Interventional cardiologists are the physician specialists who perform
diagnostic cardiac catheterizations and emergency angioplasty procedures
to treat emergency heart attack patients. FMH interventional cardiologists
have collectively performed thousands of these procedures, and
Dr. David Brill (PDF), Medical Director of FMH Interventional Cardiology Services - and
all of the FMH interventional cardiologists - are Fellowship trained.
Cardiac catheterization (also called cardiac cath or coronary angiogram)
is a procedure that allows your doctor to "see" how well your
heart is functioning. The test involves inserting a long, narrow tube,
called a catheter, into a blood vessel in your arm or leg, and guiding
it to your heart with the aid of a special X-ray machine. Contrast dye
is injected through the catheter so the physician can see X-ray-generated
video of your valves, coronary arteries and heart chambers.
Why Do I Need a Cardiac Catheterization?
Your doctor uses cardiac cath to:
- Evaluate or confirm the presence of heart disease (such as coronary artery
disease, heart valve disease, or disease of the aorta).
- Evaluate heart muscle function.
- Determine the need for further treatment (for example, angioplasty or bypass surgery)
How Should I Prepare for Cardiac Catheterization?
- Most people will need to have a routine chest X-ray , blood tests and an
electrocardiogram performed no less than 2 weeks before the procedure.
- You can wear whatever you like to the hospital. You will wear a hospital
gown during the procedure.
- Leave all valuables at home. If you normally wear dentures, glasses, or
a hearing assistance device, plan to wear them during the procedure.
- Your doctor or nurse will give you specific instructions about what you
can and cannot eat or drink before the procedure.
- Ask your doctor what medications should be taken on the day of your test.
You may be told to stop certain medications, such as Coumadin (warfarin,
a blood thinner).
- If you have diabetes, ask your doctor how to adjust your medications the
day of your test.
- Tell your doctor and/or nurses if you are allergic to anything, especially
iodine, shellfish, X-ray dye, latex or rubber products (such as rubber
gloves or balloons) or penicillin-type medications.
- You may or may not return home the day of your procedure. Bring items with
you (such as robe, slippers and toothbrush) to make your stay more comfortable.
When you are able to return home, arrange for someone to give you a ride
and stay with you overnight for the first night.
How Long Does the Procedure Last?
The cateterization procedure usually takes about 30 minutes, but the preparation
and recovery time add several hours. Plan on being at the hospital all
day for the procedure.
What Happens During the Procedure?
You will be given a hospital gown to wear. A nurse will start an intravenous
(IV) line in your arm so that medications and fluids can be administered
through your vein during the procedure.
The cardiac catheterization room is cool and dimly lit. You will lie on
a special table. If you look above, you will see a large camera and several
TV monitors. You can watch the pictures of your cardiac cath on the monitors.
The nurse will clean (and possibly shave) the site where the catheter will
be inserted (arm or groin). Sterile drapes are used to cover the site
and help prevent infection. It is important that you keep your arms and
hands down at your sides and not disturb the drapes.
Electrodes (small, flat, sticky patches) will be placed on your chest.
The electrodes are attached to an ECG, which charts your heart's electrical activity.
You will be given a mild sedative to help you relax, but you will be conscious
and may be awake during the entire procedure. The doctor will use a local
anesthetic to numb the catheter insertion site.
If the catheter is to be inserted at the groin (called the "femoral"
approach), a local anesthetic will be injected into a vein in your groin.
A small incision will be made over the blood vessel through which the
catheter and introducer sheath (a short, hollow tube through which the
catheter is placed) is will be inserted. A catheter will be inserted through
the sheath and threaded to the arteries of your heart. Although you may
feel pressure as the incision is made or when the catheter is inserted,
you should not feel pain - please tell your health care providers if you do.
When the catheter is in place, the lights will be dimmed and a small amount
of dye (or "contrast material") will be injected through the
catheters into your arteries and heart chambers. The contrast material
outlines the vessels, valves and chambers.
When the contrast material is injected into your heart, you may feel hot
or flushed for several seconds. This is normal and will go away in a few
seconds. Please tell the doctor or nurses if you feel itching or tightness
in the throat, nausea, chest discomfort, or any other symptoms.
The X-ray camera will be used to take photographs of the arteries and heart
chambers. You will be asked to hold your breath while the X-rays are taken.
When all the photos have been taken, the catheter will be removed and
the lights will be turned on.
After your procedure you will be taken to the Interventional Unit. You
will be asked to lie flat for several hours. Before leaving the hospital
you will be given instructions about medications, physical activity and
Follow up Care
FMH offers programs specifically designed for cardiac patients, use the
links below to learn more.