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What is a Cardiac Catheterization?

This procedure is nonsurgical and is performed under x-ray guidance in the cardiac catheterization lab by Dr. Mishkel. You will be given medications that make you relaxed. You and Dr. Mishkel can decide your level of sedation, keeping you either more awake or sleepier.

A catheter (a long, thin, flexible tube) is inserted through an artery in the wrist or groin, and the x-ray is used to guide the catheter up to the heart. You will be shaved in both areas in case one access site is not successful.  A contrast agent is injected through the catheter, and special x-ray pictures are taken of the heart and coronary arteries.  Please let us know if you have had prior allergic reactions to this agent.

Why is a Cardiac Catheterization done?

This procedure is performed based on your history, symptoms, results of a physical exam and other tests. This procedure will help to evaluate the following:

  • How well your heart and valves are working.
  • The extent of damage to the heart after a heart attack.
  • Which coronary arteries are narrowed and the extent of the blockage(s) and your risk of incurring a heart attack.

It will determine which of the following treatments is required:

  • Management with medications only
  • Balloon angioplasty (PTCA) or Stent: performed at the time of catheterization or may be scheduled at a later day.
  • Balloon angioplasty (PTCA) is a procedure in which a balloon catheter is inserted into a blocked coronary artery. The balloon is then inflated and the narrowed artery is widened. This improves blood flow through the artery. The cardiologist then removes the balloon catheter.
  • Stents are tiny, mesh-like tubes made from stainless steel. They are placed permanently inside an artery to hold it open after a balloon angioplasty.
  • Drug coated stents have a lower re-blockage rate than bare metal stents. They may require a longer blood thinner duration of therapy. Dr. Mishkel will discuss this with you.
  • Open heart surgery (performed by a cardiac surgeon) at a future time.
  • During the angiogram, another adjunctive procedures can be performed (intravascular ultrasound or pressure interrogation) to further guide a stent procedure.

What symptoms may be experienced during the procedure?

  • Slight discomfort or pressure as the catheter is being inserted.
  • Slight nausea, extra heartbeats, and/or warm flushing sensation throughout the body (10-20 seconds) as the contrast is being injected.
  • If an angioplasty is performed and/or a stent is placed, chest pain may occur as the balloon is being inflated, but is only temporary.

What happens after the procedure?

  • After the procedure, the sheath is often removed immediately from the wrist, and a wrist strap is placed to prevent any bleeding.
  • This strap is removed over the course of an hour or two. Bed rest is brief, usually only one hour.
  • If the groin is used, a closure device may be placed in the artery and bed rest is longer: 3-4 hours. Sometimes with groin access the sheath must be manually pulled and firm pressure applied for 15-30 minutes. This will be done 2-3 hours after the procedure after all the blood thinners have worn off.   A further 2-3 hours of bed rest is then necessary.
  • Your blood pressure will be checked frequently.
  • A knot may occur under the skin at the insertion site along with some bruising. This is temporary and will usually disappear over ensuing weeks.

How long is the hospitalization?

  • If a cardiac catheterization was performed without balloon angioplasty or Stent, most patients are discharged the same day – usually it is within eight hours after a sheath is removed
  • If an angioplasty is performed and/or a Stent is placed, most patients will be able to go home the day following the procedure

What signs and symptoms should be reported to the cardiologist?

  • Any discomfort in the chest, neck, jaw, arms or upper back, or shortness of breath
  • Discomfort or sudden, severe pain at the insertion site
  • Bleeding or swelling from the insertion site
  • If you develop a fever
  • Do not be concerned if bruising or discoloration develops in the groin or thigh or wrist