Cardiac catheterization : what to expect

Cardiac catheterization is one of the invasive procedures performed by Dr. Rasi.  Interventional cardiology, the subspecialty of cardiology in which Dr. Rasi is particularly trained, involves additional training in performing this procedure. This procedure is also known commonly by people as stenting, angioplasty etc., but each of these terms mean very specific things which we will discuss below.  For further information, please see the separate article here about cardiac catheterization.

 In this particular segment, we will be looking primarily at the patient experience with cardiac catheterization, and how to prepare for it. The procedure of cardiac catheterization is not surgery. The only needles involved, and knows cutting suturing or open heart surgery is involved with this. In the vast majority of cases, general anesthesia is not involved either  in the procedures performed under conscious sedation.

 Cardiac catheterization is done in the hospital. Prior to arriving at the hospital, someone will call you to explain what to expect. This typically involves the following steps, so please read this information carefully.  This information is not meant to be a substitute for personalized instructions that may be given to you by the hospital. This is simply a general set of rules that apply when Dr. Rasi is performing cardiac catheterization.

 Cath Lab preprocedure checklist

1. If you have not done so, please have your labs drawn two to three days  prior to undergoing the procedure. This will enable Dr. Rasi to ensure that your kidney function, electrolytes, and blood counts are all within normal limits before the procedure.
2.  If you are taking any blood thinners such as warfarin (coumadin),  dabigatran (pradaxa), rivaroxaban (xarelto) or apixaban (eliquis),  please notify Dr. Rasi, or one of his medical assistants. Depending on the medication you are taking, these medications will need to be stopped approximately 3 days before the procedure,  to minimize the risk of bleeding.  This restriction does not apply to you, if you are taking aspirin and/or clopidogrel (plavix) and/or ticagrelor (brilinta).
3.  If you have a prior documented allergy to contrast dye, please let Dr. Rasi or one of his medical assistants know.  you will need to go through a series of pre-medications in order to undergo this procedure safely.
4.  If you have had a prior allergic reaction  to sedation medications such a Fentanyl or midazolam (versed),  please also let us know since these medications would be administered to you during the procedure.
5.  If you have had any prior surgeries in your blood vessels of the leg, or in your aorta (vascular stents, lower extremity bypass surgery, or aortic aneurysm or aortic surgery),  please let the staff know.
6.  If you have any restrictions that prevent us from transfusing you with blood due to religious reasons or otherwise,  please let us know.
7.  You are expected to come to the hospital in a fasting state, after not having eaten anything for approximately 8-12 hours.

what to expect during the procedure

 Before the procedure begins,  the staff at the hospital will place  an IV in your arm,  and start you on some IV fluids. They will then transport you to the cardiac catheterization lab where you will be asked to rest on your back on the table. Surrounding the table, you will find a large machine with a moving arm which is the fluoroscopy unit. Think of this machine as a video x-ray machine that will show Dr. Rasi the blood vessels inside your heart so that he can both interrogate the patency of these vessels, and perform a procedure to correct it if there is any blockage.

First of all, Dr. Rasi will give you some medications through the IV to get you sedated. These medications will help you relax, and might even make you sleepy. The intent is to make you comfortable, and not to completely knock you out.  Thereafter, using an ultrasound machine, he will apply  lidocaine, a local anesthetic similar to what your dentist uses to numb up the skin near your leg and groin.  Once the femoral artery ( the major artery that runs down your leg)  has been located by ultrasound, a needle will be carefully passed into that artery, and using a very small wire, this needle would be exchanged for a tapered tube called a sheath.  The sheath is a plastic tube with a one-way valve that enables the doctor to place catheters ( small flexible plastic tubes)  into your femoral artery, without causing blood to travel in the opposite direction and come out of the body.  Once the sheath has been placed, you should have no further discomfort whatsoever.  Dr. Rasi will then begin the cardiac catheterization procedure, where small plastic tubes are advanced through the sheath and used to engage the arteries that directly supply blood to the heart called the coronary arteries.  To ensure that these arteries are open,  a special dye (contrast dye)  will be injected from the outside into the artery.  This contrast has the special property that it is visible as a black opaque substance on the x-ray camera, and therefore the flow of the contrast into the artery can be easily seen on the x-ray image.  This will tell your doctor whether there is a blockage that needs fixing or not.

 Typically this is all that cardiac catheterization involves.  Once the pictures have been taken, the catheters all come out of the body, and then the sheet is removed.  After the sheath is removed, Dr. Rasi may place a special suture or a small plug to close off the hole in the artery.  Sometimes, if the location of the  hole in the artery is not favorable, the staff in the Cath Lab will simply remove the sheath and whole pressure until the blood completely clots.

 You will then lay flat for about 2 to 3 hours, and then progressively begin ambulating in the recovery area, and if all goes well and no intervention is performed, you can go home the same day.

What if something needs to be fixed?

 If something needs to be fixed after the cardiac catheterization is complete,  Dr. Rasi will notify you on whether something needs to be fixed, and whether it can be done safely.  If the procedure can be completed safely, he will more than likely place a stent or perform a balloon angioplasty to correct the lesion. If the lesion is more complex, he may then  decide to transfer you to another hospital where higher level of care including on-site cardiac surgeon might be available. Typical locations for this include the Texas Medical Center where very complicated procedures can be performed in relative safety. 

 If Dr. Rasi does decide to perform an angioplasty or place a stent, this procedure will possibly add another 45 minutes to an hour to the overall procedure time. In addition, you will receive blood thinning medication (Heparin)  to help with this process.  If a balloon angioplasty or stent placement is performed, the recovery time is longer, and you will be asked to stay overnight at the very least in the hospital. This is for the sole purposes of careful monitoring.

 For more information regarding this procedure, including some of the ways Dr. Rasi makes decisions about what to do, please see the separate section on cardiac catheterization.