Cardiac Catheterization (Coronary Angiography, Coronary Arteriography, Coronary Angiogram)

Prior to Procedure

Your doctor will likely do:

• Blood and urine tests
• Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
• Chest x-ray
• Stress test

In the days leading up to your procedure:

• Arrange for a ride to and from the procedure
• The night before, do not eat or drink anything after midnight (except for liquids taken with medication)

Anesthesia

Local anesthesia is applied to the insertion site. A mild sedative may be given one hour before or through IV during procedure.

Description of the Procedure

During the procedure you will receive IV fluids and medications. An EKG will be monitoring your heart's activity.

You'll be awake, but sedated so that you'll be more relaxed and less anxious. Your doctor asks you to perform basic functions such as coughing, exhaling, and holding your breath. If you feel any chest pain, dizziness, nausea, tingling, or other discomfort, tell your doctor.

The catheter is threaded over a guide wire, inserted into an artery in your arm or leg, and fed up and into the heart. Your doctor watches the threading and placement of the catheter with a fluoroscope, which is a type of x-ray that takes pictures of moving organs.

The catheter measures blood pressure within the heart's different chambers and to take blood samples. Dye is injected into the coronary arteries. Multiple x-ray images are taken to look for any disease in the coronary arteries. An aortogram, which gives a clear image of the aorta, may also be performed at this time. The catheter is then removed.

After Procedure:

• EKG and blood studies are done.
• If the catheter was inserted in your groin, you will be required to lie flat on your back for at least six hours. During this time a catheter may be inserted in your bladder to assist with urination. A sandbag may be placed over your groin to exert pressure on the artery used for catheterization and prevent bleeding.
• If the catheter was inserted in your arm, you will be required to keep your arm perfectly straight using a stiff arm board, but you will be allowed out of bed within 2 hours.
• You will be encouraged to drink lots of fluids to flush the x-ray dye from your system.

How Long Will It Take?

The actual procedure takes 1-2 hours. The preprocedure tests take 1-2 hours.

Will It Hurt?

Although the procedure is generally not painful, it can cause some discomfort, including:

• Burning sensation (when skin at catheter insertion site is anesthetized)
• Pressure when catheter is inserted or replaced with other catheters
• A flushing feeling or nausea when the dye is injected
• Headache
• Heart palpitations

Pain medication will be given when necessary.

Possible Complications

Complications are rare, but can include:

• Blood clots, possibly resulting in heart attack, stroke, kidney damage, lung injury, or damage to arms or legs
• Allergic reaction to x-ray dye
• Arrhythmias (abnormal heart beats)
• Bleeding at point of catheter insertion
• Perforation or other damage to arteries
• Infection
• Heart attack
• Pericardial tamponade—Accumulation of fluid in the heart sac that can interfere with the heart pumping

Average Hospital Stay

0-1 days

Postoperative Care

• If you are diagnosed with heart valve disease, you may be given antibiotics. They will help you avoid valve infection or endocarditis. Take all of the antibiotics prescribed, even if you do not feel ill.
• Do not lift heavy objects or engage in strenuous exercise or sexual activity for at least 24 hours.
• Change the dressing around the incision area as instructed.
• Take medications as instructed.
• Use acetaminophen for pain relief, not aspirin or ibuprofen.
• Use an electric heating pad or warm compress to relieve pain at the insertion site.
• Bathe and shower as usual. Keep the wound dry and covered with a bandage for the first 2-3 days after surgery.