Cardiac Cath, Heart Cath, Angiogram Explanation

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Cardiac Cath 5

Cardiac Cath Equipment

The x-ray camera sits above the patient's chest, while the x-ray beam is delivered from underneath the table. A movie camera is attached to the tube to record images on a 35mm film. Images are also noted "live" on the monitor and are also recorded on a computer and/or a video tape. The x-ray tube is rotated around the patient (side-to-side, and towards and away from the head). By taking pictures from different angles, the cardiologist can inspect blockages from several points of view. This increases the accuracy of assessing the clinical importance and severity of a blockage. It also helps determine the patient's candidacy for angioplasty, stenting, surgery, medical treatment, etc. Cardiac cath is usually carried out in a hospital setting but may also be performed in some clinics or in a mobile laboratory. The patient lies on a table with an attached handle. This handle allows the cardiologist to move the table and also to rotate the x-ray tube. A plastic covered shield is present between the cardiologist and the patient to minimize radiation. The top portion of the shield is transparent so that the cardiologist can see the patient through it. The cath lab is kept cool so that heat doesn’t damage the sensitive electronic and x-ray equipment.

What is Experienced in the Cath Lab

The patient may have a feeling similar to a bee sting when the groin is numbed with local anesthesia. A mild sticking sensation is also felt when the needle is inserted. This is very tolerable. The cardiologist should be notified if there is a lot of discomfort or pain. Additional local anesthesia or more sedatives will usually alleviate the discomfort.

The patient will lie on a relatively firm table and the room will be cool. During the procedure, the patient may be asked to hold his or her breath or cough. The former improves the quality of the x-ray movies when the diaphragm (muscle partition between the chest and abdomen) partially obscures a certain portion of the coronary artery, while a deep breath improves the picture quality.

The contrast material may occasionally cause the heart to slow down. Coughing helps clear the contrast from the coronary artery. Coughing may also help correct certain types of abnormal heart rhythm.

The patient should be able to view most of the study on the monitor. The cardiologist may explain the findings while the procedure is in progress.

It is important to remember that the blue or green sheets covering the patient are sterile. Hands should be kept by the side and not placed on top of the sheet. The patient should not reach for the groin because it will contaminate the catheter. If a pillow needs to be rearranged or a cheek scratched, the staff will be happy to help.

Fleeting chest discomfort may also be felt during some coronary artery injections. A transient "hot flash" is usually felt when pictures of the Left Ventricle (LV) are taken. This sensation generally clears up in under 30 seconds.

Angiogram of the Left Ventricle

The coronary arteries are relatively small and can be easily filled by injecting around 5 to 8 cc or ml of contrast material or dye, with a hand-held syringe. X-ray movies are usually taken when the arteries are filled with contrast. The left ventricle (LV, or the major pumping chamber of the heart), on the other hand, is larger and requires more contrast to fill. To allow proper visualization of the LV, nearly 30cc or more of contrast is injected over 2 to 3 seconds with the use of a power injector.

The cardiac cath Tech helps load the power injector with contrast material. When instructed to do so by the cardiologist, a button is pushed and the contrast is injected into the left ventricle through the catheter, which has its tip positioned in that chamber of the heart.

The x-ray pictures are taken by a movie camera. There is a hum, motor, or loud sewing machine sound when pictures are being recorded.

Removal of the Sheath from the Artery

After the procedure is compete (usually 10 to 15 minutes), the patient is taken to the recovery room, where the sheath is removed from the groin. Firm pressure is applied for approximately 10-15 minutes (time may vary) to stop/prevent bleeding from the small needle hole. In many cases, hand pressure may be substituted with (or followed by) the use of a compression device.

A dressing is then placed on the groin and a sand bag or ice bag may be used on top of the dressing. The patient will have to lie flat for three to four hours. It is important to not sit-up, bend the leg or strain during the time of bed rest. However, the head of the bed may be raised slightly and the feet can be moved to a small degree. Removal of the sheath is delayed if heparin or other "blood thinners" are used during the procedure. The sheath is pulled when a blood test indicates that it is safe to do so.

If there is a warm or wet sensation around the catheter insertion site or if there is blood on the dressing, pressure needs to be applied at the site and the nurse called immediately. If there is bleeding, try not to panic. Additional pressure will almost always take care of the problem.

If there is a need to sneeze or cough, light finger pressure must be applied right above the catheter insertion point. A nurse will provide instructions. This will reduce the risk of bleeding.

If the arm is used during the procedure, pressure will be applied over the insertion point.

Some cardiac centers use closure devices in the cath lab. In such cases, the hole is sealed when the patient leaves the lab and application of pressure is not usually needed. This increases the cost of the procedure and carries a very small, but acceptable, complication rate.

When the anesthesia wears off, the patient may experience soreness. The nurse can provide pain medication to take care of this problem. The blood pressure and pulse rate are monitored during the recovery phase.

The nurse should be notified if there are any problems with dizziness, lightheadedness or chest discomfort. Nausea may occasionally occur and is usually resolved with medications. The contrast material acts as a diuretic or "water pill." Also, a lot of intravenous fluids are used. This combination will cause the patient to produce large amounts of urine. Some patients may not be able to void in the flat or supine position. If the bladder gets distended and causes discomfort, a tube may be temporarily placed in the bladder.

After bed rest is complete, the patient is assisted with sitting and standing. After further observation, if there are no problems or bleeding, the patient is discharged.