Cardiac Catheterization or Coronary Angiography
Explanation of the Test
Cardiac catheterization or coronary angiogram is a diagnostic study, not an operation, performed to look at the arterial blood flow to your heart. During the procedure, a catheter (small, thin hollow tube) is inserted into an artery passed up to your heart. Through this catheter, radiographic contrast material, or dye, is injected into the coronary arteries. When injected, the contrast material mixes with the blood in the arteries, allowing the doctor to visualize the blood flow through the arteries. The dye may cause some discomfort or a warm sensation when injected. The contrast material is iodine-based.
Some people have a known allergy to iodine, shellfish or x-ray dye. If you are one of these people, let your doctor know before the test. Medication can be given to prevent an allergic reaction.
Percutaneous Transluminal Angioplasty (PTA)
Your doctor may recommend a PTA, which is a procedure that improves blood flow through the coronary arteries when an area of narrowing or plaque has been identified. Special supplies are used for this procedure, including a small wire to cross the area of plaque and a catheter with a balloon on the tip to inflate within the area of plaque. The wire and balloon catheters are positioned across the area of blockage and the balloon is inflated, compressing the plaque against the artery wall. It may be necessary to inflate the balloon several times. You may feel pain or cramping in the affected leg but this will subside. The PTA is successful when the narrowed artery has been opened wide enough to allow adequate blood flow.
Your doctor may also choose to place a stent at the area of narrowing. A stent is a metal coil, slotted or mesh tube that is mounted on a balloon. When the balloon is inflated, the stent expands. When the balloon is deflated, the stent remains expanded, acting as scaffold to hold the artery open. A stent is placed permanently in the artery; the lining of the artery will grow over the stent.
After the Procedure
After the procedure, the sheath in your groin may be sutured in place and removed later in the day, or an arterial closure device may be used to seal the artery. When the sheath is ready for removal, a physician or nurse will apply pressure to the area for about 20-60 minutes.
When you return to your room, your nurse will check your blood pressure and the insertion site frequently to be sure there is no bleeding. The nurse will also check the pulse below the site of insertion. You will have an I.V. infusing and may have oxygen, if needed. You may also eat and drink at this time based on physician orders.
You must remain flat in bed for a specified length of time. The nursing staff will assist you in turning and/or raising the head of your bed based on physician orders. Your leg needs to remain straight and if you need to cough, laugh or sneeze, hold pressure over the Band-Aid applied to your groin. If you have discomfort, inform your nurse; pain medications are available. You may shiver after the procedure; this is normal and usually due to the coolness of the procedure room and the contrast material used. A bruise or small lump under the skin at the point of insertion is common and will disappear in about one week. Notify the nurse if you feel numbness or tingling down your legs. It is possible that the groin site may bleed or ooze after returning to your room. Signs to watch for are painfulness or a warm, wet feeling near the groin site. If you feel this, hold pressure on the site and call your nurse immediately. Your nurse may need to hold additional pressure to your groin or apply a pressure device.
After the procedure, the physician will provide a progress report to your family. Later, your doctor will talk with you and your family about the results when you are back in your room, usually the same day.
- Avoid heavy lifting (over 20 pounds) or strenuous exercise for three days.
- You may shower but do not take a tub bath or swim for one week.
- Watch the site for signs of infection: swelling, drainage or tenderness. If bleeding should occur, apply pressure and go to an emergency room or call 911.
- Do not have a MRI scan within eight weeks of stent implantation without first discussing it with your physician.
- Call your doctor if you notice tingling or pain in your leg, or if your leg is white in color and cold to touch.
You will need to call immediately upon discharge for a follow-up appointment with your physician. This visit will help monitor your progress.