FREMANTLE HOSPITAL & HEALTH SERVICE

Department of Cardiology - Testing Unit

Cardiac Catheterisation

 Cardiac catheterisation (also known as a coronary angiogram) is a procedure used to determine whether coronary arteries are blocked or narrowed.  It is important to determine whether disease exists, as it is these arteries that supply the heart muscle with oxygen and nutrients.  The most accurate way to see coronary arteries is to injecting an x-ray dye (or contrast) into them during a cardiac catheterisation procedure.

The Procedure 

During cardiac catheterisation your Doctor will insert a long thin tube into a blood vessel in your groin or wrist.  The tube will be gently directed to the heart and to the origin of the coronary arteries.   Contrast is then injected into the coronary artery while x-ray pictures are taken.  The contrast in the coronary artery is seen on the x-ray as a thin black line.  During the same procedure, contrast is injected into the heart’s main pumping chamber in order to see how well the heart muscle is contracting and how well the valves are working. 

Pre-Catheterisation: 

On the morning of your procedure you will need to arrive at Fremantle Hospital at 7.00am, having fasted from midnight.  You can still take your medication with a small sip of water, however, please check with the Cardiac Catheter Theatre staff if you are taking any diabetic medication or a table name Warfarin. 

You enter the hospital through the main entrance which is located on Alma Street and report to the Enquiries Counter.  From there you will be directed to that Admissions area where you will have your admission paperwork performed before being escorted by an orderly to the Cardiac Catheter Theatre preop/recovery room. 

Once you have arrived at the Cardiac Catheter Theatre, one of the nurses will need to complete some paperwork relating to your past medical history.  Make sure you have with you all the medications that you are currently taking.  You will then be required to get changed into a hospital medical gown.  It might be a good idea to bring along a dressing gown and a pair of slippers, as it can get quite chilly.  Also you may wish to bring along a book to help pass the time. 

Please be aware that due to limited space in the Cardiac Catheter Theatre, your friends and relatives will be unable to sit with you during your stay.  They will be asked to return later that afternoon to collect you. 

Catheterisation: 

When it comes time for your procedure you will be taken into the procedure room and asked to move on a large x-ray table.  You will see a lot of equipment around you.  Nurses and Cardiac Scientists will prepare you for the procedure by placing ECG electrodes on your chest, cleansing your groin area and waist with antiseptic solution and covering you with a sterile drape. 

You will be awake during the procedure and should experience very little discomfort.  You may ask your Doctor for medication to help you relax.

Yor Doctor will inject your groin or wrist witha local anaesthetic that will numb the area.   After the local anaesthetic has taken effect, your Doctor will use a needle to insert a sheath.  It is through this sheath that the catheters will be lassed u to your heart.  The Doctor will watch the movement of the catheter by x-ray.  You may feel some pressure at the site of the insertion, but you will not feel the catheter inside your body.  Once the catheter has been guided to your heart, the contrast is   administered through the catheter.

There may be several injections of the contrast, and the catheter may be moved around during the procedure.  This is required in order to get different views of your heart and coronary arteries.  A warm flushing sensation may occur while taking the picture of your heart muscle.  This will only last 15-30 seconds and is a normal reaction to the contrast.  You may also experience some palpitations which is quite normal.

The entire procedure will take approximately 30-60 minutes.  During the catheterisation procedure you may be asked to breathe deep and cough.  Be sure to let your doctor know if you feel dizziness, nausea, tingling, numbness or chest discomfort.

Once the procedure is over, the sheath is removed and firm pressure applied to the incision in your groin for approximately 20-30 minutes.  A small dressing will be applied over the incision.  If the procedure is performed through the wrist, firm pressure will be provided by a splint device before the application of a firm bandage.

Post Catheterisation:

After the procedure, you will be returned to the revovery area.  You will have to lie flat in bed for 3 to 4 hours so the puncture site can heal.  If the procedure was through the wrist you will be asked to keep your arm straight.  You will then be allowed to resume eating and drinking.  You may be asked to drink up to two litres of fluids.   This is to flush the x-ray contrast out of the body.  Your blood pressure and pulse, as well as the puncture site and limb, will be checked frequently.  If you feel any pain or discomfort, please let the Nurses know immediately so they can provide you with pain medication or warm blankets if you feel cold.

Results:

Your Cardiologist will discuss your findings with you later that same day before you go home.

Discharge:

Outpatient cases will be discharged on the same day of their procedure.  The Nurse will give you an instruction pamphlet on how to take care of your leg or wrist and will supply several large bandaids for your wound.  When the dressing is removed, you will notice a small bruise at the catheter insertion site, no larger than the size of a 20c piece.  You may also feel a hard lump at the insertion site.  The bruise may become slightly larger and darker the first few days that you are home. The bruise and the lump are the result of the blood vessels’ normal healing process and in one to two weeks will completely disappear.  If you are uncomfortable about the size and appearance of the bruise, or are experiencing any discomfort, please contact your doctor.

Transoesephageal Echocardiography.     Electrocardiography.    Echocardiography.     Holter Monitoring.    King of Hearts Monitoring.    Exercise ECGs.  

Thallium Exercise ECG.           Percutaneous Coronary Intervention.    Insertable Loop Recorder.     Permanent Pacemaker Implant.    Elective Cardioversion.  Electro Physiology.