Cardiac Angiography Cardiac Catheterization

Cardiac catheterization is a test used to diagnose abnormalities of thecoronary blood vessels. These vessels supply blood to your heart. The test can also beused to observe your heart chambers and heart valves. The supplies used for this examinclude:

long thin tubes, called catheters

a TV system

an X-ray machine

First, a catheter is inserted through your skin and into your artery. An arteryin your groin is the usual entry site. Dye is then injected through the catheter. X-ray picturesare taken as the dye travels through your arteries.

Who is a candidate for the test?

This test may be advised for people who have or are suspected to have oneof the following conditions:

abnormal enlargement of the heart

angina, whether stable anginaor unstable angina,which is the chest pain that you get when too little oxygen reaches your heart for a shortperiod

coronary artery disease,which is a blockage in the arteries that supply blood to your heart, and is often the cause of anginaand heart attacks

heart attack,which occurs when your heart is permanently damaged from not getting enough oxygen over anextended period

heart defects present at birth, also called congenital heart disease

irregular heartbeats, which are also called arrhythmias

How is the test performed?

Cardiac catheterization is done in a special room with cameras, TVscreens, and X-ray devices. Usually, the doctor who performs the test is a heartspecialist, also called a cardiologist. Sometimes, an X-ray specialist, called aradiologist, may perform the test. During the procedure, the doctor and his or herassistants operate the equipment in the suite. A nurse checks your vital signs,such as heart rate and blood pressure, throughout the exam.

During the test, you lie on a flat platform. The doctor selects anartery in which to insert the catheter. The femoral artery in the right groin is used most often.The skin in the groin area is numbed with local anesthesia.A small needle is then inserted through your skin and into your artery. Next, the doctorinserts a catheter into your artery through the small puncture made with the needle.

After being placed in the artery, the catheter can be pushed up into your aorta.This is the largest artery in your body. It connects directly to your heart and can be used toget into your heart chambers. Your coronary arteries, which supply blood and oxygen to yourheart, also stem from the aorta. An X-ray machine is used to help guide the catheter intoproper position.

Dye is used to light up the structures of your heart and itsarteries. The dye is injected into the catheter and enters your heart and heart arteries.This allows these structures to be clearly seen, as the dye used is easily seen whenX-ray pictures are taken. Pictures are taken with an x-ray machine as the dyetravels through your heart and heart arteries. The doctor usually takes severalpictures of your heart filled with dye from different angles and positions. More than oneinjection of the dye is often needed. The images can be projected onto aTV or video screen so that the doctor can view your heart and its arteries during the test.

The standard test will typically take less than an hour. In more complexcases, the exam may last for several hours. The doctor may sometimes see anabnormality during the test that can be corrected during the exam. For example, aprocedure called angioplastyis sometimes used to open up clogged arteries. This involves inserting a balloon catheteror other device through the catheter to open the area of blockage.

What is involved in preparation for the test?

Special preparation is needed before the test. A brief physical exam is doneto evaluate pulses in your groin and legs. If you have a weak pulse in your groin, your doctor may usea different artery to insert the catheter. Your doctor will also review your medical andsurgical history. He or she may ask questions such as the following.

Do you have a bleeding tendency or any blood disorders?

Do you have any kidney disease or other kidney problems?

Have you had a prior allergic reaction to contrast agent or dye?

Do you take blood thinning medicines such as aspirin or warfarin?

Before the test, your blood is checked for kidney function and forsigns of a bleeding tendency. A woman of childbearing age will be screened forpregnancy.This is usually done with a urine or blood pregnancy test. Radiation from the test could harman unborn child.

You cannot eat or drink anything for six to eight hours before the test.Dentures, eyeglasses, and jewelry, such as necklace or earrings, should be removed beforethe exam.

The risks, benefits, and complications of the test are usually explained to youon the day of the procedure. Some possible complications you may have from the test are as follows:

allergic reactions to the contrast agent used

bleeding in the groin

heart attack, which occurs in less than 1% of cases

irregular heartbeats called arrhythmias

stroke, which occurs in less than 1% of cases

If procedures are done during the exam, such asangioplasty,additional risks are involved. These will be discussed before the test by your doctor.

This test may be done on an outpatient basis. This means that you cango home after the test. However, sometimes you might have to stay in the hospital for a day or moreafter the test. Often, this test is used for people in the hospital who have serious orlife-threatening heart conditions.

What do the test results mean?

The doctor who performs the test is usually the one who reviews the results.This involves looking at the pictures taken during the exam to check for any abnormalities.The doctor uses the results of this test to help plan your treatment and figure out the next course ofaction.