The department of Cardiovascular Internal Medicine

A Talk of heart disease,Cardiac Catheterization

Cardiac Catheterization

Tube means catheter in Latin,
There are many kinds of examinations for different purposes, we generally call examinations conducted using this catheter, “Cardiac catheterization”.
Angiographic examination It is an examination performed with radio-imaging agent such as coronary arteriography.
Left ventriculography examination It examines the movement of left chamber of the heart and backflow of mitral valve.
Intracardiac pressure measurement and inspection Examination for measuring the Intracardiac pressure, in condition of cardiac failure It measures the blood pressure of the heart, to examine to which degree the heart is strained. The blood pressure of the heart increases as the heart is strained in a state of cardiac failure.
Oxygen saturation test It measures the level of oxygen, to examine if there is any abnormality in blood flow caused by congenital heart problems etc.
Electrophysiological test It examines if there is any abnormal cardiac rhythm or needs for cardiac pacemaker.

Flow of examination/ treatment

Examination is completed in one day.

Before examination:
  1. Examinations such as echocardiography, blood sampling, cardiac electrogram, ABI (Ankle Brechial Pressure Index) are conducted beforehand.
  2. Doctor will explain to you about contents of examinations you are to undergo and their possible complications.
The day before your examination day:
  1. According to contents of examination, we may ask you to stop taking medicines you’ve been taking (antihypertensive drug). If that applies to your case, doctor will explain to you in person.
On the examination day:
  1. if it starts in the afternoon, you can eat breakfast. Drinking water is allowed as well. Examination will be conducted with local anesthesia in wrist, elbow, groin etc. You will be remained conscious, if anything happens, please don’t move and inform us by words. You might experience some symptoms due to the medicine used in the examination, your hands might feel hot, your mouth might feel cold, or you might experience an uncomfortable feeling in your elbow but, they are all temporary that there is no cause for concern.

Treatment will be conducted in 2 days and 1 night.

  1. Please take therapeutic medicine prescribed before your treatment on the day of your examination, too.
    By any remote chance, if anything unusual occurs, consult with medical staff as early as possible. On the day of examination, we, in principle, ask your family to accompany you,
  2. as there is an explanation about your treatment.

Coronary Angiogram

Change clothes and move to Catheterization laboratory in a wheelchair while put on a drip
We put electrocardiogram stickers on your body, on an examining table.
We sterilize (Isodine) the wrest (elbow, thigh, neck)
Local anesthesia (Xylocaine) is applied to the catheter insertion site.
We insert a sheath which is approx.1.5mm (1.5-3mm) in diameter into an artery, making a path for a catheter.
We pass a catheter through an (radius) artery in the wrest to the gate of coronary artery
We perform coronary angiography
We remove all the catheters and stop the bleeding by applying a firm pressure to the artery with a tourniquet. The time until bleeding stops is 3 hours on average.
You leave Catheterization laboratory in a wheelchair.
Examination time: about 10-20 minutes
Amount of radio-imaging agent: 50cc
Fluoroscopy time: about 1-3 minutes
*When it is performed with other examinations such as lower extremity angiography examination, the sites where catheters will be inserted, the examination time and the amount of radio-imaging agent change according to the contents of examination.
*The time required for the blood to stop bleeding is different with each person being influenced by the contents of medicine and size of its tube.

Cardiac catheterization and its considerable complications

Various kinds of technological innovation have contributed to accuracy of testing, improvements in its speed and risk of complications has surely decreased but still we are sorry we are not able to removing the risk all together, there are still people who develop complications for constitutional reasons. We ask for your understanding of the examination, we try as hard as possible to provide our patients with early detection and early treatment.
  1. Risk of Death
    Frequency is approx. 0.02% which is 1-2 person(s)/10,000 people
  2. Acute Myocardial Infarction
    There is a risk of breast pang developing into heart infraction during the examination.
  3. Emergency coronary artery bypass surgery
    Emergency coronary artery bypass surgery becomes necessary at the frequency of approx. 0.02%.
  4. Cardiac tamponade
    Blood is pooled around the heart, and it causes a state of shock when the heart is pressed. It is recovered once the blood pooled around the heart has quickly been removed.
  5. Allergic reaction
    There is a mortality rate of 1/100,000 people who die due to allergies Once allergy is triggered by radio-imaging agent, it causes more serious allergic reaction if the same radio imaging agent is used again. In most cases, the rejection is prevented by using different radio-imaging agent and applying injection drug to control allergic symptoms. However, If you have any allergy, please inform us beforehand.
  6. Bleeding
    While the blood pressure of blue pipe (the vein used for drips and blood sampling) is sucked by the heart is about 20mmHg, the blood pressure of arteria is over 100mmHg, which makes it easier to bleed.
    It is necessary to pressing it tightly(compression) after the examination.
  7. False aneurysm
    A risk is involved when it bleeds a lot after the examination, the arteria into which a catheter has been inserted might be swollen and a surgery might be necessary then.
  8. Embolic disease
    There is a risk of the arteria being clogged up by blood clot and skinned fatty deposit, developing cerebral infarction and arterial embolism.
  9. Infection disease
    There is a risk of being infected with bacteria, not only during the examination but also after that, from the wound.
  10. Neurological damage
    There is a risk of developing muscle atrophy and motor disorder resulted from compressing outside of nerves due to bleeding after the examination.
    We respond to it by prescribing oral medicines.
  11. Pneumothorax
    Once a hole is perforated in the lung and the lung becomes shrunken, it leaks the air outside, expanding it by inhaling air from outside becomes necessary.
  12. Irregular heartbeat
  13. Dissection of the vessel
    There is a risk of hurting blood vessels