart. You may feel an occasional 'missed' or 'extra' heartbeat during the procedure. This is normal and of little concern. During the procedure your heartbeat is monitored by electrodes placed on your chest which provide a tracing on an electrocardiograph (ECG) machine. Sometimes a sedative is given before the test if you are anxious.

What is cardiac catheterisation used for?

Coronary angiography

The coronary arteries are the blood vessels that take blood to the heart muscle. If they become narrowed then less blood and oxygen gets to the heart muscle. This can cause angina, heart failure and other heart conditions.. This procedure shows up the structure of the coronary arteries 'like a road map'. It aims to detect any narrowing of the coronary arteries, and the exact site and severity of any narrowing.

Other uses

A cardiac catheter can be used for various other functions which include:

Measuring the blood pressure within the heart chambers.

To sample blood from within the heart chambers or coronary arteries.

To perform 'operations' within the heart or coronary arteries.

The catheter tip can include a tiny balloon which can inflate to widen narrowed heart valves (valvuoplasty) or narrowed coronary arteries (angioplasty). See separate leaflet called 'Coronary Angioplasty'.

Catheter ablation (destruction) treatment. This is where a device at the catheter tip can destroy a tiny section of heart tissue. This is sometimes used to treat arrhythmias (abnormal heart rhythms). The source or 'trigger' of the abnormal electrical impulses can sometimes be destroyed by this technique. This is only suitable if the exact site of the trigger can be found by special tests, and be located accurately by the catheter tip.

Newer techniques are being developed which use devices at the tip of the catheter. For example, a tiny ultrasound scanner at the tip of the catheter is a recent development. This can give detailed pictures from within coronary arteries.

Cardiac catheterisation tests in children

Cardiac catheterisation is commonly done to assess the heart of children and babies with certain types of congenital heart disease. A general anaesthetic is normally given to children to keep them asleep during the procedure.

How do I prepare for a cardiac catheterisation?

  1. You should get instructions from your doctor about what you need to do. The sort of instructions may include:
  2. If you take warfarin or another anticoagulant ( 'blood thinning' drug) you will need to stop this for 2-3 days before the test. (This prevents excessive bleeding where the catheter is inserted.)
  3. If you take insulin or drugs for diabetes, you may need to alter the timing of when you take these. Some medicines may need to be stopped for 48 hours. Your doctor should clarify this with you.
  4. If you may be pregnant, you need to tell the doctor who will do the test.
  5. You may be asked to stop eating and drinking for a few hours before the test.
  6. You may be asked to shave both groins before the test.

How long does cardiac catheterisation take?

'Routine' cardiac catheterisation for angiography usually takes about 20-30 minutes. In most cases it is done as a day-case procedure. However, some 'operations' using a cardiac catheter can take longer, and some people need to stay in hospital for a short time.

The doctor will discuss what he or she found during the test.

You will need to rest for a few hours after the test. You should ask a friend or relative to accompany you home. Most people are able to resume their normal activities the next day.

There may be some bruising at the site of the catheter insertion which may be a little sore when the anaesthetic wears off. Painkillers such as paracetamol will help to ease this.

Are there any risks or side-effects?

Most of the side-effects are minor and may include:

A bruise may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.

The small wound where the catheter is inserted sometimes becomes infected. Tell your doctor if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs.

Some people get a short angina-type pain during angiography. This soon goes.

If dye is used to get X-ray pictures (angiogram), you may have a hot, flushing feeling when the dye is injected. Rarely, some people have an allergic reaction to the dye.

Serious complications are rare, but do sometimes occur. For example, stroke or a heart attack during the procedure. Also, rarely, the catheter may damage a coronary artery. The risk of serious complications is small and is mainly in people who already have serious heart disease. Your doctor will only recommend cardiac catheterisation if they feel the benefits outweigh the small risk

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