Cardiac Catheterization

The good news is that not all heart problems may require open-heart surgery. Qualified patients may benefit from cardiac catheterization, a minimally invasive technique for treating or diagnosing a range of heart problems. At Palm Beach Gardens Medical Center, we have state-of-the-art cardiac catheterization laboratories where our healthcare providers can better understand your heart condition.

With around 8,000 procedures performed in one of our four catheterization suites each year, our Cardiac Cath Lab at the Heart and Vascular Institute was designed to provide you with access to some of the finest health care services in Palm Beach Gardens, FL.

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What Is Cardiac Catheterization?

Cardiac catheterization is a way to examine how well the heart is functioning. It involves inserting a thin, flexible tube called a catheter from the arm or groin into the heart. This procedure can measure blood pressure and oxygen levels in the pulmonary arteries and heart chambers to check your heart’s condition.

Doctors use the results from cardiac catheterization to confirm that other cardiovascular tests are done beforehand, such as cardiac magnetic resonance imaging (MRI), echocardiography (ECG) or computer tomography (CT) scan. It is a reliable way to diagnose:

• Arrhythmia
• Cardiomyopathy
• Coronary heart disease
• Heart attack
• Heart valve diseases
• Pulmonary hypertension

Some of the procedures we perform in our Cardiac Cath Lab include:

• Atherectomy – involves removing the plaque blocking the artery by using tiny rotating blades at the end of the catheter to shave or pulverize the plaque. We have two atherectomy procedures:
• Directional atherectomy – involves using a device with a tiny cutting tip rotating very fast to cut away plaque. During this procedure, a small balloon widens the blood vessel so the procedure can be performed more efficiently and protect the vessel walls.
• Rotational atherectomy – this procedure may be performed for more difficult plaque blockages and prepare a heavily clogged artery for stent placement. In this procedure, a rotating device runs at an extremely high speed to pulverize the plaque, reducing it into tiny particles that can pass through the bloodstream with no adverse effects.
• Balloon angioplasty - to widen the blocked part of the artery so blood flow can improve. This procedure is also known as angioplasty or percutaneous coronary intervention (PCI).
• Balloon valvuloplasty – to widen the diseased heart valves.
• Carotid angiography and stenting – to open blocked arteries to restore blood flow to the brain.
• oronary angiography – to inspect the heart or blood vessels by injecting dye through the catheter.
• Left ventricular digital angiography – to look at the function of the valves and chambers on the heart’s left side.
• MitraClip implantation – a device to repair mitral regurgitation, a disorder of the heart’s mitral valve preventing it from closing correctly.
• Peripheral angiography and intervention – procedures for diagnosing, evaluating and treating peripheral artery disease, a condition wherein there is a blockage in the arteries that supply blood to the limbs, neck and abdomen.
• Right and left heart catheterization - measures the pressure in the left and right heart ventricles.
• Stent procedure - to hold a narrowed or blocked artery open by implanting a stent, a small metal tube.
• Structural heart procedures – procedures designed to treat atrial septal defect (ASD) and patent foramen ovale (PFO).
• Thrombectomy - to remove blood clots from inside a blood vessel.
• Transcatheter aortic valve replacement (TAVR) - replacing a diseased heart valve with an artificial valve implant.

How Serious Is Heart Catheterization?

Cardiac catheterization is generally a safe procedure with very minimal risks. It is not a major surgery but can be used to evaluate a patient for possible heart surgery and diagnose and treat various heart conditions. It is natural to feel discomfort or develop bruises in the catheter’s puncture site. Some people may develop allergic reactions from the contrast dye used in heart catheterization diagnosis.

Who Are the Candidates for Cardiac Catheterization?

Only your primary care physician and cardiologist can determine if you need heart catheterization. This procedure may be recommended if you experience chest pain, dizziness, fatigue, shortness of breath and other heart attack symptoms. If you have any of these conditions, your doctor may wait or not recommend a cardiac cath for you:

• Abnormal blood electrolyte levels
• Acute gastrointestinal bleeding
• Acute kidney failure
• Acute stroke
• High levels of digoxin in blood, a medicine to treat heart failure or arrhythmia
• Previous serious allergic reaction to the cardiac cath dye
• Severe anemia
• Severe kidney disease
• Thin blood
• Unexplained fever
• Untreated infection

Before you get recommended for cardiac catheterization, your doctor will thoroughly review your medical test results and health history. If you are allergic to radio-iodinated contrast material, your doctor may ask you to take corticosteroids and antihistamines. Patients with chronic kidney disease need adequate pre-hydration and planning to reduce the risk of worsening kidney function. Follow your doctor’s instructions in preparation for your cardiac catheterization.

How Is Cardiac Cath Performed?

A doctor with special training works with the support of radiologic technologists and registered nurses to perform the cardiac catheterization procedure safely. Various tools may be placed at the catheter’s tip, such as those used for:

• Measuring blood pressure in heart chambers
• Removing a tissue sample from the heart
• Taking blood samples from different parts of the heart
• Viewing the blood vessel interior

Most cardiac cath procedures can be performed with moderate or minimal local anesthetic sedation. It can last for about an hour. Local anesthesia means a small body area is numbed, and the patient remains conscious. A lower sedative dosage will keep you conscious and able to follow instructions during the procedure.

Some heart catheterization procedures require patients to undergo general anesthesia, so they remain unconscious. Here’s an overview of the step-by-step process in a cardiac cath lab:

1. A nurse will put an intravenous line into your arm’s vein where a sedative will pass through, helping you relax.
2. The nurse will clean and shave your body area where the doctor will puncture. A local anesthetic may be used to numb this area.
3. The doctor will pierce through your skin and into a large blood vessel where a sheath (a straw-sized tube) will be inserted.
4. The doctor will insert a catheter through the sheath and into your vessel.
5. A video monitor will show the location of the catheter as the doctor guides it through your major blood vessels and to the heart.
6. The doctor performs a cardiac catheterization procedure.
7. The doctor removes the sheath and catheter.
8. The nurse will put pressure on the puncture site to prevent bleeding.

What Happens After Cardiac Cath?

You will be transferred to a recovery room where you will have to lie flat on a bed and your vital signs checked. Keep your legs straight and immediately report if you experience chest pain, bleeding or swelling at the puncture site. You will receive written instructions before you leave the hospital.

Most cardiac cath patients can return to their routines the day after their procedure, depending on whether additional interventions were performed during their appointment. Ensure you follow all instructions and take your medications as prescribed. Attend follow-up appointments.

A bruised puncture site is normal. If it bleeds, lie flat and press it firmly for a few minutes, then check if the bleeding has stopped. Call your doctor if:

• The puncture site’s bruising worsens, or the bleeding does not stop even after pressing on it
• There is swelling or fluid draining from the puncture site
• Your leg with the puncture site tingles or becomes numb, or your foot turns blue or feels cold