Diagnostic Cardiac Catheterization

To prepare for a cardiac cath, an intravenous (IV) line will be placed in a vein in your arm that will administer a sedative to keep you comfortable during the procedure. The skin where the cardiologist will insert the catheter will be cleaned and prepped (shaved if hair is on the region) and numbed with a local anesthesia. If you are having a left heart cath, a vein in your arm or groin will be used. As in the left heart cath, a catheter is inserted into a larger vein, normally your groin, but a vein in your neck or arm may also be used. Your cardiologist will make a tiny incision into the skin and insert the catheter. Using fluoroscopic guidance, the catheter is advanced into either the left or right heart chamber. Once at the site, the doctor can perform tests and look for any abnormalities in the valves, check pressures and measure blood flow. In some cases, your cardiologist may be able to make minor repairs to correct certain problems. The catheter is then removed and some stitches may be used to close the incision site. Pressure will be applied to the site to control bleeding.

Length of Stay

Most patients stay in the hospital overnight since you will have to lie flat for several hours. During this time, you will not be allowed out of bed. Your doctor will advise on when you can resume your normal activities. A driver will need to drive you home as you will not be allowed to drive.

Before a Left/Right Heart Catheterization

Do not eat or drink after midnight on the evening before the procedure. Take your regular medications, but only have a small amount of water to take pills. If you take blood thinners or have diabetes, talk with your doctor about any special instructions.  If you are allowed to return home, you will not be able to drive, so you will need to have a driver to take you home from the hospital. Your cardiologist will advise you of any special instructions and precautions once you are home.

Stent Placement

What is a stent?

A stent is a tiny metal tube that pushes on the walls of your artery and literally reopens a blocked or narrowed passage way. The following outlines how stents are typically placed:

• A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated and the stent expands to the size of the artery and holds it open.

The balloon is then deflated and removed while the stent stays in place permanently.

• Over a several-week period, your artery heals around the stent.

Why would a doctor use a stent? 

Sometimes stents are inserted emergently to restore blood flow immediately following a heart attack. More frequently, though, a cardiologist has diagnosed a blockage either by a diagnostic cath or an imaging study that shows the severity and location of the blockages. Often, patients who have a blocked artery or those with angioplasty or stenting and who suffer from chest pain or shortness of breath are candidates for stent placement. Stents are commonly placed during interventional procedures such as angioplasty to help keep the coronary artery open. Some stents contain medicine (drug-eluting) and are designed to reduce the risk of reblockage or restenosis. Your doctor will determine if this type of stent is appropriate for your type of blockage. If your physician determines that the blockage in your artery are clogged and you need a cardiac intervention, he or she may recommend inserting a stent to allow the blood to once again flow freely. After the stent is inserted and the artery is open, many patients notice benefits immediately.

How invasive is stent placement? What is the recovery time after placement? 

Stents are inserted using a minimally invasive catheter inserted either in your wrist (trans-radial approach) or your groin. Stent placement is a procedure that typically requires an overnight stay in the hospital, and it offers a fast recovery. If your doctor determines that you are a candidate for the trans-radial approach to stent insertion, it can reduce recovery time. It is worth noting that while the insertion of a stent may eliminate or delay the need for bypass surgery, getting a stent inserted is not a cure for heart disease. You will still need to modify your lifestyle and control your heart disease risk factors.