Coronary Angiography & Cardiac Catheterisation
Cardiac Catheterisation is a general term that describes the procedure of placing catheters inside the heart. Coronary angiography is one form of Cardiac Catheterisation procedure. These procedures are performed in a special x-ray facility called a "Cath Lab" or "Catheter Suite" or “Angiography Suite”. Coronary Angiography is a diagnostic x-ray procedure performed to evaluate the arteries of the heart for the presence of narrowing due to fatty deposits.
The arteries of the heart are called "Coronary Arteries" since they form a crown ("corona") over the surface of the heart.
About the procedure
Coronary Angiography may be performed to further evaluate the cause of symptoms that might include: chest pain or discomfort, shortness of breath, black outs. The procedure involves passing a catheter into the coronary arteries via a needle puncture through the skin at the upper leg or arm.
Prior to your Coronary Angiography, you may be asked to fast for 4-6 hours before the test. You will require a day admission but sometimes it is necessary to remain in hospital overnight. A local anaesthetic is then injected over the artery in the groin (Femoral Artery), the wrist (Radial Artery), or the elbow (Brachial Artery). A sheath is then inserted into the artery, through a needle puncture in the skin. Your cardiologist makes the choice of insertion site.
After a catheter is passed through the puncture site and positioned at the origin of the major coronary arteries, x-ray contrast is injected into the coronary artery, whilst an x-ray movie is recorded.
Most people do not experience any trouble with this procedure, but some people may have nausea or chest discomfort when the dye is injected. Very rarely, there might be a more serious complication. Often, the pumping action of the heart is also evaluated during this procedure. This involves injecting a larger amount of x-ray contrast into the main pumping chamber (called the left ventricle); this will usually cause a hot, flushing sensation that lasts for 10-15 seconds.
The procedure takes 30-40 minutes. Once the test is completed, you will be returned to the recovery ward. The sheath will be removed and pressure is applied to the site until bleeding has stopped. Skilled nurses who are specifically trained to care for patients undergoing cardiac procedures will closely monitor you. Usually, you will be able to go home the same day - people who live alone or a long distance away from Geelong might be asked to stay in hospital overnight.
Coronary Angioplasty & Stenting
Coronary Angioplasty and Stenting are performed to unblock a coronary artery that has developed a narrowing due to build-up of fatty deposits.
The fatty deposits are called by a number of different names, all of which mean the same thing: atherosclerosis, or atheroma, or "plaque". When these deposits form inside the arteries of the heart, we call this coronary artery disease or coronary heart disease.
Coronary Angioplasty and Stenting are collectively known as Percutaneous Coronary Intervention (PCI). These procedures are performed to improve the blood supply to your heart and may be recommended to manage the following conditions: heart attack, angina, an abnormal stress test, congestive heart failure, ventricular arrhythmias.
How is a Coronary Angioplasty performed?
Coronary Angioplasty is performed via a needle puncture through the skin, into an artery in the groin or arm. A special balloon catheter is then positioned inside the artery, across the narrowing, and inflated to stretch up the coronary artery. The plaque is not removed, but instead it is "pushed back into the artery wall".
The long-term success is improved by inserting a stent. This can be thought of as a piece of metal scaffolding that is positioned at the site of the plaque and prevents the plaque protruding back into the artery lumen (the lumen is the channel through which blood flows). Once the coronary stent has been deployed, it cannot be removed. Your cardiologist performing the procedure will choose the appropriate stent for your specific situation.
Your preparation for Coronary Stenting is similar to that for diagnostic Coronary Angiography. However, there are some important differences that you need to know about:
- 1.You must fast for at least 6 hours prior to the procedure
- 2. You will be required to stay in hospital overnight
- 3. If you are not already taking Aspirin, this will be commenced prior
- 4. In addition to Aspirin, Clopidogrel (Plavix or Iscover) will be required
There is a slightly higher risk than diagnostic Coronary Angiography
Electrophysiological Study & Catheter Ablation
Electrophysiological Study (EPS) is a diagnostic test that records the electrical activity from inside your heart.
This test is usually performed to identify the cause of your heart rhythm problem, especially if you have episodes of an abnormally fast heart rate (tachycardia). If you have a tachycardia, your cardiologist might recommend that you have Catheter Ablation performed at the same time as EPS.
These procedures are performed in a special laboratory (called a "Cath Lab" or "Catheter Suite" or “Angiography Suite”) at St John of God Hospital. A day admission is often appropriate, but your cardiologist may recommend an overnight stay.
Carrying out a study
The procedure can be performed under sedation but sometimes a general anaesthetic will be advised. The procedure takes a variable duration of time. No special preparation is required, but you must fast for at least 6 hours prior to the procedure. You may be asked by your cardiologist to stop some of your medications before being admitted to hospital.
EPS catheters will be passed into your heart via a needle puncture into a vein, either in your groin (Femoral Vein), or elbow (Brachio-Cephalic Vein), or neck (Internal Jugular Vein and Sub-Clavian Vein).
It may be necessary to use a combination of these sites. After the catheters have been positioned, a number of recordings are made of the heart's electrical activity and a series of electrical stimulation tests are performed to help initiate your tachycardia. This enables the precise localisation of the tachycardia circuit prior to Catheter Ablation of the abnormal electrical pathway.
During Catheter Ablation, a specialised catheter is used to deliver a radio-frequency pulse at the site of the abnormal pathway. This creates a localised lesion that can permanently block the pathway from conducting your tachycardia.
Permanent Pacemaker
If your heart is beating too slowly, this may cause you to have symptoms such as dizziness, lightheadedness, black outs (also called syncope), shortness of breath, and fatigue. Your Cardiologist may recommend that you have a permanent pacemaker to improve these symptoms and allow you to regain your usual quality of life.
A permanent pacemaker consists of a "pulse generator" and one or more "pacing leads" that connect the pulse generator to the heart.
The pacemaker is essentially a sophisticated battery that is able to detect the electrical activity from your heart and monitor your heart rate. When the pacemaker recognises that your heart rate is too slow, it will apply a small electrical impulse to maintain your heart rate at an acceptable level.
Pacemaker implantation
Implantation of a permanent pacemaker is usually performed in a Cath Lab (“Catheterisation Suite” or “Angiography Suite”) under local anaesthetic and sedation. Sometimes a general anaesthetic may be required, but for most patients this is not necessary.
A small incision is made just below one of your collar bones. A needle puncture is then made into the vein (Subclavian vein) behind the collar bone. Through this needle puncture, one or more pacing leads are passed into the heart and attached inside once a satisfactory position has been achieved. The free end of the lead is then connected to the pulse generator and the wound sutured closed.
After the procedure, you will usually stay in hospital overnight for monitoring in the Cardiac Care Unit. Regular follow up of the pacemaker is then required to ensure it is functioning as expected and to monitor the battery life. Depending on the type of pacemaker and the frequency of impulses, your pacemaker battery could last as long as 10 years before needing replacement.
Appointments will be made for you to attend our Consulting Rooms for your pacemaker checks. Initially this will be about 4 weeks after the pacemaker was implanted. Subsequent checks are performed every 6-12 months, but more frequently, if necessary, as determined by your cardiologist. These pacemaker checks are conducted by a qualified technician and supervised by a cardiologist present at the time.
Your pacemaker may have remote monitoring capabilities, allowing monitoring of your pacemaker from your own home. This can provide your cardiologist with important information about your pacemaker, without the need for you to attend our rooms. This service is especially helpful for those patients who live far away or have difficulty in travelling.
Implanted Cardioverter Defibrillator (ICD)
If your heart condition has a high risk of you developing a life-threatening arrhythmia (VT or VF) you may benefit with having an Implanted Defibrillator (ICD). An ICD is similar to a permanent pacemaker and has the added ability to apply a series of electrical shocks to restart the heart should VT or VF occur. An ICD consists of a "pulse generator" and one or more "ICD leads" that connect the pulse generator to the heart.
The ICD is able to detect the electrical activity from your heart and monitor your heart rate and rhythm. When the ICD recognises that your heart rhythm is either VT or VF it will automatically deliver a series of electrical shocks to restore your heart rhythm to normal. If your heart rate becomes too slow, your ICD will also act as a pacemaker and will apply a small electrical impulse to maintain your heart rate at an acceptable level.
Performing the procedure
Your implanting cardiologist will perform the procedure in a Cath Lab (“Catheterisation Suite” or “Angiography Suite”). A general anaesthetic is often recommended to maintain your comfort.
An incision is made just below one of your collar bones. A needle puncture is then made into the vein (Subclavian vein) behind the collar bone. Through this needle puncture, one or more ICD leads are passed into the heart and attached inside once a satisfactory position has been achieved. The free end of the leads are then connected to the pulse generator and the wound sutured closed. After the procedure, you will stay in hospital overnight for monitoring in the Cardiac Care Unit.
Regular follow up of the ICD is then required to ensure it is functioning as expected and to monitor the battery life. Depending on the type of ICD and the frequency of impulses, your ICD battery could last as long as 10 years before needing replacement. Appointments will be made for you to attend our Consulting Rooms for your ICD checks. Initially this will be about 4 weeks after the ICD was implanted. Subsequent checks are performed every 6-12 months, but more frequently, if necessary, as determined by your Cardiologist. These ICD checks are conducted by a qualified technician and supervised by a Cardiologist present at the time.
Your ICD may have remote monitoring capabilities, allowing monitoring of your ICD from your own home. This can provide your Cardiologist with important information about your ICD, without the need for you to attend our rooms. This service is especially helpful for those patients who live far away or have difficulty in travelling.