What if they put a small camera inside your heart and look at it? That's cardiac catheterization!

Do you often get chest pain? Or does your doctor suspect that you have a heart problem? Today we are going to talk about a special test that is done to see exactly what is happening inside your heart. This is what we call `(Cardiac Catheterization)`. The name may sound like a big deal, but don't be afraid. Let's talk about this simply.

What is Cardiac Catheterization? Simply put...

Imagine that you wanted to check whether the blood vessels inside your heart, the small tubes that carry blood to your heart, are working properly and whether there is a blockage somewhere. That's when this ``Cardiac Catheterization`` test is done.

Simply put, this involves passing a very thin, small tube (also called a ``catheter``) through a large blood vessel in your arm or groin into your heart. It's like putting a small camera inside. When the tube goes into your heart, doctors can clearly see the main blood vessels in your heart, such as the ``coronary arteries`` (the arteries that supply blood to the heart muscle) or the ``pulmonary artery`` (the artery that carries blood from the heart to the lungs). This can then tell exactly if there is a problem with the shape or function of the heart.

This is not a major surgery. That means there is no major incision in the body. So the recovery time is much shorter than surgery. However, sometimes after this test, depending on the results, the doctor may decide that you need surgery.

This test is performed by a cardiologist who has received special training in this area and his team. This team is joined by other doctors, nurses, and technicians.

What are the types of cardiac catheterization?

There are mainly two types of this:

1. Left heart catheterization: This involves passing a small tube (catheter) through an artery into the heart. This procedure allows you to see the condition of the chambers and coronary arteries on the left side of your heart, and measure the pressure on that side.

2. Right heart catheterization: In this, a tube is inserted through a vein. This allows us to see the chambers of the right side of the heart and the pressure on that side.

Why would a doctor recommend this cardiac catheterization test?

There are several reasons why a doctor might recommend this test. Let's take a look at what they are:

• If you experience frequent chest pain or an abnormal heart rhythm, find out the cause.
• Take a blood sample or a very small piece of tissue from the heart and examine it (`(biopsy)`).
• Make sure there is no problem with your coronary arteries or heart valves.
• Check if the heart muscle is functioning properly and detect heart muscle disease (cardiomyopathy).
• Check for problems with the arteries leading to your lungs (pulmonary arteries) and high blood pressure (pulmonary hypertension).
• Check blood flow, oxygen levels, and pressure in different parts of the heart.
• Obtain information that other tests cannot accurately find.
• Decide what treatment is needed next. For example, if a blood vessel is blocked, this will help decide whether to clean it, insert a stent, or perform surgery such as coronary artery bypass graft (CABG).
• This test is also important when planning a heart transplant.

How does cardiac catheterization work?

Let me explain this a little. After the doctor inserts that small tube into the heart, a special liquid (called a `contrast material`) is injected through that tube into the heart and blood vessels. This liquid makes the blood vessels and heart chambers clearly visible on the `X-ray` images.

As this fluid travels through the heart, it is recorded on an X-ray (also called a coronary angiogram). From these digital images, the doctor can:

• Find exactly where a coronary artery is blocked or narrowed.
• Assess the size and shape of the heart's chambers and blood vessels.
• Check for unusual bleeding or bruising.

Sometimes, if you need to learn more in-depth information, other special tests may be done at the same time as this ``Cardiac Catheterization''. For example:

• Intravascular ultrasound (IVUS): This can be used to see plaque and calcium deposits inside blood vessels, and to check if a stent is in place.
• Fractional flow reserve (FFR): This is used to measure the pressure on both sides of a blocked blood vessel and determine if the blockage is severe enough to be treated.
• `(Optical coherence tomography - OCT)`: This can take very clear pictures of the inside of blood vessels.

Also, sometimes the doctor can perform some treatments while performing this ``Cardiac Catheterization''. These are not surgeries.

• Angioplasty: Widening narrowed heart arteries and improving blood flow to the heart.
• `(Stent placement)`: Inserting a small mesh-like device (`(Stent)`) into the widened artery to keep it from narrowing again.
• Valvuloplasty: Opening a narrowed heart valve.
• `(Rotablation)`: A treatment to remove calcium deposits in the arteries.
• Intravascular lithotripsy: This involves using a special balloon and pressure waves to break up the calcium.
• Cardiac ablation: A treatment to correct an abnormal heart rhythm.

Imagine how valuable it would be if you could find problems with your heart with a single test, and sometimes treat them right there? That's what this is all about.

How long does this heart catheterization (Heart Cath) test take?

A typical cardiac catheterization, which looks at just your coronary arteries, takes about 30 minutes. However, this time may vary depending on the purpose of the test.

But, when you add up the time to prepare for this and the time to recover after the test, you will have to stay in the hospital all day. It could take five, nine, or even more hours. Even if you are awake during the test, you will still have to set aside the whole day for this. If for some reason the doctors decide to do a procedure like angioplasty, it could take even longer, maybe several hours.

What to expect before the test?

Before a `(Cardiac Catheterization)`, you should be aware of these things:

• You will need to stop eating and drinking for a few hours before the test (usually about six to eight hours).
• Your doctor may tell you to temporarily stop taking certain medications or change the dosage. You should do so accordingly.
• You should tell your doctor about any allergies you have and all medications you take.

After you arrive at the hospital:

• You have to wear a gown given to you by the hospital.
• A small tube (intravenous - IV) line) will be inserted into a vein in your arm to give you medicine and fluids.
• You have to lie down on a special bed. Above this bed is a large X-ray camera and several TV monitors.
• The skin is prepared where the small tube (catheter) will be inserted (either in the arm or groin).
• Several small, flat, sticky patches (electrodes) are placed on your chest. These are connected to an electrocardiograph monitor (EKG). This monitors your heart rate and rhythm.
• You will be given a mild sedative to help you relax, but you will remain awake and conscious throughout the entire test.
• It is advised to be careful about things like allergies, nausea, and chest discomfort.

What happens during the test?

During a cardiac catheterization, the doctor will do the following:

• A numbing medicine is injected under your skin with a small needle.
• A small plastic sheath (an `introducer sheath` - the catheter is passed through this) is inserted into a blood vessel in your arm, neck, or groin.
• The catheter is inserted through the sheath and guided into the heart. (You may feel a slight pinch when the sheath or catheter is inserted, but it should not be painful.)
• To help position the catheter properly, you may be asked to turn your head or take a deep breath and hold it for a few seconds.
• The room is dimmed, and a small amount of a special liquid (contrast material) is injected through a catheter into your arteries and heart chambers. During this time, you may feel a warm sensation in your body or face for a few seconds .
• Using an X-ray camera, the fluid will be passed through your arteries and heart chambers to take pictures (you will be asked to hold your breath while the X-ray is taken).
• While you're still, they'll remove the catheter and the sheath.
• The lights are on again.

What to expect after cardiac catheterization?

After the examination is complete, the doctor removes the catheter and the sheath.

If the catheter was inserted in your hand:

• A bandage is placed where the tube was inserted.
• You have to keep your arm straight for at least an hour (but you can walk).
• You will be monitored for a few hours to see if there are any symptoms or side effects.
• They will give you instructions on how to take care of your hands when you go home.
• If you feel like you are bleeding (wet, warm), if your fingers are numb, or if you feel anything unusual, you should tell your doctor.

If the catheter was inserted through your groin:

• The insertion site is tightened, sometimes with a suture or "plug" (this reduces bleeding).
• They tell you to lie in bed with your legs straight for two to six hours to stop the bleeding (this time can be reduced if you insert the "plug"). They also tell you not to raise your head more than two pillows.
• To protect against infection, a clean bandage is placed over the groin area and it is checked regularly.
• If you feel bleeding (wet, warm), if your toes are numb, or if you feel anything unusual, tell them.

Recovery after Cardiac Catheterization

Take care of these things during your recovery:

• You need to drink plenty of water to flush out the special fluid (contrast material).
• The doctor will tell you whether you will go home the same day or stay in the hospital overnight (either way, you will be observed for a few hours after the test).
• Talk to your doctor about how to care for the wound.
• You need someone to drive you home (if your home is more than two hours away, stay at a hotel and walk for five to ten minutes every hour).

You can usually drive 24 hours after leaving the hospital. Depending on where the catheter was inserted, you should avoid strenuous activities (such as sports or heavy lifting) for two to five days. Your doctor will tell you when you can return to work.

While at home, it is best not to immerse the wound in water for a week. This means no swimming or soaking in a bathtub. However, you can take a shower 24 hours after the test.

What are the risks of this test?

As with all medical tests, there are some minor risks involved, but these are very rare.

• Allergic reaction.
• Irregular heart rhythm.
• Low blood pressure.
• Bleeding or infection at the catheter insertion site.
• Collapse of a lung (pneumothorax).
• Persistent chest pain.
• Kidney failure.
• Fluid accumulation around the heart (`(cardiac tamponade)`).
• Blood clots, heart attack, stroke or death (these are very rare ).
• Having to undergo emergency surgery, for example a coronary artery bypass graft (CABG) surgery.

When you talk to your doctor, make sure you understand all of these risks. Also, ask why you are being asked to have this test. Although this is not a surgical procedure, it may seem like a serious procedure. However, remember that complications from this procedure are rare.

What are the results? What is the meaning of Eve?

After the cardiac catheterization, your doctor will have a lot of important information to help decide your next course of treatment. The results may vary depending on the reason for the test.

The doctor can:

• Find a problem, like a blockage in one of your coronary arteries, and treat it right there.
• Identify a medical condition that requires surgery.
• A sample of your heart muscle is sent to a laboratory for a ``biopsy''.
• Get the information you need to plan treatment.
• Make sure your heart is working well after previous treatment.

When will the results be known?

Your doctor may talk to you about the results right away, but since it takes time for something like a tissue sample to be analyzed in the lab, it can take a few days to get the results.

If the results are abnormal, what do you do next?

If the doctor finds any problems during the heart cath, he will plan further testing or treatment. With the information received, he may even prepare for surgery.

When should I call the doctor?

If you experience any of these symptoms after cardiac catheterization, call your doctor immediately:

• If you get a fever .
• If you feel dizzy .
• If there is pain, swelling, bleeding, or pus at the site where the catheter was inserted.
• If you have chest pain .
• If you have difficulty breathing .
• If your heartbeat feels abnormal .

If you feel like you are having a heart attack or stroke, seek medical help immediately.

Finally, what to remember (Take-Home Message)

It can be scary to think that someone is looking inside your heart. But remember, this `(Cardiac Catheterization)` is not surgery, and you have a skilled medical team to take care of you. The information obtained from this test is very valuable to the doctors who choose the most suitable treatment for you. Therefore, this test is only one step on the journey to your recovery. Never be afraid to ask your doctor any questions or doubts you have. It is very important to clarify what is on your mind.

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