Cardiac catheterization diagnostic coronary angiography
Diagnostic cardiac catheterization is a minimally invasive procedure in the blood vessels, where it is known as an imaging of the vessels that supply the heart which called Coronary Vessels. Catheterization helps the cardiologist identify and treat problems of the heart and blood vessels. You may have a left or right heart, depending on your symptoms and what your doctor suspects.
Angiography, a diagnostic method, in which angiography is preformed with contrast material, a type of medical dye. The nomenclature varies according to the area being performed, for example: coronary angiography to show the vessels of the heart, carotid and vertebral angiography to show the vessels of the neck, and lower peripheral angiography to show the vessels of the leg. The data obtained from this procedure helps both in the diagnosis and in determining the form of treatment.
The test is preformed while you are awake, but with light sedation. A catheter (very thin wire) is inserted from an artery or vein in your arm or thigh (leg) to the site of symptoms- either the left or right heart- for a closer look by a specialist and do some diagnostic tests to find out how the heart works.
Why do I need a cardiac catheterization?
A specialist doctor uses cardiac catheterization to:
- Check for heart disease (such as coronary artery disease, heart valve disease, or aortic disease)
- Check how the heart muscle works
- Through the catheter, it is confirmed whether you need further treatment (such as interventional procedure or open-heart-surgery)
- To check these functions in case of suspicion of a problem in the functions of the heart muscle.
- Develop the most appropriate treatment method for the current body condition to treat heart disease.
- Provides early diagnosis of various vascular diseases or coronary artery diseases.
Coronary angiography is a diagnostic test that shows obstruction and hypertrophy of the heart vessels in a practical setting, in other words, an intervention is made for the patient, includes radiation that considered the best test that shows cardiovascular disease, according to the results of the coronary vessels, the patient is transferred either to drug therapy or the balloon and stents are placed or transferred to coronary bypass surgery. Coronary angiography is the best technique for the structural and functional assessment of coronary heart vessels. It is not only a diagnostic method, but also a technique through which treatment is planned and the problem addressed as well.
Common uses of cardiac catheterization
A specialist doctor can use cardiac catheterization to find and solve problems. The procedures that can be preformed during cardiac catheterization include:
- Catheterization: the specialist inserts a catheter with a small balloon at its tip. When this balloon is inflated, it pushes the blockage out and widens the artery.
- Biopsy: the doctor takes a small sample of heart tissue.
- Repairing heart defects: a specialist doctor closed a hole in your heart or stops a leaky valve.
- Placement of a stent: a small mesh called a stent is placed in the artery to help keep it open.
Diagnostic catheterization through the vein of the arms
It is preformed through entry from the carpal vein (radial artery). Angiography in the arm is better than angiography in the thigh in terms of patient comfort. After the angiography of the arm, the patient can stand immediately, the possibility of problems related to blood vessels in the radial artery is much less.
When is Coronary Angioplasty preformed?
- Coronary angiography can be performed without further investigation, except in the presence of symptoms that strongly suggestive of cardiovascular disease.
- Coronary angiography may be preformed when findings suggestive of cardiovascular disease are present during exercise testing, echocardiography, and cardiac scintigraphy.
- Coronary angiography can be preformed for patients who have had a heart attack.
- Coronary angiography can be preformed for patients who will undergo another open-heart surgery or large vessel surgery other than coronary vessels.
- Coronary angiography can be preformed for patients with arrhythmias or heart failure, which indicates the possibility of cardiovascular disease.
What is the purpose of left cardiac catheterization?
the patient undergoes a left heart catheterization to achieve the following:
- Coronary heart disease
- Valve disease
- Blood flow problems
- Left ventricular weakness (the lower left chamber of the heart and the point from which blood leaves and travels to the rest of the body).
The purpose of right heart catheterization
the patient undergoes a right heart catheterization:
- Cardiac output (the amount of blood being pumped out of your heart)
- Left ventricular filling pressure (presence in the chamber as it fills with blood)
- Pulmonary arterial wedge pressure (PAWP) also known as pulmonary artery obstructive pressure (PAOP)
- Pulmonary hypertension (high blood pressure that affects the arteries in the lungs and the right side of the heart)
Preparation for a diagnostic cardiac catheterization
In preparation for the cardiac catheterization, an intravenous line (17) will be placed in the vein (the patient’s arm) to give him a sedative and to keep the patient comfortable during the procedure. The skin where the cardiologist will insert the catheter must be cleaned and prepared (shaved if there is hair in the area) for local anesthesia. The left heart will use a vein in your arm or groin, as in a left heart catheterization, the catheter is usually inserted from a larger vein in the thigh, but sometimes a vein can be used in your neck or arm. The cardiologist will make a small incision in the skin and insert the catheter, Using fluoroscopic guidance. The catheter is inserted into right or left chamber of the heart. Once the site is reached, the doctor can perform tests and look for any abnormalities in the valves, check the pressure and measure blood flow. In some cases, your cardiologist may be able to make minor repairs to correct some problems, then the catheter is removed. Some stiches maybe used to close the incision site, as pressure is applied to the site to control the bleeding.
Duration of stay
Most patient’s stay in the hospital all night, because the patient has to lie down for several hours. During this time, the patient will not be allowed to get out of bed, and he will be instructed by the specialist doctor about when the patient can resume his normal activities, the patient will need someone to drive him home where he will not be allowed to drive.
Before cardiac catheterization
Do not eat or drink after midnight on the day before the operation. Take your usual medication, but only drink a small amount of water to take the pills. If you are taking blood-thinning medications or have diabetes, talk to your doctor about special instructions. If you are allowed to go home, you will not be able to drive and you will need a driver to take you home. The patient will be informed by his cardiologist of the instructions and special precaution once the patient returns home.
Stent placement
What is stent placement?
A stent is a small metal mesh that presses against the walls of an artery and literally reopens the blocked or narrowed passageway. placed the stent will be explained as follows:
- A balloon catheter placed on a guide wire is used to insert the stent into the narrowed coronary artery. Once it placed, the tip of the balloon is inflated and the stent expands to the size of the artery and remains open.
- Then the balloon is deflated and removed while the stent remains permanently in place.
- Over several weeks, the artery around the stent heals.
Why does the doctor use a stent?
sometimes stent is inserted in an emergency to restore blood flow after a heart attack. Often, though, the cardiologist will diagnose the blockage with either a diagnostic catheter or an imaging study that will show the severity and location of the blockage. Often, patients with clogged arteries, or those with angiography or stenting, who have chest pain or candidates for stent placement.
Stents are usually placed during interventional procedures such as angioplasty to help keep the coronary artery open.
Some stents contain medications (filled with drugs) and are designed to reduce the risk of re-occlusion or restenosis. Your healthcare professional will determine if this type of stent is appropriate . If the specialist determines that your artery is blocked and you need heart surgery, he may recommend inserting a stent to allow blood to flow freely again. After the stent is inserted and the artery is opened, many patients noticed a changed in their condition immediately.
Cardiac catheterization risks
Cardiac catheterization is generally safe. But as with any procedure that involves entering your body, there are risks. The specialist doctor will be careful in term of reducing the chances of its occurrence.
Risks include:
- A hole that passes through a blood vessel (perforation)
- Air embolism (when air enters your blood vessels, this can be fatal)
- Allergic reaction to the dye
- Bleeding
- Blood clots
- A bruise
- Heart attack
- Infection
- Kidney damage from the dye
- Deep vein thrombosis
- Arrythmia
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