Heart Care FAQ

Are allergic to any medications
Are allergic to contrast material (dye) or any other substance that contains iodine (shellfish)
Have asthma or other breathing problems (sleep apnea)
Are taking any medications for ED such as Viagra
Have any bleeding problems or take blood-thinning medication
Are or might be pregnant
Have kidney disease or diabetes, especially if you take Metformin (Glucophage)

You will be asked to sign a consent form before the test. The consent is giving your cardiologist permission to proceed with the diagnostic angiogram and to provide the appropriate treatment, such as balloon angioplasty, stenting, etc.

Talk to your health care provider about any concerns you may have regarding the need for the test, how the test is performed, the risks involved and the benefits obtained from the test. Be sure you clearly understand what treatment may be recommended if a blockage is found during the test. Your physician and the cardiac team at Springhill Medical Center will be glad to answer any questions you may have.

Cardiac catheterization may be done on an outpatient basis, without requiring an overnight stay in the hospital. You will need to know what time to arrive prior to your testing.

You will also need to arrange to have someone pick you up after your test is completed, because you will not be allowed to drive yourself home.

Be sure to wear comfortable clothes and pack an overnight bag in case you need to be admitted to the hospital after the procedure. It is recommended to remove your jewelry. It is best not to bring valuables to the hospital with you. Also, remove any nail polish to permit observation of the blood circulation in your fingers and toes.

If you currently take medications, ask your physician if you should take those with sips of water on the day of the test.

You will be asked not to eat or drink for several hours prior to the test. Your physician will give you specific instructions regarding how long to fast before the test.

How Safe Is The Test?

Cardiac catheterization is a relatively safe procedure and is performed all over the world, usually on an outpatient basis. As with any test or procedure, the possible benefits of the test have to be weighed against the risks.

The risk for serious complications (for example: stroke, heart attack) from the procedure is approximately 1 in 1,000. Other complications include the following:

Allergic reaction to iodine-based dye
Bleeding at the insertion site
Damage to arteries
Infection at the insertion site
Kidney damage and/or kidney failure

You should discuss the risks and benefits for you thoroughly with your doctor before having the test.

How Is The Test Done?

After completing the registration process, you will be escorted to an exam room. You will be asked to remove your clothes and put on a hospital gown. Please remember to remove your undergarments as well. Once in bed, you will be asked questions regarding your medical history, medications and allergies. It will be very helpful if you bring a list of your medications, including the dosages and frequency. If you have an allergy to iodine or shell fish, or have had prior problems during an X-ray procedure or cardiac catheterization, please be sure to notify the nurse. Areas on your arms or groin will be shaved to prepare these sites for possible insertion of the catheter. An IV (intravenous line) will be started and some blood will be drawn for blood tests, and an electrocardiogram (EKG) will be performed. It is possible other tests or a chest X-ray may also be performed.

Be sure to empty your bladder completely just before the test. To perform cardiac catheterization, a thin, flexible tube called a catheter is placed into a blood vessel in your arm or groin and threaded to your heart. Through this catheter, your doctor can measure pressures, take blood samples and inject contrast. Your doctor will watch the contrast flow through your heart’s chambers and blood vessels to see whether the coronary arteries are narrowed or blocked.

If your coronary arteries are blocked, your physician may be able to use the catheter to open them and to restore normal blood flow to your heart. This is called percutaneous coronary intervention (PCI). Three common types of PCI are angioplasty, coronary stenting, and coronary atherectomy. These three procedures can be done separately or in combination.

Angioplasty may be done by inserting a small balloon-tipped catheter and inflating the balloon against the plaque on the wall of the artery, improving blood flow.

Stenting may be done along with angioplasty. Once the plaque is pressed against the wall of the artery, a small, expandable wire-mesh tube called a stent is placed into the artery to hold it open.

Atherectomy, which is usually the removal of plaque with a laser, may also be done during cardiac catheterization to open a partially blocked coronary artery. Once the tip of the catheter reaches the narrowed portion of the artery, a laser beam is used to remove the plaque.

What Can I Expect During The Procedure?

You will be brought to the cath lab and asked to lie on a firm, flat table under a large X-ray machine. The room is kept cool to protect the sensitive electronic and X-ray equipment from overheating and the lights are often dimmed to make it easier for the cardiologists to see the images of your heart on the video monitor. Several electrodes will be attached to your legs and arms. These are connected to an electrocardiogram (EKG) that will continuously record the electrical activity of your heart during the test. A device called a pulse oximeter will be placed on one of your fingers to monitor your pulse and oxygen levels during the procedure. Intravenous (IV) fluids and sedation medications will be given through the IV that was started during the pre-procedure phase.

Your groin (or in rare cases, one of your arms) will be cleansed with an antibacterial solution and covered with sterile, surgical drapes. Then the physician will numb the area with a local anesthetic. You may feel a “bee sting” type sensation for a few seconds, similar to when your dentist numbs your gums.

Your cardiologist will gain arterial access and place a small tube (sheath) about the size of a coffee straw in the groin/arm. You should notify the doctor or the nurse if there is any discomfort or pain. Additional local anesthesia or sedation will usually take care of the problem. A long, soft plastic tube or catheter is inserted and guided toward the heart and your cardiologist will rotate and gently move the catheter to guide its tip into various positions in the heart’s vessels and chambers. Some people experience skipped heartbeats for a few seconds when the catheter touches the walls of the heart.

Contrast material or "dye" is injected through the catheter, and you may be asked to momentarily hold your breath during the injection of the contrast. You may also experience a very warm feeling or "hot flash" during the injection; this is caused by the contrast displacing blood and may last about 30 seconds. Some patients experience some nausea, lightheadedness, chest pain, irregular heartbeat, headache, mild itching, or an urge to cough. If you have any of these symptoms, be sure to tell your cardiologist.

You may feel the table move and the X-ray camera move in one direction or another during the test. This is to allow your cardiologist to obtain different views of your heart with the X-ray equipment. Throughout the procedure, your cardiologist will constantly monitor your EKG and blood pressure. X-ray pictures obtained during injection of the contrast are viewed on a second monitor. You may be able to watch most of the study on the monitor. The camera which takes these X-ray pictures will make a humming sound.

It is important to remember that the sheets covering you are sterile. Your hands should be kept by your side and not placed on top of the sheet. Do not reach for your groin because it will contaminate the operative site and/or the catheter. If you need any assistance, the cardiac staff will be happy to help you. You need to remain as still as possible, since motion can distort the images.

When the test has been completed, the sheath will either be removed or sutured in place and you will be taken to the recovery room.

What Happens After The Test?

After completion of the procedure you will be taken to the recovery room where the sheath will be removed from your groin. Firm pressure will be applied for approximately 15-20 minutes (the time may vary) to stop and/or prevent bleeding from the small needle hole. A dressing will then be placed on the groin and a sand bag or ice bag may be used on top of the dressing. You will have to lay flat for four to six hours. It is important to not sit-up, bend your leg or strain during the time of bed rest.

Should you feel a warm or wet sensation around the catheter insertion site or if there is blood on the dressing, pressure needs to be applied at the site and the nurse called immediately. If there is bleeding, there is no need for panic. Additional pressure will almost always take care of the problem.

During your recovery, a nurse will monitor your vital signs (heart rate, blood pressure, oxygen saturation and temperature) and check for signs of bleeding at the site where your sheath was. The nurse will also be checking the pulse, color and temperature of your arm or leg in which the sheath was inserted.

Unless additional treatment or procedures are required, you will be allowed to get out of bed and be discharged home with a family member or friend.

You can expect some soreness and perhaps a bruise at the site, which should resolve in a few days. If you notice any signs or symptoms of infection (increased redness, swelling, warmth, drainage or discharge, persistent fever), please notify your cardiologist.

You will be instructed to drink plenty of fluids the night after the procedure to flush the contrast material (dye) out of your body.

Contact your doctor immediately if:

Your leg or arm becomes pale, cold, painful or numb
Redness, swelling or discharge from the catheter insertion site
You have a fever of higher than 100.4°F.