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Left and Right Heart Catheterization

What You Should Know:

A left heart catheterization (kath-uh-ter-i-ZA-shun) is a test to look inside your heart. They will also look at the arteries on your heart. It is also called coronary arteriography (r-teer-e-OG-ruh-fee) or a left heart cath. A catheter (long, thin, bendable tube) is put into an artery. The artery may be in your arm at the bend of your elbow, or in your groin. The groin is the area between your abdomen (belly) and the top of your leg. Using a TV screen and x-rays, the catheter is gently guided into your heart. The catheter is moved around inside your heart and blood vessels. This lets caregivers see how well your heart is working.

  • During the heart cath caregivers can learn how strong your heart muscles are. The pressure in the chambers (rooms) inside your heart will be checked. The valves (doors) between the chambers of the heart can be checked. The arteries of your heart will be checked to see if they are blocked. You may go home after the heart cath or you may stay in the hospital overnight.

A right heart catheterization (kath-uh-ter-i-ZA-shun) or "right heart cath" is a test to look inside your heart. As in the left heart cath, a catheter is put into a large vein, usually in your groin.  The catheter may be put into a vein in your neck or arm instead. Using a TV screen and x-rays, the catheter is gently threaded (pushed) into your heart. The catheter is moved around inside your heart and into the blood vessels going to your lungs.

  • During the heart cath, caregivers can check the pressure and blood flow in the chambers inside your heart. Caregivers can also see how much oxygen is in your blood in different parts of your heart. They can check the valves and blood vessels. A heart cath may help caregivers decide if you need surgery. Caregivers may use a right heart cath to repair certain heart problems. You may go home the same day after the heart cath or you may stay in the hospital overnight.

GETTING READY:

Before Your Procedure: 

  • Ask your caregiver if you need to stop taking aspirin or any other blood thinning medicines before your procedure.
  • Arrange family support. Ask a family member or friend to stay with you after the heart cath. They can help take care of your needs while you are lying flat in bed after the procedure. You will need them to drive you home when you leave the hospital after your heart cath.
  • A dye is a liquid that will be used during your heart cath. It helps the parts of your heart to show up better. People who are allergic to shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  • You may need blood tests before your procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.  You may need to have blood drawn more than once.
  • You may be asked to stop taking your blood thinner 2 to 3 days before your left heart cath. Ask your caregiver before you stop taking this or any medicine.
  • Ask caregivers about directions for eating and drinking the day before the procedure.

The Day of The Procedure: 

  • Write down the correct date, time, and location of your procedure.
  • Ask caregivers before taking your medicines today. Caregivers may tell you not to take them. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.
  • Wear your glasses, dentures, or hearing aids. Do not wear contact lenses the day of the heart cath. You may wear your glasses. If you regularly wear dentures or hearing aids, wear them to the hospital. You should be able to keep them in during the heart cath. Your caregivers may need for you to hear and talk to them clearly during the procedure.
  • Bring personal belongings. If you are staying in the hospital after the procedure, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers. Do not wear jewelry or bring money to the hospital.
  • Take a full bath or shower before your heart cath. Take a complete bath or shower and wash your hair before your heart cath.  Remove any nail polish.
  • Make sure you sign an informed consent. You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do a heart cath. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What Will Happen The Day of the Procedure: 

  • You will be asked to change into a hospital gown.  An IV (intravenous) line will be started.  An IV is a tube placed in your vein that is used to give you medicine or liquids.
  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  • Oxygen: You may need to get oxygen through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that are placed inside your nose. Tell your caregiver if the mask or prongs bother you, or if your nose gets dry. Ask your caregiver before taking off your oxygen mask, or removing your nasal cannula.
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  • Pulse Check: Caregivers will check the pulses (heartbeat) in your feet and ankles. The pulse is the feeling under the skin when the heart pushes blood through your artery. Your caregiver may put an "X" over the spots on your feet where the pulse is the strongest.
  • Transport: You will be taken on a stretcher to the room where your procedure will be done. Your caregiver will help you get comfortable on the bed. A belt may be put over your legs for safety. Your arms may be tucked at your sides to give your caregivers more room to stand beside you.
  • Medicines: You may be given medicine right before the procedure. This medicine may make you feel sleepy and more relaxed. You may also receive the following types of medicines:
    • Anti-anxiety: This medicine may be given to help you feel less nervous.
    • Antibiotics (an-ti-bi-AH-tiks): This medicine may be given to help you fight infection caused by a germ called bacteria
      (bak-TEER-e-uh).
    • Antihistamines: This medicine may be given to help decrease itching. This medicine may protect you from a reaction to the dye.
  • Anesthesia (an-iss-THEE-zuh): This is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best. Do not make important decisions for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. The medicine may make you drowsy and your thinking unclear. An adult may need to drive you home and stay with you after you have had anesthesia.
    • Local or monitored anesthesia: This is a shot of numbing medicine put into the skin where you will have surgery. You may still feel pressure or pushing during surgery but you should not have pain. With local anesthesia, you will be fully awake during the procedure. With monitored anesthesia care, you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the procedure.

What Will Happen During The Procedure:

  • You will be taken on a stretcher to the Cardiac Catheterization Lab where the procedure will be done. You will get medicine called local anesthesia (an-iss-THEE-zuh) that will numb the area where the catheter will go in.
  • You will lie on a hard movable x-ray bed. There will be large x-ray machines and other equipment in the room. A lead apron may be placed over your throat to protect your thyroid from the x-rays. Your skin may be shaved to see the area better. Your caregiver will clean the skin over an artery with soap. This soap may make your skin yellow, but it will be cleaned off later. Sterile (no germs) sheets will be put over you to keep the area clean.
  • During a left heart cath procedure a catheter will be placed into an artery in your arm or groin.  The catheter is guided into the left ventricle (VEN-trik-ull) of your heart. The left ventricle is the biggest and strongest chamber of the heart.  Your caregiver will take many pictures of your heart and arteries. Dye is injected through the catheter so that your heart and arteries show up better on x-rays. You may feel warm all over or just in your head as the dye is put into the catheter. You may get a headache or feel sick to your stomach. You may feel as though your heart is beating fast or having unusual beats. These are normal feelings and will pass quickly. Tell your caregiver if you feel chest pain or discomfort while you are getting the dye.
  • During a right heart procedure a catheter will be put into a vein in your groin, neck, or arm. The catheter is gently threaded (pushed) through the chambers in the right side of your heart. The catheter is then threaded into the pulmonary artery. You will be kept awake so your caregiver can give you instructions. Caregivers may ask you to cough, breathe out, or to tell them how you feel during the procedure.
  • When the procedure is finished, your caregiver will remove the catheter. A tight pressure bandage will be put over the artery. Caregivers may use one or more of the following to stop bleeding from the artery:
    • A sandbag may be placed over the bandage for pressure. The sandbag will stay in place for 2 or more hours. You will need to lie flat in bed with your leg or arm straight for this time.
    • A collagen plug may be used to seal the site. You may have your head elevated after a short time. You may be able to get out of bed sooner.
    • A stitch may be put into the artery. You may be able to get out of bed right away.

Waiting Room: This is a room where your family can wait until you are ready for visitors after the heart cath. Your doctor or nurse will find them to let them know how the heart cath went. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

  • You cannot make it to your heart cath appointment on time.
  • You have questions or concerns about the procedure.
  • You have a fever (increased body temperature). Your heart cath may need to be done later when you are healthy.
  • The problems for which you are having the heart cath get worse.

SEEK CARE IMMEDIATELY IF:

  • You have signs of a heart attack:

    • Chest pain for discomfort that spreads to your arms, jaw, or back.
    • Nausea (sick to your stomach)
    • Trouble breathing.
    • Sweating.
    • This is an emergency. Call 911 or 0 (operator) for an ambulance to take you to the nearest hospital or clinic. Do not drive yourself!

After Your Procedure- Recovery: 

  • You will be taken back to your room or to a recovery area. You may be able to go home in a few hours. Caregivers will watch you closely for problems that can happen after a cath. Do not get out of bed until your caregiver says it is OK. Caregivers will take your vital signs every 15 minutes for 1 to 2 hours. The pulses in your feet or wrist will also be checked often. Your toes or fingers will be checked to see if they are warm. Caregivers will watch you closely for problems that can happen after a heart cath. Tell your caregiver if you have any of the following:

    • Chest pain or discomfort
    • A change in color or temperature of your arm or leg.
    • Pain, numbness, or tingling in your arm or leg.
    • Swelling or bleeding from the area where the catheter was
    • Pain in your back, thigh or groin.
    • Nausea (sick to your stomach)
    • Sweating a lot.
  • Eating: You may be able to eat "finger foods" shortly after your heart cath. These are foods that can be eaten while you lie flat in bed.
  • Pain Medicine: Caregivers may give you medicine to decrease your pain. This medicine may be given in your IV, as a shot, or by mouth. Tell caregivers if the pain does not go away or comes back.
  • Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots.

AFTER YOU LEAVE:

Medicines:

  • Keep a written list of what medicines you take and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  • Always take your medicine as directed by caregivers. Call your caregiver if you thing your medicines are not helping or if you feel you are having side effects. Do not quit taking it until you discuss it with your caregiver. If you are taking antibiotics (an-ti-bi-AH-tiks), take them until they are all gone even if you feel better.
  • If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
  • Blood thinners are medicine to help prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may first be given in your IV or as a shot in your abdomen (belly). Later they may be taken by mouth or continued as a shot. Blood thinners may make it easier to bleed or bruise. Do the following things if you are taking a blood thinner.
    • Watch for bleeding from your gums or nose, or in your urine or BMs.
    • Use a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding.
    • Tell your dentist and other caregivers before dental cleanings or other procedures that you take blood-thinning medicine.
    • If you shave, use an electric razor.
    • Do not play contact sports since you may bleed or bruise easier.
    • Wear a medic-alert bracelet or necklace that says you are taking a blood thinner medicine. You may get one from your local drugstore or contact the MedicAlert Foundation listed below.

Activity: 

  • You may feel like resting more after your heart cath. Slowly start to do more each day. Rest when you feel it is needed. Keep your leg or arm straight as much as possible. Do not bend over.
  • Avoid lifting heavy objects.
  • Once you are stronger after the procedure, start exercising. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy. Talk to your caregiver before you start. Together you can plan an exercise program.
  • Ask caregivers when you can begin driving a car again.
  • Ask your caregiver when you can return to work or school.
  • You may have sex when you feel ready. Stop if it causes pain. Talk to your caregiver if you have questions or concerns

Appointment: 

Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Bathing: When you are allowed to bathe or shower, carefully wash the incision site with soap and water. Afterwards put on a clean, new bandage. Change your bandage any time it gets wet or dirty. If you cannot reach the bandage, ask someone else to help you change it.

Diet: You may eat your regular diet as soon as you get home. Eat foods that you can swallow easily today because you will be lying down and resting until tomorrow.

Ice: Ice causes blood vessels to constrict (get small) which helps lessen inflammation (swelling, pain, and redness). Ice is best started after your procedure and for the next 24 to 48 hours afterwards. Put crushed ice in a plastic bag and cover it with a towel. Put this on your incision for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice packs because you can get frostbite.

Heat: After the first 24 to 48 hours, use heat 15 to 20 minutes every hour as long as you need it to lessen pain or swelling. Heat brings blood to the surgery area and helps it heal faster. Use warm compresses, a heating pad, or a hot water bottle.

  • A warm moist compress is a small towel dampened with hot water and placed in a plastic bag. Wrap a towel around the plastic bag to prevent burns.
  • Be careful if you use a heating pad by keeping it turned on low.
  • Make sure you wrap the hot water bottle in a towel. Do not sleep on the heating pad or hot water bottle because it can cause a bad burn.

Wellness Hints: 

  • Eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster.
  • Drink 6 to 8 (soda pop can size) glasses of liquid each day. Or, follow your caregiver's advice if you must change the amount of liquid you drink. Limit the amount of caffeine you drink, such as coffee, tea, and soda.
  • Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy.
  • It is never too late to quit smoking if you smoke. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, or cancer if you smoke. You will help yourself and those around you by not smoking. It is never too late to quit.
  • Stress may slow healing and cause illness later. Since it is hard to avoid stress, learn to control it. Learn new ways to relax (deep breathing, relaxing muscles, meditation, or biofeedback). Talk to your caregiver about things that upset you.

Wound Care: Watch the place on your groin where the catheter was put in. It is normal to have a bruise. Draw a line with a pen around the edges of the bruise. This will show you if the bruise starts to get bigger.

CONTACT A CAREGIVER IF:

  • Your incision is swollen, red, or has pus coming from it. This may mean it is infected.
  • You have a fever (increased body temperature).
  • You have chills, a cough, or feel weak and achy. These are signs that you may have an infection.
  • Your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic (uh-LER-jik) to your medicine.
  • You have questions or concerns about your left heart cath, illness, or medicine.

SEEK CARE IMMEDIATELY IF:

  • The bruise where the catheter went into your groin or arm gets bigger and is swollen.
  • Your leg or arm used for the heart cath becomes numb, hurts a lot, or changes color.
  • You become weak on one side of your body or face.
  • You have trouble speaking clearly.
  • You have a change in your vision.
  • If the place where the catheter was put starts to bleed, use your hand to put pressure on the bandage. Hold this pressure for 30 minutes. Call your caregiver to tell him/her that you are bleeding. If you cannot stop the bleeding, Call 911 or 0 (operator) for an ambulance to take you to the nearest hospital or clinic. Do not drive yourself!

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