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Since the 1960s, it has become increasingly more frequent for a patient to undergo heart catheterization in the diagnosis of their potential or known heart disease. Today, hundreds of thousands of heart catheterizations are done yearly to define whether or not a patient's heart condition is related to congenital, muscle, valve, artery, or rhythm problems, or a combination of all of these.







. How long does it take?

In order to have the procedure done, a patient needs to be in a suitable hospital or outpatient facility for at least six or eight hours, and sometimes overnight. The catheterization (cath) itself generally lasts 15-20 minutes and is not associated with discomfort in most cases. Following the cath the patient is moved to the recovery area for 15-20 minutes. The patient then goes back to his/her room for 3-6 hours of bed rest. Then, ambulation (walking) occurs for 1 or 2 hours so that the insertion site can be evaluated for any bleeding. After this observation period, you will either be dismissed, or admitted, whichever your cardiologist suggests is appropriate.
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. What happens during a heart catheterization?

Preparation: To do the test, the right or left groin is shaved in preparation for the study. The patient is then brought to the catheterization laboratory and placed on a special x-ray table, which is fairly well padded and reasonably comfortable. A special soap is applied to sterilize the right and/or left groin area. The groin area is covered with a large sterile drape that extends from around the chin area down below the feet. A cutout in the drape has been made so that there is access to the femoral artery, which is just below the skin in the groin area.

Procedure: Lidocaine or a similar anesthetic is injected around the femoral artery through the skin. This stings or burns a little. Once the area has been anesthetized, a hollow needle is inserted through the skin into the femoral artery. A very slender and soft guide-wire is inserted through the needle and is advanced up toward the heart. You will not be aware of this movement, as there is no physical sensation or discomfort during this phase.

The needle is removed and the guide-wire remains in place in the artery. Next a catheter (thin plastic tube) is threaded over the guide wire and advanced up into the heart area. The guide wire is removed, leaving the catheter in place. An x-ray dye material is injected into the heart pumping chamber and rapid sequence x-ray pictures are taken of the dye as it is pumped from the heart out to the body. This determines whether or not the pumping chamber of the heart (left ventricle) has any weakness. It also evaluates the function of the various heart valves on the left side of the heart.

The first catheter is removed and a second catheter is inserted into the artery and advanced up into the heart. This second catheter, by its shape, is able to identify and enter one of the main arteries of the heart, the left main coronary artery. Dye is injected through the catheter into the left coronary artery system (revealing three of the four heart arteries). Rapid sequence x-ray pictures of the injection of dye through the heart artery system are taken in multiple angle views of the arteries so that all parts of the arteries can be clearly seen.

The second catheter is then removed and a third catheter is inserted. Third catheter is able to identify the arteries of the heart that supply the underside of the heart. Additional x-ray pictures are taken with this third catheter.

That catheter is then removed. If the patient has had prior bypass surgery, some additional views of the bypass arteries are obtained in a similar manner.

Post Procedure: The patient is then moved to a recovery area where the sheath is removed and a pressure device is placed on the involved groin area for 15-20 minutes. After 20 minutes, the pressure device is removed and a pressure dressing is applied. The patient goes back to his/her room for 3-6 hours of bed rest. Then, ambulation (walking) occurs for an hour or two so that insertion site can be evaluated for any signs of bleeding.

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. Is this safe?

Today, many hundreds of thousands of heart catheterizations are done yearly. The procedure itself is very safe and carries with it a very small risk of significant complications of probably 1 in 1,000 or less.

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. What is the recovery time?

What is the recovery time? You should not anticipate any complications relating to the test once you have gone home. You may notice a temporary increase in urination since the dye leaves your body through the kidneys. Some patients have some minimal soreness in the groin area for a couple of days. You may also notice some bruising in the groin area which is just some blood that went underneath the skin. It will gradually fade. If you should notice an increase in the bruising or should a hardened area appear, please let us know.

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. How should I prepare?

In general, you are not allowed to eat anything after midnight just prior to your cath. If it is scheduled for later in the day, you will be given different instructions on your food/fluid intake. You will be able to take your medications with sips of water unless instructed otherwise. You should also arrange to have someone drive you home following the procedure.

When our staff schedules your heart catheterization, you will be given specific instructions. The procedure will be explained again and/or questions answered so that you can sign an informed consent form.

Please do not hesitate to ask any questions you may have.

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