Cardiac Catheterization Patient Guide CardiacAdvantage
CardiacAdvantage Cardiac Catheterization For more information, please visit: stjoeshealth.org/cardiovascular
Understanding Your Cardiac Catheterization At Saint Joseph Mercy Health System, we recognize the importance of providing innovative, compassionate, patient focused care when it comes to treating heart disease. Your doctor has recommended that you undergo cardiac catheterization. The staff at St. Joseph Mercy Ann Arbor have designed this booklet to provide answers to questions you may have concerning the cardiac catheterization procedure. Please take a few minutes to read through this material. If you have any additional questions after reviewing the information, please feel free to ask your doctor or nurse. You can also visit us at stjoeshealth.org/cardiovascular. DiscoverRemarkable 1
The Heart: How it Functions The Heart and How it Functions We want you to understand the cardiac catheterization procedure. It will help if you know the basics about how the heart works. Anatomy of the Heart The heart is a muscle that pumps blood to the body. It has four chambers or rooms. It has four doors or valves. It has blood vessels that bring blood into the heart. These are called veins. It has blood vessels that take blood away from the heart. These are called arteries. Blood Flow through the Heart Blood flows into the heart, through the right side of the heart into the lungs. In the lungs, the blood picks up oxygen. Blood flow enters the left side of the heart and is pumped throughout the body. In order for blood to be delivered to the body s cells, all parts of the heart must work well. Coronary Arteries The heart needs its own blood and oxygen supply. Blood is delivered to the heart muscle through the coronary arteries. These arteries lie on the surface of the heart. The right and left coronary arteries are the two main vessels that carry blood to the heart muscle. The left coronary artery has two main branches and supplies blood to the front and side of the heart. Left Anterior Descending (LAD) artery Circumflex artery The right coronary artery supplies blood to the bottom of the heart. 2
Heart Anatomy Aorta Superior Vena Cava Pulmonary Artery Pulmonary Veins Right Atrium Left Atrium Left Ventricle Right Ventricle Papillary Muscle Inferior Vena Cava CardiacAdvantage 3
Heart Diseases: Artery, Valve and Muscle Diseases of the Heart There are a number of diseases of the heart that we can identify and/or treat with a cardiac catheterization procedure: Coronary Artery Disease (CAD) Heart Muscle Disease Heart Valve Disease Pericardial Disease Coronary Artery Disease (CAD) A disease known as atherosclerosis may affect the coronary arteries. In this condition, cholesterol deposits form in the arteries and normal blood flow through them is reduced. This process is similar to the progressive formation of rust or corrosion found in plumbing fixtures. When the obstruction in a coronary artery is greater than 70 percent, the blood flow and thus the oxygen supply to the heart muscle is significantly reduced. This may result in chest discomfort that is called angina pectoris. When a coronary artery is completely blocked, usually by a blood clot formed in the artery, damage to the heart muscle occurs. This is called a myocardial infarction or heart attack. A person having a heart attack may feel pain or discomfort in the chest, arms, neck, back or stomach region. There may be other feelings or symptoms that are felt such as nausea, shortness of breath, tiredness, jaw pain or back pain. 4
Heart Valve Disease There are four heart valves within the heart. These valves are like doors that are between rooms. These valves open and close to let blood flow through the heart. They keep blood flowing in a forward direction. Heart valves can become blocked over time and not open completely. This can decrease blood flow. They may also become loose and not close completely. Then blood flows backward rather than forward. Some valve problems cause a sound called a murmur that can be heard when the doctor listens to your heart. Others are more quiet but can be seen or heard on an echo test. Heart Muscle Disease The heart muscle can become enlarged and/or stiff or weak. The heart does not function correctly and does not pump enough blood to meet your body s needs. Pulmonic Valve Mitral Valve Tricuspid Valve Aortic Valve CardiacAdvantage 5
Cardiac Catheterization: Possible Risks and Complications Cardiac Catheterization There are several words you may hear used for this test. It may be called a heart cath, coronary angiogram, arteriogram or angiography. These all mean the same thing. A Diagnostic Cardiac Catheterization will: Allow your cardiologist to see the blood supply to your heart. Find any blockages in the arteries (blood vessels) that supply blood to the heart. May see how well your heart muscle and heart valves work. Look at the condition of bypass surgery grafts, should you have any. Possible Risks and Complications In any medical procedure, including a heart catheterization, there is some risk involved. The staff that perform this procedure are specially trained and the room is fully equipped to handle any possible emergency that may arise. Complications, although rare, can happen. These may include the following: Bleeding Allergic reaction Blood clots Infection Rhythm Irregularities Injury to the heart or vessels In very rare cases, heart attack, stroke or death If you have any specific questions or concerns about these risks, please ask your cardiologist. 6
Preparing for Your Heart Catheterization Before you Arrive You may have your procedure as an outpatient or your doctor might order it during your hospital stay. You may be discharged on the day of your procedure. The procedure will be explained to you and you will be asked to sign a consent form. Your provider will meet with you prior to the procedure. You will be asked not to eat or drink anything for several hours. You will receive specific instructions. Bring an overnight bag in case you need to stay after your procedure. Let your cardiologist know if: You are taking anti-clotting medication. You are diabetic. You have kidney disease. You have any bleeding problems. You are allergic to any medications, especially x-ray dye, iodine, aspirin or heparin. You are allergic to latex. You are pregnant or think you may be pregnant. You have had previous stents or bypass grafts. You have had vascular surgery or stents to your aorta or legs. You are planning any surgery in the next year. You have sleep apnea or use a breathing machine at home (C-PAP). When you Arrive You will be placed on a stretcher. Your blood pressure and pulse will be checked. Small sticky patches (electrodes) will be placed on your chest to monitor your heart rhythm. We will review your current medications. Please bring them with you. You will have an intravenous line (IV) inserted so you can be given fluids and medications. > continued on page 8 CardiacAdvantage 7
Cardiac Catheterization: Preparation Preparing for Your Heart Catheterization (continued) Outpatients Do not eat anything six hours prior to your procedure. You may have clear liquids up until four hours prior to your procedure. You should take your medication as usual the morning of the procedure with small amounts of water, unless instructed otherwise. If you are a diabetic, ask your physician specifically whether to take your diabetes medicine. Usually, you should not take glucophage (Metformin) for 48 hours before the procedure. You must take aspirin the morning of your procedure prior to your arrival (325 mg if you are not taking this medication on a regular basis and at least 81mg if taking aspirin daily). Failure to take this dose of aspirin could delay your procedure. Bring ALL your medication in the original containers to the procedure. Bring your breathing machine (CPAP) if you use one at home. You will need to have someone to drive you home. They must remain in the waiting room or in the hospital the entire time you are having your test. Please check in at the Imaging Center located in the Treatment Centers Area. Parking for the Imaging Center is in Lot Q. Sign in at the Registration Desk. Your family member or friend will be able to track you by an electronic messaging board located in the waiting room. You and your family will receive information at registration how to use this board. 8
What to Expect During Your Heart Catheterization The test is performed in the Cardiac Catheterization Lab by one of our cardiologists. The cardiologists who perform the cardiac cath are specially trained in their field. The cardiac cath will last about an hour. If an intervention is performed, it will take longer than an hour. The procedure room is kept cool for the equipment. You will be kept warm with blankets. Please let us know if you are comfortable. You will lie on a hard flat table under a large x-ray machine. The staff will clean and prepare your groin, arm or wrist. Alternative sites A sterile drape will be placed over your body to maintain a germ free area. You will be asked to keep your arms by your side during the cath. You will be given sedation to help you relax. The cardiologist will numb the procedure area where Catheter the insertion catheter site will be inserted. A long, thin, flexible tube called a catheter will be inserted and threaded to your heart. Alternative sites Catheter Catheter insertion site Cath A special dye will be injected through the catheter so the cardiologist can see your blood vessels, heart muscle and heart valves. Pictures will be taken. The x-ray camera will move around your head and chest. You may be asked to hold your breath or cough. > continued on page 10 CardiacAdvantage 9
Cardiac Catheterization: What to Expect What to Expect During Your Heart Catheterization (continued) When the x-ray dye is injected, you may feel a warm, flushing sensation through your body. This will only last a few seconds. When the pictures have been completed, the catheter will be removed. If you have the catheter in your groin: The opening in your artery will be closed with a plug, stitch or other device, if possible. If that does not occur, the sheath will remain in your groin until it is safe to remove the sheath. A dressing will be placed once the sheath is removed. You will still need to lie still for a few hours. If you have the catheter in your wrist: The sheath will be removed in the procedure room. A compression device will be placed. You will be able to sit upright immediately after the procedure. Once you are feeling more awake you will be able to walk. Do not twist or bend your wrist after the procedure, this can cause bleeding. Staff will be performing frequent important assessments to the hand, wrist and forearm. The pressurized wrist-band will be removed approximately two hours after the catheterization. 2007 Terumo Medical Corporation You will be taken to a recovery area where you will rest and be watched. Plan to spend several hours resting while we monitor your recovery. If you are an outpatient, plan to be at the hospital the majority of the day. The cardiologist will talk with you and your family about the results of your test and plan of care that is right for you. 10
After the Procedure When you return to the recovery area, your blood pressure, pulse and catheter insertion area will be checked often. You may eat after the test and you will be encouraged to drink plenty of fluids. You will be asked to: Avoid moving the leg or arm used during the procedure. Not bend the limb for several hours. Rest for a period of time. Your nurse will give you more specific instructions on your limitations of activity. Please tell your nurse right away if: You have discomfort, swelling or bleeding at the catheter insertion area. You have numbness or pain in the limb used for the catheterization procedure. You have any chest pain or chest discomfort. CardiacAdvantage 11
Cardiac Catheterization: After the Procedure For the Next Three Days, please follow these instructions Keep the site clean and dry. Observe the insertion site for any of these changes: Bruising Some discoloration is common, however, if it increases in size you should call your physician. Bleeding It is not normal for your site to bleed. If your site starts to bleed, lie down, apply pressure to the site where the catheter was inserted and call your physician. If the bleeding is severe or will not stop, call 911 or contact your local emergency services. Swelling It is normal for a small knot to appear at the site for a few days after the procedure. Notify you physician if the swelling at the site increases or if you have increased redness or warmth. Tenderness or Discomfort It is normal to have some discomfort at the insertion site. If the discomfort increases in intensity or becomes very painful, notify your physician. If you experience any flank or low back pain or discomfort, notify your physician. Numbness or Tingling It is not normal to feel numbness or tingling in your leg/arm after the procedure. If numbness and/or tingling is constant, progressive or severe, notify your physician. If your leg/arm becomes cold or turns blue in color, seek emergency help immediately. Infection If your site becomes infected, contact your physician. There should only be a minimal clear drainage from your site. If drainage increases and/or becomes cloudy or pus-like, contact your physician. Other signs to watch for include increased swelling, increased tenderness, increased warmth, chills and/or fever of 100.5F or greater. Diet For 24 hours: Force fluid, and then resume previous diet as prescribed by your physician. 12
Activity For 24 hours: Do not drive a car or operate heavy equipment. For three days: Do not sit for more than an hour without getting up to walk around (i.e. car trips over one hour, desk jobs, watching TV, etc.) Do not push, pull or lift heavy objects (five to ten pounds or more) Do not take a tub bath (you may shower) After three days you may resume normal activity as tolerated. Notify your physician if you have any symptoms of heart attack: Pain or discomfort in chest, arms, neck, back or stomach Difficulty breathing Nausea Lightheadedness Questions to Ask Your Physician 24-Hour Phone Number: 734-712-8000 CardiacAdvantage 13
Cardiac Catheterization: Glossary Angina Pectoris Chest discomfort that results when the oxygen supply to the heart muscle is too low. This discomfort may come and go. Atherosclerosis When cholesterol deposits form in the arteries decreasing normal blood flow. Atrium Upper chambers of the heart that receive blood from the veins. Blood Vessel A canal that carries blood Cardiac Catheter A soft, narrow, flexible plastic tube inserted through a blood vessel and advanced into the heart or its blood vessels. Coronary A term used to describe blood vessels of the heart. Electrodes Small, sticky patches applied to the surface of the skin for the purpose of monitoring the electrical function of the heart. Intravenous Within a vein. Myocardial Infarction When a coronary artery is completely blocked, causing permanent damage to the heart muscle. Also called a heart attack. Ventricles Lower chambers of the heart that pump blood to the lungs and body. 14
Results of Your Cardiac Catheterization CardiacAdvantage 15
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CardiacAdvantage ST. JOSEPH MERCY ANN ARBOR 5301 McAuley Drive, Ypsilanti, MI 48197 734-712-3456 ST. JOSEPH MERCY LIVINGSTON 620 Byron Road, Howell, MI 48843 517-545- 6000 ST. MARY MERCY LIVONIA 36475 Five Mile Road, Livonia, MI 48154 734-655-4800 For additional information, please call 734-712-5204 or visit stjoeshealth.org/cardiovascular. DiscoverRemarkable 83540-055 R 3/15T