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Cardiac Catheterization, This Is What You Need To Know

Cardiac catheterization is a medical procedure that aims to detect the condition of the heart, and treat various heart diseases by using a catheter, which is a device resembling a long thin tube inserted into a blood vessel, then directed towards the heart. Through cardiac catheterization which is assisted with X-rays and dyes (contrast), can be observed heart blood vessels (coronary), so that it can be known if there is a blockage or plaque in the coronary arteries. This action is called coronary angiography, which is one of the most common types of cardiac catheterization. In addition to X-rays, cardiac catheterization can also be combined with ultrasound. In addition to coronary angiography, a heart catheterization procedure can be performed to take a sample of heart muscle tissue or to do a small surgery. Heart catheterization is done by a cardiologist.

Indications for Cardiac Catheterization

Heart catheterization can be done, both for the purposes of diagnosis and treatment of heart disease. Examples for diagnostic purposes are:
  • Checking for narrowing and blockage of coronary arteries (coronary heart disease) that causes chest pain.
  • Take a sample of heart tissue which will be examined under a microscope (biopsy) to see the possibility of cardiomyopathy or myocarditis.
  • Check for problems with the heart valve (heart valve disease).
  • Examine the decreased ability of the heart chambers to pump blood, in the case of heart failure.
  • Checking the pressure and oxygen levels in the heart, which is often problematic in pulmonary hypertension.
  • Check for suspected congenital heart defects.
Whereas cardiac catheterization is done for the purpose of treatment, for example:
  • Doing angioplasty, which is a dilation of the arteries that are blocked by using a balloon. This can be done simultaneously with the installation of a stent or ring.
  • Repair heart muscle that experiences abnormal thickening in patients with hypertrophic obstructive cardiomyopathy.
  • Repair the heart valve or replace it with an artificial valve.
  • Closing holes in the heart due to congenital heart defects.
  • Overcoming artemia in the heart.

Heart Catheterization Warning

Several conditions can cause patients not allowed to undergo cardiac catheterization, or special consideration is needed. These conditions are:
  • Acute kidney failure.
  • Suffered from a blood clotting disorder.
  • Stroke.
  • Allergy to contrast.
  • Suffers from gastrointestinal bleeding.
  • Arrhythmia.
  • Suffering from uncontrolled hypertension.
  • Anemia.
  • Electrolyte disturbances.
  • Infections.
Although the above conditions can cause patients to not be able to undergo cardiac catheterization, but if it has been treated, patients are allowed to undergo this procedure. To avoid the complications of cardiac catheterization due to these conditions, the doctor will carry out the heart catheterization preparation procedure carefully.

Preparation of Cardiac Catheterization

The patient will undergo a blood test and a heart record (ECG) examination before cardiac catheterization is performed. If the patient is a diabetic, the patient should consult with a doctor regarding medications taken before undergoing cardiac catheterization. If you suffer from allergies to certain drugs, tell your doctor immediately. The doctor will also ask the patient to stop taking blood-thinning drugs, such as warfarin or aspirin. If the patient is taking other drugs or supplements, tell the doctor. If possible, bring the medicine packaging to be shown to the doctor, so that the information is clearer and more detailed. Patients who will undergo cardiac catheterization will be asked to fast at least 6 hours before the catheterization procedure is carried out. The aim is to avoid the appearance of side effects due to anesthesia. Hair around the blood vessels to be pierced will also be shaved. Patients who undergo cardiac catheterization often have to undergo hospitalization. Therefore, patients must prepare for the need to stay overnight in the hospital, along with families who will deliver and accompany during the hospital. Try to stay calm and relax when you are going to undergo cardiac catheterization. If you feel nervous, tell your doctor to help you calm down.

Cardiac Catheterization Procedure

Cardiac catheterization procedures are performed in special rooms that have scanning devices. Patients who undergo cardiac catheterization are usually given local anesthesia, so that they will remain awake during the procedure. However, if needed, patients will be given general anesthesia, especially for those who will undergo heart valve repair or replacement. The patient will be put on an IV line to deliver the medication during the heart catheterization procedure. The patient will also have electrodes attached to the chest to help the doctor monitor the condition of the heart. The insertion site (can be in the arm or leg) will be given an anesthetic to be numb before the catheter is inserted. If the catheter is inserted through an artery in the leg, the heart doctor will make a small incision in the skin as a catheter entry point. The catheter is inserted into an artery with a special plastic wrap first. Then the doctor will perform cardiac catheterization according to the patient's needs. Among others are:
  • Coronary angingorafi. This action is done by entering the contrast to obtain visual images of coronary vessels through a heart catheter. After the contrast dye is inserted, the doctor will scan the heart using a photo of coronary angiography done to see the blockage or narrowing of the coronary arteries.
  • Coronary angioplasty. The purpose of this procedure is to dilate narrowed or blocked blood vessels. The doctor will insert a catheter together with a small deflated balloon through a vein, until it reaches a narrowed or blocked artery. When the catheter arrives at the location, the doctor will inflate the catheter balloon, so that the blood vessels will dilate and blood flow returns to normal. To keep the dilated vessels from narrowing or clogging again, doctors can attach a special wire called a stent or better known as a ring at that location.
  • Heart biopsy. This action is done by taking a sample of heart tissue to be observed using a microscope. Catheters used for cardiac biopsy are usually equipped with special claws to take heart tissue. This catheter is usually inserted through a vein near the neck or in the groin. The patient will not feel anything when the heart tissue sample is taken using a catheter.
  • Balloon valvuloplasty. The purpose of this procedure is to repair a narrowed heart valve using a balloon. The procedure is similar to cardiac angioplasty, only the target is the heart valve. A special balloon will be placed in the catheter, then inserted through a vein to the heart valve. Arriving at the heart valve, the balloon will be inflated, so that the heart valve will widen again. If needed, a narrowed or leaky heart valve will be fitted with an artificial heart valve through a heart valve replacement procedure.
  • Repair of congenital heart defects. The purpose of this procedure is to correct abnormalities in the heart, for example the hole in the barrier between the chambers of the heart (patent foramen ovale). This procedure is different from other cardiac catheterizations, because it will use two catheters that are inserted through the arteries and veins. A special instrument will be installed on the catheter to correct heart abnormalities. If the abnormality occurs is a heart valve leak, the doctor can install a special stopper to stop the leak.
  • Heart tissue ablation. The purpose of this procedure is to treat arrhythmias caused by abnormalities in the heart's tissue. Through the inserted catheter, the doctor will destroy the abnormal tissue using high temperatures in the form of radio waves, or low temperatures through nitrous oxide gas or lasers. The heart tissue that is affixed will be destroyed, so the heart rate returns to normal.
  • Thrombectomy. This procedure is done to destroy blood clots that have the potential to clog arteries and move to other organs, for example to the brain and cause strokes. The catheter will be inserted into a vein until it reaches the location of a blood clot. Arriving at the location, the doctor will destroy the blood clot.
Heart catheterization generally lasts less than an hour. During the catheterization procedure, the patient will be asked to hold his breath, take a deep breath, cough a little, and shift the position of the hand by the doctor. This is to produce a more accurate picture of the condition of the heart, but can only be done if the patient is given local anesthesia. Catheters that are moved during cardiac catheterization will not cause pain in the patient, although they are always moved during the procedure. If you feel discomfort during cardiac catheterization, tell your doctor. The location of the incision where the catheter is inserted will be closed with stitches, then covered with a bandage that is pressed to prevent bleeding.

After Heart Catheterization

Patients will be treated after undergoing cardiac catheterization to monitor the condition after administration of anesthesia and assist recovery after undergoing cardiac catheterization. However, the length of hospital stay after cardiac catheterization depends on the heart catheterization procedure. Generally patients are allowed to get out of bed and walk after 6 hours. If the catheter is inserted through the arm, recovery time is usually faster than the catheter inserted through the groin or leg. Patients are required to rest and not undergo heavy activity for 2-5 days after undergoing cardiac catheterization, to prevent bleeding. If the patient undergoes cardiac catheterization for treatment, such as heart tissue ablation or angioplasty, the healing time will last longer. If the patient underwent a biopsy examination of the heart tissue, the doctor will present the results a few days after the observation is completed. Patients who undergo cardiac catheterization as a method of diagnosis, such as angiography, will discuss with their doctors the method of treatment that needs to be done after seeing the results of the diagnosis.

Risk of Cardiac Catheterization

Cardiac catheterization rarely causes complications. However, the risk of complications is greater in patients suffering from diabetes or kidney disease, as well as in elderly patients. Some complications that can occur due to undergoing cardiac catheterization include:
  • Damage to heart tissue.
  • An allergic reaction to the contrast or drugs used during the catheterization procedure.
  • The formation of blood clots that can trigger heart attacks and strokes.
  • Arrhythmia.
  • Kidney damage due to the contrast material used.
  • Low blood pressure.
  • Damage to the arteries in the place where the catheter is inserted, or in the area through which the catheter is passed.
  • Bruising, bleeding, or infection at the site where the catheter is inserted.
  • The occurrence of a buildup of fluid in the lining of the heart (pericardial effusion) which can interfere with the work of the heart in pumping blood.

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