Cardiac Catheterization
What is a cardiac catheterization (also termed cardiac angiogram, cardiac
cath)?
A cardiac catheterization is an invasive diagnostic procedure
during which dye or contrast material is injected into the
heart arteries to detect blockages or narrowings in the arteries.
It is the most specific and accurate diagnostic test for information
about the coronary arteries. It also assesses the function
of the heart valves and heart muscle.
Sometimes cardiac catheterization and angioplasty are performed at the same time. If your Inova cardiologist sees blockages that can be treated with angioplasty, he/she may treat them. This avoids the need to have a second invasive procedure.
How is a cardiac catheterization performed?
A thin tube, called a catheter, is inserted into the leg
and sometimes the arm arteries and advanced to the heart.
A dye is injected through the catheter, and X-rays are taken
to identify the coronary arteries. The pictures are examined
to determine if blockages are present and where they are located.
Part of the procedure also measures pressures in the heart
and assesses how well the heart muscle and heart valves are
functioning. An experienced team of cardiologists, nurses,
and technologists perform this procedure in state-of-the-art
laboratories.
What are the risks?
The risks of cardiac catheterization are low. The most common
risks are usually minor and include bleeding from the catheter
insertion site in three percent of patients and contrast allergies
in one percent of patients. Other complications are more serious,
but fortunately rare. These include severe bleeding requiring
minor surgery or a transfusion, heart attacks, heart failure
where the lungs fill with fluid, stroke, heart rhythm problems,
kidney damage, embolus (a blood clot that detaches from one
area and occludes a vessel in another area), emergency surgery
including a coronary bypass operation, and death. These complications
occur in about one in a thousand patients. Your Inova cardiologist
can tell you more about your specific risks. The benefit of
knowing the exact condition of your heart outweighs the few
risks. Click on outcomes to read more about the results of
this procedure at the Inova Heart Center.
What are the benefits?
Cardiac catheterization is the most accurate test to determine
if you have coronary artery disease or blockages in your arteries.
If blockages are present, your Inova cardiologist will assess
their severity and your prognosis and then use this information
to plan further management with medications, angioplasty,
or surgery. If no blockages or heart disease are found, your
doctor may conclude that your heart is not the cause of your
symptoms and can evaluate other causes for your symptoms.
For more specific information regarding before, during and after the procedure, click here.
Now that I've had a catheterization, what are my treatment options?
Your Inova cardiologist will review the results of your
diagnostic tests to determine the correct diagnosis and the
best treatment. The cardiac catheterization often provides
the most information about your heart, including the presence
of blockages in the heart arteries. This includes very specific
information about the number, severity, location, and composition
of any blockages and the function of the heart valves and
heart muscle. The three major treatment options for blockages
in the heart arteries are 1) medical therapy, 2) angioplasty,
or other advanced interventional procedures, or 3) bypass
surgery. The choice of the best therapy is often
complex and will require a discussion between you and your
physician. Each option has advantages and disadvantages. In
general, patients and physicians prefer less invasive approaches.
However, more invasive therapies are clearly best for some
patients.
Medical therapy
Medical therapy is useful in all patients. All patients
need education about or treatment of the risk factors for
heart disease. You may need to make lifestyle changes, such
as following a low cholesterol diet and exercising regularly.
The use of tobacco in any form, especially smoking cigarettes,
greatly increases the risk for developing or worsening heart
disease (as well as other diseases such as cancer, emphysema
and stroke). Your doctor will closely monitor your diabetes,
high blood pressure, and high cholesterol if these are present.
Aspirin or similar drugs are used to thin the blood, because
blood clots can form in a narrowed artery. Aspirin has been
shown to reduce the risk of heart attack and death. Other
medications that are used lower blood pressure and heart rate.
These medications do not remove the blockages in the heart
arteries, but reduce symptoms by making less work for your
heart. Some of these medications have been shown to reduce
the risk of a heart attack. Cholesterol-lowering medications
may be used if your cholesterol is high. This prevents future
blockages and lowers your risk of a heart attack and stroke.
Medical therapy has the advantage of being non-invasive. It
is often the therapy that is needed in patients with mild
to moderate blockages or with blockages in small arteries,
or in patients with limited activity.
Angioplasty
Angioplasty or other similar procedures such as stent, atherectomy,
or laser are used in about one-fourth of patients undergoing
cardiac catheterization. These procedures involve advancing
a small catheter into the heart artery to open the blockage.
This improves blood flow to the heart and relieves symptoms.
These procedures are often used to treat blockages in one
or two arteries and occasionally blockages in all three arteries.
The procedure has a high initial success, but the blockage
can return in about one-third of patients. For patients with
a blockage in one artery, angioplasty usually provides better
symptom relief and improved ability to tolerate activity and
exercise than medications alone. However, since angioplasty
is an invasive procedure, it has slightly higher risks. For
some patients with blockages in two or three arteries, angioplasty
can provide similar outcome results such as survival or having
a heart attack, when compared to bypass surgery outcomes.
Angioplasty has several advantages over bypass surgery: it
is less invasive, has a shorter recovery time, and has lower
initial costs. However, angioplasty patients more frequently
need a repeat procedure because the blockage returns.
The choice of angioplasty or other procedures such as stent, atherectomy, or laser is based on specific features of the blockage such as length, severity, amount of calcium deposit, and locations in a major or smaller branch artery. Angioplasty is the most common and simplest procedure to perform. Stents are slightly more difficult, but are commonly performed. Stents may lower the incidence of recurrence of the blockage. Atherectomy and laser are more difficult to perform and are used primarily for blockages that have calcium deposits, are long, or are located at branches in locations where stents are difficult to place, or where blockages have occurred within a stent.
Bypass surgery
Bypass surgery is the treatment of choice in about one-fourth
of patients who undergo diagnostic cardiac catheterization.
This surgery takes veins from your legs and arteries from
within your chest to redirect the blood flow to your heart
around the blockages. It is a major operation, but it is very
effective in relieving symptoms and improving quality of life.
It is performed routinely and with low risk at Inova Heart
Center. For some patients, surgery is the best treatment because
it improves survival compared to other therapies. It is the
best treatment for patients with 1) a severe blockage in the
left main coronary artery, which is the heart's major artery,
2) for patients with several blockages and moderate damage
to their heart muscle, and 3) for patients with several blockages
and diabetes. Bypass surgery is a reasonable alternative for
patients with several blockages who cannot be treated with
angioplasty or similar procedure.
