Cardiac Catheterization

Cardiac catheterization is often referred to as coronary angiography or a coronary angiogram. It is a radiographic procedure that is used to look at and visualize the heart and the coronary arteries. During a cardiac catheterization it is possible for the cardiologist performing the procedure to see how effectively blood is flowing through the coronary arteries. In addition, this procedure allows the cardiologists to see how blood is moving through the chambers of the heart and how effective the heart valves are functioning.

A cardiac catheterization can also allow for the visualization of the movement of the walls of the heart to see if the pumping action of the heart is normal. The primary application of cardiac catheterization is to determine if there is the presence of coronary artery disease. If there is occlusion of the coronary arteries this is the result of atherosclerosis, or plaque build up within the coronary arteries. During a cardiac catheterization it is possible for the physician to identify the location and size of these plaque deposits.

The presence of plaque within the coronary arteries can lead to a myocardial infarction; therefore, if the plaque buildup is substantial, therapeutic action has to be taken. This treatment may include coronary bypass surgery if the coronary artery disease is widespread and or the arteries are occluded to a large degree. A large number of patients who do have coronary artery disease are treated in the cardiac cath lab during the catheterization with procedures such as percutaneous coronary intervention (PCI) and angioplasty with stenting and artherectomy.

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Angioplasty is performed by inserting a catheter into the coronary artery that is blocked. The catheter has balloon that can be inflated where the blockage is present. The pressure from the inflated balloon will force the plaque to the sides of the coronary artery. This will allow the artery to open and allow for increased blood flow through that branch of the coronary arteries. Once the plaque is moved aside the cardiologist will insert a tiny expandable wire tube known as a stent. The stent will be placed where it can be expanded to hold the artery open.

Some stents are designed to simply keep the artery held open. Other stents used are drug-eluting stents. These stents are coated with pharmacologic agents that work to prevent restenosis of the artery. Another form of PCI is artherectomy. This is a procedure that has a cardiologist using a cutting blade that spins rapidly or a laser beam to cut away or burn away plaque that is blocking a branch of the coronary arteries. To perform a cardiac catheterization the patient is brought to the cardiac catheterization lab. These procedures are performed by specially trained cardiologists, nurses and radiologic technologists.

The procedure is performed on a specialized table with fluoroscopy equipment, cardiac monitoring equipment, and the use of computerized technology to assist in data and image collection and analysis. To perform a cardiac catheterization the cardiologist will insert a sheath, or a short tube usually into the femoral artery. A long very thin catheter will then be fed through the sheath and guided through the arteries until it is in the heart and coronary arteries. The physician uses fluoroscopy equipment to guide the catheter into the coronary arteries.

To allow for clear viewing of the coronary arteries, contrast material is injected into the catheter. As the contrast material flows through the heart chambers and coronary arteries x-rays are taken. The physician can than visualize the heart, valve function, and the flow through the coronary arteries. Any obstructions in the coronaries will become readily visible. The contrast material used to allow for the visualization of blood flow is iodine based and is flushed through the patients system rather quickly once the test is completed.

The contrast material will be injected into the catheter that has been fed into the heart. As the contrast material flows through the heart x-rays are taken as a motion picture. This allows the cardiologist to not only visualize the flow of blood through the heart and coronary arteries, but the wall motion and valve function can be seen as well. This component of a cardiac catheterization is the actual coronary angiogram. If there is coronary artery disease, which is a blockage in some branch or branches of the coronary arteries, these blockages will be visible during the angiogram.

The cardiologist performing the procedure will then determine the course of therapy to enhance blood flow through the coronaries. In mild cases, the patients may be treated medically with no cardiac catheterization intervention. In more severe cases the cardiologist might perform angioplasty with stenting. In those cases where stent placement cannot be done, or if the coronary artery disease is too widespread, then coronary artery bypass surgery might be warranted. A cardiac catheterization generally takes about 30 minutes.

It can take longer if the cardiologist has to perform angioplasty and place multiple stents. Following the procedure the patient may remain in the hospital overnight or they may be able to go home after a few hours of recovery time. Most cardiac catheterizations are done via catheter insertion into the femoral artery. When the procedure is completed the sheath will be removed and the entry site will be closed with the application of pressure and a suture device or plug. A cardiac catheterization is an invasive procedure done in a sterile O. R. like environment.

Although, the complications are rare, they do exist. Complications include: Allergic reaction to the contrast material, irregular heart rhythm, bleeding where the catheter was removed, infection, coronary artery spasm or acute closure, a tear and bleeding, and the need for emergency heart surgery. However, the benefits far out weigh the risks. The clinical information that this gold standard test provides about the heart, and the ability to open coronary arteries without surgery makes this procedure critical for those who are believed to have heart disease.

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