Cardiac catheterization is a procedure that aims to detect and overcome various heart diseases with using a catheter, which is a device resembling a long thin tube that is inserted into a blood vessel, then directed toward the heart.
Cardiac catheterization is performed by a cardiologist. One of the most common types of cardiac catheterization is the examination of blood flow in the coronary arteries, also known as coronary angiography.
Apart from being an examination procedure, cardiac catheterization can also be performed to treat coronary and heart disorders. This procedure can also be combined with several other examinations, such as X-rays, dye (contrast), and ultrasound.
Indications for Cardiac Catheterization
Cardiac catheterization can be performed for the purposes of diagnosis and treatment of heart disease. Examples for diagnostic purposes are:
- Check for narrowing or blockage of coronary arteries (coronary heart disease) that causes chest pain
- Taking a sample of heart muscle tissue (biopsy) to look for cardiomyopathy or myocarditis
- Checking for problems with heart valves
- Checking for decreased ability of the heart chambers to pump blood, in conditions of heart failure
- Checking the pressure and oxygen levels in the heart, which is often problematic in conditions of pulmonary hypertension
- Checking for congenital heart disease in babies
While for treatment, cardiac catheterization is used to:
- Perform angioplasty, which is the widening of blocked blood vessels using a balloon, with or without stent (heart ring)
- Repairing abnormally thickened heart muscle in sufferers hypertrophic obstructive cardiomyopathy
- Repair heart valves or replace them with artificial valves
- Closing the hole in the heart due to congenital heart defects
- Treat arrhythmias with ablation
Cardiac Catheterization Warning
If the patient suffers from any of the following conditions, the patient may not be allowed or need special consideration to undergo cardiac catheterization:
- Acute kidney failure
- Blood clotting disorders
- stroke
- Allergy to contrast agents
- Active bleeding in the digestive tract
- Arrhythmias in the chambers of the heart
- Uncontrolled hypertension
- Severe anemia
- Electrolyte disturbance
- Congestive heart failure
- Untreated fever or infection
Before planning cardiac catheterization, the doctor will perform a series of examinations to ensure that the patient is fit for the procedure. If any of the above conditions are found, the doctor may prioritize treating them first.
Patients who are pregnant, planning a pregnancy, or breastfeeding should inform their doctor of their condition before performing cardiac catheterization. This is because radiation exposure to cardiac catheterization is at risk of causing miscarriage.
Patients also need to tell their doctor if they are taking any medications, including herbal products and supplements. If possible, the patient should bring the drug packaging to show the doctor, so that the information is clearer and more detailed.
Cardiac Catheterization Preparation
Patients undergoing cardiac catheterization will be asked to fast for 6–8 hours prior to the catheterization procedure. The goal is to reduce the risk of side effects from the anesthetic. The hair around the blood vessels where the catheter will be inserted will also be shaved
After cardiac catheterization, patients generally need to be hospitalized. Therefore, the patient must prepare for the need to stay at the hospital, as well as invite family or relatives who can pick up and accompany you while in the hospital.
Before cardiac catheterization is performed, the patient may also undergo several supporting examinations. Examinations that are usually done are blood tests, examination of the heart record (ECG), or chest X-ray.
Cardiac Catheterization Procedure
Cardiac catheterization procedures are performed in a special room equipped with scanning devices. Before starting, the patient will be asked to remove all jewelry that might interfere with the procedure, such as necklaces.
Patients also need to change into hospital clothes that have been provided. After changing clothes, the patient will be asked to lie down on a special table where the procedure will be performed.
The patient is expected to remain calm and relaxed. However, if needed, the doctor can give a sedative to make the patient feel relaxed during the procedure.
The patient will be placed in an IV tube to deliver drugs during the cardiac catheterization procedure. The patient will also have electrodes attached to the chest so that the doctor's heart condition can be monitored.
The catheter insertion site can be in the neck, arm, or leg. Before the catheter is inserted, the section will be given an anesthetic to numb it.
Anesthesia given is usually a local anesthetic, so the patient will remain conscious throughout the procedure. However, if needed, the patient can be given general anesthesia, especially for patients who will undergo repair or replacement of heart valves.
To insert the catheter, the cardiologist will make a small incision in the skin as an entry point. Through the incision, the catheter is inserted into the artery with a special plastic wrapped first.
After that, the catheter will be pushed and directed towards the heart. This process is not painful, but may make the patient feel uncomfortable or tense.
The next cardiac catheterization procedure can be different, according to the patient's needs. The following is an explanation of some of the actions in cardiac catheterization:
1. Ancoronary giography
After the catheter reaches the heart, the doctor will perform a scan with X-rays to see whether there is a blockage or narrowing of the coronary arteries. To make the resulting image clearer, the doctor can inject a dye (contrast).
2. Heart biopsy
This action is done by taking a sample of heart tissue to be observed using a microscope. Catheters used for heart biopsies are equipped with special clamps to remove heart tissue.
This catheter is usually inserted through a vein near the neck or in the groin area. The patient will not feel anything when the heart tissue sample is taken.
3. Angioplasty coroner
The goal of this procedure is to widen the narrowed or blocked coronary vessels. The doctor will insert a catheter along with a special balloon that is still deflated into the narrowed or blocked coronary vessel.
Once the catheter is in place, the doctor will inflate the balloon, allowing the blood vessels to dilate and blood flow to return to normal. To keep the dilated vessels from narrowing or becoming blocked again, the doctor may place a heart ring.
4. Balloon valvuloplasty
The goal of this procedure is to repair a narrowed heart valve using a balloon. The procedure is similar to coronary angioplasty, but here the target is the heart valves.
In the process, the catheter will be attached to a special balloon, then inserted through the blood vessels to the heart valves. Arriving at the heart valve, the balloon will be inflated, so the heart valve will widen again.
If needed, the narrowed or leaking heart valve will be fitted with an artificial heart valve through a heart valve replacement procedure.
5. Repair of heart defects default
The purpose of this procedure is to correct abnormalities caused by congenital heart disease, such as holes in the septum between the chambers of the heart.patentforamen ovale). This procedure is different from other cardiac catheterization, because it will use 2 catheters that are inserted through the arteries and veins.
A special device will be attached to the catheter to correct heart defects. If the abnormality is a leaky heart valve, the doctor can install a special plug to stop the leak.
6. Ablation of heart tissue
The purpose of this procedure is to treat arrhythmias caused by heart tissue abnormalities. Through the catheter that is inserted, the doctor will destroy abnormal tissue that causes irregular heart rhythms. This procedure usually requires more than one catheter.
7. Thrombectomy
This procedure is done to destroy blood clots that have the potential to block blood vessels or move to other organs, for example to the brain and cause a stroke.
In a thrombectomy, a catheter is inserted into a vein until it reaches the site of the blood clot. Arriving at the location, the doctor will destroy the blood clot.
During the catheterization procedure, the doctor may ask the patient to hold his breath, take a deep breath, cough slightly, or shift the position of the hand to make the procedure easier. The entire cardiac catheterization process generally takes less than 1 hour.
After the procedure is complete, the catheter will be removed from the vein. The incision where the catheter is inserted will be closed with sutures and a thick bandage to prevent bleeding.
After Cardiac Catheterization
After cardiac catheterization, patients need to be hospitalized to help with recovery. The length of hospital stay depends on the type of cardiac catheterization procedure being performed and the patient's overall condition.
Early after cardiac catheterization is performed, the patient's movement needs to be limited, especially at the site where the catheter is inserted. Generally, new patients are allowed to move more freely after 6 hours.
To help the process of removing the contrast substance from the body, patients are advised to drink more water. Patients are allowed to go home after making sure they can walk on their own without help from others.
After discharge, the patient is still required to rest and not undergo strenuous activities for 2-5 days. This is done to prevent bleeding at the catheter insertion site.
If the patient is undergoing cardiac catheterization for medical procedures, such as heart tissue ablation or angioplasty, the healing time may take longer. If the patient undergoes a heart tissue biopsy or angiography, the doctor will explain the results a few days after the examination is complete.
Cardiac Catheterization Risk
Cardiac catheterization rarely causes complications. However, the risk of complications is greater in patients who are elderly, have diabetes, or have kidney disease. The following are some of the complications that can occur as a result of cardiac catheterization:
- Heart tissue damage
- Allergic reaction to the contrast agent or drugs used during the catheterization procedure
- Formation of blood clots which can lead to heart attacks and strokes
- Arrhythmia
- Kidney damage due to the contrast material used
- Low blood pressure
- Damage to the arteries where the catheter is inserted, or in the area where the catheter is passed
- Bruising, bleeding, or infection at the catheter insertion site
- Low body temperature during catheterization, especially in children