Cardiac catheterization is a minimally invasive procedure and is considered a final solution to many heart problems. Turkey has developed the catheterization process significantly in recent times.
Cardiac catheterization is an imaging procedure of the arteries that feed the heart muscle, called the coronary arteries. It has two purposes or types: diagnostic catheterization and therapeutic catheterization.
Cardiac catheterization can be performed symmetrically from the hand and thigh, depending on the doctor’s choice. Is cardiac catheterization dangerous? When does a patient need a heart catheterization? What is the success rate of cardiac catheterization for the elderly? Find out with us in this article.
Cardiac catheterization procedure and general information about it
Cardiac catheterization (or coronary angiography) is a deeply invasive imaging procedure of the arteries of your heart that allows your doctor to evaluate your heart function. Cardiac catheterization is used to:
- To evaluate or diagnose the presence of coronary artery disease, valve disease, and the need for replacement, or aortic artery disease.
- Evaluation of myocardial function.
- Determine the patient’s treatment needs (such as an interventional procedure or coronary artery bypass grafting surgery).
During cardiac catheterization, a long, narrow tube called a catheter is inserted through a plastic insertion sleeve (a small, hollow tube inserted into a blood vessel in the patient’s leg or arm). The catheter is guided through the blood vessels into the coronary arteries with the help of a special X-ray machine.
Contrast material (contrast material) is injected through the catheter, and an X-ray video is taken as the contrast material moves through the heart chambers, valves, and major vessels. This part of the procedure is called a coronary angiogram.
Coronary artery disease is narrowing or blockage of the coronary arteries, so the doctor may suggest interventional procedures to open the coronary artery, which increases blood flow to the heart.
Digital images of contrast material are used to locate a narrowing or blockage in a coronary artery.
Additional imaging procedures—such as intravascular ultrasonography (IVUS) and fractional flow reserve (FFR)—can be performed during cardiac catheterization in some cases to obtain detailed images of the blood vessel walls. However, these two procedures are currently only available in specialized hospitals and research centers in Turkey.
Cardiac catheterization causes
There are many reasons for cardiac catheterization. It may be to diagnose or deny a disease or for a therapeutic reason. Among these causes, we mention:
- Find out the cause of the heart rhythm disorder, whether the patient needs to install a heart battery or a defibrillator, and the reason for the patient’s slow heartbeat.
- Investigating the cause of non-parietal chest pain.
- Cardiac catheterization helps diagnose cardiomyopathy, aortic stenosis, mitral valve regurgitation, or pulmonary hypertension (high blood pressure in the lungs).
- Evaluation of heart valves if the patient needs mitral valve replacement or mitral valve repair, catheter aortic valve replacement or aortic valve repair only, or coronary artery bypass surgery without a pump.
- Preparing for a heart transplant or artificial heart transplant.
- Taking a biopsy of the heart muscle by cardiac catheterization.
- Preparing for open heart surgery and endoscopic heart surgery.
What interventional procedures may be performed during cardiac catheterization?
An interventional procedure (also called angioplasty) is a non-surgical treatment to open narrowed coronary arteries to improve blood flow to the heart. If a blockage is identified during diagnostic cardiac catheterization, this intervention may be done during the procedure or scheduled later.
Interventional procedures include:
- Balloon angioplasty
- Placement of stents
During balloon angioplasty, a balloon is inserted into the narrowed blood vessel using a catheter, which helps expand it and improve blood flow to the heart. This step may be accompanied by the placement of stents, often coated with medications that help keep these arteries open.
Cardiac catheterization is not considered a surgical procedure because there is no large incision or opening of the chest, but it is a minimally invasive procedure, and the recovery time is much shorter than that of surgery. Depending on the results of the procedure, surgery may be recommended in some cases.
Where is cardiac catheterization performed, and who performs it?
Cardiac catheterization is performed in the Cardiac Catheterization Unit in the Department of Cardiology and Surgery. It is performed by a physician specializing in cardiovascular surgery, who is supported by a team of specialists, including cardiologists, nurses, and technicians.
It generally takes 30 minutes, but preparation and recovery time add several hours to the procedure time (five to nine hours or more).
Preparations before Cardiac Catheterization in Turkey
The doctor must conduct some tests before starting the heart catheterization procedure to ensure the patient’s readiness and his body’s ability to bear the consequences of this operation. He must also know the medications that the patient is taking.
Allergy tests
Please discuss all types of allergies you have with your doctor, especially those listed below:
- Allergy to IVP dye/contrast agent
- Allergy to iodine
- Allergy to rubber/latex products
pharmaceutical
Your doctor may want to stop or adjust doses several days before or on the day of the procedure, especially:
- Anticoagulant medications
- Aspirin
- Diabetes medications
Blood tests, ECG, and chest X-ray are also routinely performed.
Procedures of cardiac catheterization
Before the operation, they will give you a hospital gown to wear, and then you will enter the operating room and:
- The nurse will insert an intravenous (IV) line into your arm to provide you with medications and fluids during the procedure.
- The cardiac catheterization room is cool and dimly lit. The air must be kept cool to prevent damage to the X-ray machine used during the procedure.
- The nurse will clean your skin where the catheter tube (arm or groin) will be inserted. The cardiac catheterization insertion site may be shaved.
- Electrodes, which are small, flat patches, will be placed on your chest. The electrodes will then be connected to an electrocardiogram (ECG) machine, which monitors your heart rate and rhythm.
- You will be given a mild sedative to calm you, but you will be awake and conscious during the cardiac catheterization procedure.
- In some cases, a urinary catheter may be needed during the procedure.
- The doctor will use a local anesthetic to numb the site. Then, a plastic sheath (a short, hollow tube through which the catheter is placed) will be inserted into a blood vessel in your arm or thigh.
- A catheter will be inserted through the sheath into the heart’s arteries. You may feel pressure when the access sheath or catheter is inserted, but you will not feel pain.
When the cardiac catheter is in place, the lights will dim, and a small amount of contrast material will be injected through the catheter into the heart’s arteries. The contrast material will outline the vessels and valves.
When the doctor injects the contrast material into the heart, you may feel heat or redness for several seconds. This is normal and will disappear quickly.
Instructions after cardiac catheterization
You must drink plenty of fluids to get rid of the contrast material, otherwise kidney toxicity and necrotic nephritis will occur.
Creatinine and urine should also be checked several times after the operation to ensure that the contrast material does not damage the kidneys after the cardiac catheterization procedure.
You must have someone drive you home. You will not be discharged from the hospital unless there is someone available to do so.
While driving home, stop every hour and walk for 5 to 10 minutes. If you’re flying home, stand to stretch your legs and walk down the aisle at least every hour.
At home, you should follow the following instructions after cardiac catheterization:
- The location of the wound must be carefully taken care of and not do any strenuous actions so that the wound does not open or bleed.
- The wound site should be monitored, and the doctor should be informed of any redness, swelling, or bleeding.
- Bed rest should not be less than four or five hours a day.
- Follow the doctor’s instructions to shower and clean the wound site (depending on the wound closing method).
- Take medications regularly and do not stop them without a doctor’s order.
Suitable foods after cardiac catheterization
The patient can eat light foods, but he must stay away from fatty foods with high levels of fat so as not to stress his heart and make the problem of atherosclerosis worse if he has it.
You should not consume excessive sugars or any stimulants such as coffee and tea in the first period, especially if the patient has diabetes.
After heart catheterization, the patient must eat many foods rich in fiber, grains, healthy fats, and nuts.
Vegetables and fruits should be abundant in all circumstances, especially after heart catheterization.
Sports after cardiac catheterization
You should not do strenuous work after the operation for a period determined by the doctor (often several weeks). The patient can return to his normal work almost on the same day, with the preference of resting completely for two or three days.
Light exercises such as jogging and brisk walking can be performed in addition to strenuous sports that place a burden on the heart.
If you feel pain or anything strange, you should immediately stop the exercise and see your doctor.
Side effects after cardiac catheterization
Your cardiologist will discuss the procedure’s potential risks and benefits. Some potential risks of cardiac catheterization include:
- An allergic reaction to the medication or contrast material used during the procedure
- Arrhythmia
- Getting an infection
- Bleeding at the catheter insertion site
- Persistent chest pain or angina
- Mild to moderate skin burns (such as sunburn) due to exposure to X-rays
- Renal failure due to contrast material
- Heart attacks, blood clots, stroke or death
- Severe closure (spasm) of a coronary artery
- Emergency coronary artery bypass grafting (CABG) surgery
In the end, we find that cardiac catheterization is a safe procedure with several indications. It helps the doctor diagnose and treat many heart diseases. The procedure is inexpensive compared to open heart surgery, and its complications are few. The recovery period is significantly shorter.
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