Cardiac Catheterisation and Balloon Coronary Angioplasty

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1 Cardiac Catheterisation and Balloon Coronary Angioplasty Exceptional healthcare, personally delivered

2 Cardiac Catheterisation This process is known as Angiography or Angiogram. It is a test performed under a local anaesthetic, which means you will not be put to sleep. This is a test which examines the blood flow through the coronary arteries, assesses the function of the heart valves and measures how well the heart muscle pumps. This will help the doctor make a decision about the best form of treatment for you. Preparation for cardiac catheterisation Is it possible you are pregnant? If so, please contact us in advance. Are you allergic to Iodine? If so, please contact us in advance. Approximately one hour before the procedure you will be asked to remove all your clothes and put on a gown. Nil by mouth four hours pre procedure. You can eat or drink once the procedure is finished. The procedure The procedure usually takes minutes. You will lie on a special X-ray table. The doctor will inject a local anaesthetic into your skin and insert a small tube (sheath) through the skin into the artery in your groin or wrist. This will be decided by the doctor on the day. You will be awake during your catheterisation and you will be asked by the doctor to hold your breath for short periods and occasionally to cough. Pressure measurements are taken from various chambers of the heart and blood vessels. The doctor injects liquid contrast through the catheter which allows us to look at your coronary arteries the arteries which supply blood to the heart muscle. 2

3 Will it hurt? You will have a small puncture site where the catheter is inserted into your artery and/or vein in either your groin or wrist. This small area will be anaesthetised (numbed). Everyone feels the sharp needle and a mild stinging sensation from the local anaesthetic, but there is little or no discomfort or pain during the procedure. Sometimes when the tube is in the pumping chamber of your heart you may feel a missed beat or a fluttering sensation. You may be asked to place your arms above your head for the majority of the procedure and they may ache, but this is necessary for us to take pictures of your heart. If you have problems raising your arms above your head please let us know. You may have a very brief warm feeling when the dye is injected and you may feel a sensation of passing water and/or a feeling of nausea which will pass fairly quickly. After the procedure If the artery has been used the doctor or nurse will apply firm pressure to that area for approximately 10 minutes to stop the bleeding once the catheter has been removed. It is important to keep your head flat on the pillow and not to bend that leg for 2 hours after the procedure. This is to make sure that the wound in your groin heals without disturbing the small clot that will have formed there. If your groin starts to bleed, do not panic, call for help. If you need to cough or sneeze, please apply pressure to your groin. If you had a Seal used in the groin artery, you can sit up 45 degrees immediately and can mobilise 2 hours following the procedure. If there is no Seal insitu, you need to lie flat for 1 hour and can mobilise 3 hours following the procedure. In both cases, this is providing you have no bleeding at the puncture site. A nurse will advise you. 3

4 Sometimes the radial artery in the wrist is used. If this is used you can mobilise very soon afterwards. Upon return to the recovery area you can have something to eat and drink. It is important to drink fluids to flush the contrast through your system. If you want to go to the toilet the nurse will bring you a urinal or a bedpan. After the procedure the doctor will see you to discuss the preliminary results and possible treatment with you. This treatment could consist of modified drug therapy, balloon coronary angioplasty, or surgery for coronary artery bypass surgery. This advice will be confirmed later on, either by letter or in the outpatients clinic. Getting back to normal Following the procedure please do not do any strenuous exercise or heavy lifting for 2 days. Do not drive for 48 hours. Avoid straining when opening your bowels. Your leg or wrist will be sore. You may need to take some painkillers for a short time. Any problems? Problems after cardiac catheterisation are rare. Sometimes your leg is bruised but this fades over 3 to 4 weeks. If the puncture site becomes very painful seek medical attention. Occasionally patients feel a hard lump in the groin, which is a hard bruise - do not worry. If your groin area becomes painful or it suddenly starts to bleed, apply direct pressure over the puncture site. 4

5 Checklist for Day Case patients n Have nothing to eat or drink after 6am if your procedure is in the morning. n Have nothing to eat or drink after 10am if your procedure is in the afternoon. n If you take diuretics (water tablets), do not take them on the morning of your procedure. If you are taking Metformin (Glucophage), it should be stopped 48 hours prior and not continued until 48 hours after to your procedure. Some people on Warfarin will be told to stop it 4 days prior to the procedure. All your other normal medication can be taken on the morning of your procedure with a cup of water. n Bring all your medication in with you on the day of the procedure. n Bring a newspaper or a book with you so that you will have something to do when the procedure is over. n Bring slippers and a dressing gown, but as few other possessions as possible. n Arrange for someone to come with you to the hospital. Staff will ring them with the time to collect you. In most cases, relatives will be unable to stay with you. n Arrange for someone to escort you home after the procedure and to stay with you overnight if you live on your own. If this is not possible, you must let us know. n Your wedding ring can be taped to your finger but please leave other valuables at home. Please remove all nail varnish. n If you need an interpreter, please let us know as soon as possible. 5

6 Risks Cardiac catheterisation is a safe procedure and has been performed in Bristol for many years. Complications are rare but, like any procedure, there are risks associated with it. These risks are higher in patients who are unwell or have certain other medical conditions. Any risk has to be balanced against the benefit of obtaining the information that the investigation provides. The table below shows the overall rates of major complications associated with cardiac catheterisation in the UK. These figures are derived from data collected in 1995 from 27 UK centres who performed 40,000 procedures(1) and are still relevant to current practice. It is generally accepted both nationally and locally that the benefits from doing this test greatly outweigh these small risks. If you have any questions or worries do not hesitate to speak to your nurse, who can arrange for you to discuss them with your Doctor. Please ask any questions you may have concerning the procedure before you sign the hospital consent form. Diagnostic Cardiac Catheterisation Overall risk of any complication Overall mortality (risk of death) Emergency cardiac surgery Stroke Heart attack (myocardial infarction) 8 per 1, per 10,000 8 per 10,000 6 per 10, per 10,000 6

7 Information for patients undergoing Balloon Coronary Angioplasty (PCI) Balloon Coronary Angioplasty is a procedure that is very similar to cardiac catheterisation. Occasionally it is carried out as an extension of the cardiac catheterisation procedure. The main difference is that cardiac catheterisation only collects information whereas PCI performs a treatment. PCI is performed in the same X-ray room and under the same conditions as cardiac catheterisation. However, once the cardiac catheter (tube) is placed at the entrance of one of your heart arteries. A fine, soft wire is passed up inside the catheter. It emerges out of the end of the catheter and is moved down the length of the coronary artery passing through the narrowed area. Once the wire is in the correct position a small balloon runs along the wire down the coronary artery and to the point of the narrowing which needs treatment. The balloon is then inflated and stretches the narrowed segment of the artery from the inside. A stent is a wire mesh tube that is slipped over and crimped onto a deflated balloon. When the balloon is inflated the metal mesh of the stent expands to the size of the balloon. When the balloon is deflated, the stent remains embedded in the wall of the artery, acting as internal scaffolding. The cells of the artery will grow over the stent. 7

8 Risks Balloon Coronary Angioplasty (PCI) is a safe procedure and has been performed in Bristol for over 20 years. Complications are rare but, like any surgical procedure, there are risks associated with it. These risks are higher in patients who are unwell or have certain other medical conditions. Any risk has to be balanced against the benefit of the procedure. The table below gives the rates of major complications of PCTA. These complication rates are derived from 62,000 procedures performed in the UK in 2004.(2) Please ask any questions you may have concerning the procedures before you sign the hospital consent form. Balloon Coronary Angioplasty (PCI) Overall mortality (risk of death) 0.5% e.g. 1 in 200 Heart attack (Myocardial Infarction) 0.3% e.g. 1 in 300 Emergency cardiac surgery 0.2% e.g. 1 in 500 Total risk of serious complication 1% e.g. 1 in 100 Following your procedure you should not drive for 1 week if you have had a PCI. 8

9 Discharge Information Following Angiogram and Angioplasty Do s and don t after your day case angiogram Femoral (groin) approach n Rest as much as possible keeping your leg relaxed and avoid bending from the hip for 48 hours Radial (wrist) approach n Try to avoid activities that involve flexing the wrist for 48 hours General approach to both above procedures n Apply hand over puncture site and apply light pressure on coughing or sneezing n You should drink adequate amounts of fluid (1-1.5l) n Following an Angiogram, do not drive for 48 hours (as directed by DVLA). Following angioplasty (PCI) do not drive for 1 week. n Do not do any heavy lifting or strenuous exercise (i.e. swimming, walking, running, gardening or weight lifting) for 3-4 days post procedure. n Try to avoid straining when opening your bowels. n Avoid bathing for 48 hours post procedure. You may shower but be careful of the wound and avoid scrubbing the wound. n Do not lift anything heavier than 10lbs for 3-4 days. n You must not sign any legal documentation for 48 hours post procedure if you have had any sedation. 9

10 Any Problems Problems with day case angiograms are rare but can occur within the first 24 hours and so it is important that you know what action to take. It is common to have a bruise in the leg (if femoral) or the wrist (if radial) and this should fade after 2-3 weeks. If the think the bruise or swelling is increasing in size you should contact your GP. If the wound, wither wrist or leg, becomes inflamed or develops persistent tenderness with swelling either contact your GP or the cardiac centre. Occassionally patients may feel a lump in the groin, this can be if a Seal has been inserted or can be the result of a bruise or bleeding, but if there is any discomfort contact your GP or the cardiac centre. If the wound suddenly starts to bleed, lie flat and get the person you are with to apply direct pressure to the puncture site for minutes and bleeding should cease. If the bleeding does not stop call 999. If you experience chest pain or chest discomfort in the chest area and/or down your arms you should contact your doctor immediately. if they are unavailable to attend - call for an ambulance. 10

11 References and sources of further information British Heart Foundation Web site available at: [accessed February 2008] British Cardiovascular Intervention Society [accessed February 2008] British Heart Foundation Web site available at: [accessed February 2008] NHS Constitution. Information on your rights and responsibilities. Available at 11

12 If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published May Review due May NBT002237