Cardiac Catheterisation

What is it?

Why have a cardiac catheter? A cardiac catheter is an X-ray examination of the coronary arteries, the heart pump and valves.

The investigation is carried out to find out whether you have any narrowing or blockage of the coronary arteries (the blood vessels that supply the heart muscle), which may be the cause of your symptoms.

Occasionally patients have no symptoms of coronary artery disease. The doctor might suspect coronary artery disease if, for example, you have had a routine medical examination which demonstrates an abnormal ECG. The catheter investigation can also give information about the heart pump and the heart valves themselves.

What preparation do I need?

Dr Lipkin will normally request that you have a blood test before the investigation. You will almost certainly have had an ECG and I might request that you have a chest X-ray.

Do not drive to the hospital as it is sometimes difficult to park and I do not want you to drive home immediately after the procedure.

If you are taking Warfarin (to thin the blood) We will ask you to stop the drug 3 or 4 days before the test
If you have diabetes we will ask you not to take your insulin or diabetic tablets on the morning of the test. We will normally carry out your investigation early in the morning so that you can recommence your diabetic medication
If there is any possibility you could be pregnant please inform Dr Lipkin
You will be asked not to eat or drink for a minimum of 4-6 hours before the procedure. In practice this means that you will miss breakfast if you have a morning investigation and lunch if you have an afternoon investigation

On the day of the examination:

Usually we will ask you to come into hospital on the day of the procedure. Dr Lipkin will explain again the purpose of the investigation and exactly what it involves and he will ask you to sign a consent form to confirm that you understand the procedure and you have agreed to go ahead with it. Please do not hesitate to ask any questions that concern you
A nurse will usually ask you to shave your right groin
You will be given a hospital gown to change into
A nurse will take you to the Cardiac Catheter Department where you will have the procedure

What does it involve?

The Cardiac Catheter Laboratory is quite simply just an X-ray room with a very high resolution X-ray camera that can take a movie picture of your heart. Dr Lipkin will perform the test and a radiographer will take the X-ray
You will be asked to lie on the table which can be moved. The X-ray machine is mounted above the table
It is understandable that you may be anxious and if you wish Dr Lipkin can give you an injection of some Valium to make you feel calm during the test
We will paint antiseptic on your groin when you are lying flat on the table and then cover you with a sterile drape. You will be able to chat to Dr Lipkin throughout the procedure if you wish although there will be certain times when he will ask you to hold your breath and not to talk
Dr Lipkin will inject some local anaesthetic in the skin at the top of your leg. This sometimes stings a little bit like having a blood sample but it is rarely any worse. You will then feel him put pressure on the skin and he will insert a very fine tube into a blood vessel at the top of your groin. Most people do not feel anything apart from the pressure of his fingers at this stage
We will inject dye (it looks like water) into the coronary arteries and the chamber of the heart (the left ventricle)
We will record an X-ray as the dye passes through the arteries
When the catheter is removed at the end of the procedure there may be little bleeding from the needle puncture site. To control this we will apply pressure to the site. We frequently use a little plug to close the tiny hole left after removing the catheter. This avoids the need for prolonged pressure to the site
If we use a "plug" you will probably be able to get up and go home after a couple of hours. If for technical reasons a plug cannot be used you will need to stay in the hospital 5 to 6 hours before going home. When you get home we want you to rest and not to exercise until the following day
The cardiac catheterisation is not painful but sometimes you may feel a very slight discomfort like your anginal pain. Do not worry, this does not mean anything is wrong but just inform Dr Lipkin
It usually takes me 5 to 7 minutes to carry out the procedure and Dr Lipkin will normally tell you the results immediately after he has looked at the pictures at the end of the investigation
Your cardiac catheter will be carried out either at the Wellington Hospital or rarely at the Royal Free Hospital
Sometimes the angiogram suggests that we should unblock an artery with a balloon and implant a stent. This can often be carried out at the time you have the angiogram. If this is carried out you will need to stay in hospital overnight and go home the following morning
A letter will be sent to your GP

Going home:

Please ask a friend or relative to collect you and accompany you home
You can resume normal activities the next day including bathing when you feel comfortable