The Cardiac Catheterization Laboratory (CCL) at Hackensack University Medical Center is one of the premier services of The Heart Center, which is renowned for its technological advances and expertise in cardiac care. The comprehensive services of the CCL are provided by skilled invasive cardiologists and highly trained healthcare professionals who are friendly and compassionate. The CCL physicians and staff members are dedicated to providing the highest quality of care possible. What is Cardiac Catheterization? Types of Cardiac Catheterization Procedures Patient Preparations for a Cardiac Catheterization What to Expect During a Procedure What to Expect During Recovery Receiving Results Scheduling of Your Procedure Educational Resources and Web Links What is Cardiac Catheterization? Cardiac Catheterization is a procedure during which a small plastic tube, called a catheter, is inserted into a vein or an artery and gradually moved to reach the heart.   The insertion site is the arm or groin, one of which is cleansed and numbed after the patient is sedated.   A small incision is then made that enables access to the chosen vein or artery through an introducer sheath (a small, plastic tube used to enter a vein or artery).   The Cardiac Catheterization Laboratory (CCL) is equipped with special imaging equipment that allows the physician to view the catheter as it is threaded towards the heart.   Once inside the heart, x-ray pictures are taken, various cardiac functions are studied and treatment of certain conditions can be performed, if needed. Return to Top Types of Cardiac Catheterization Procedures and Why They Are Done The term "cardiac catheterization" applies to any procedure that requires the insertion of a catheter into the heart. Some of these procedures are done to diagnose diseases or abnormalities, while others are done to access the heart for treatment or correction of certain conditions. Types of cardiac catheterization procedures include:   Angiography (also called an angiogram)   Non-Surgical Coronary Intervention           These procedures include:(Coronary Artery Disease)           (Angioplasty,   Laser Angioplasty,           Atherectomy and Stent Implantation)   Valvuloplasty Angiography — Coronary angiography, also called an angiogram, is a diagnostic tool during which a contrast dye is injected through a into the heart. This enables an image of the coronary arteries to be displayed on a monitor. These images reveal the location and approximate size of any blockages that are found, and the pumping ability of the heart can also be obtained. Depending on the reason for this procedure, you may have a second catheter inserted to record pressures in the heart’s chambers and to obtain blood samples. This procedure can help to detect:   blockage of the coronary arteries   valve disorders   abnormalities in the heart’s pumping function   congenital heart disease. Return to Top Non-Surgical Coronary Intervention — If your angiography reveals Coronary Artery Disease (narrowing or blockages in the arteries that restrict blood flow to the heart), your cardiologist may then perform a Non-Surgical Coronary Intervention to remove the obstruction from the arteries and replenish the blood flow to the heart. There are four types of Non-Surgical Coronary Intervention procedures that are used to open an obstructed artery, and your physician determines which type is appropriate based on your individual needs. These procedures include: angioplasty, laser angioplasty, atherectomy or stent implantation. Angioplasty — During an angioplasty, also called percutaneous transluminal coronary angiography (PTCA), a catheter is guided directly to the blocked vessel. A tiny, deflated balloon is passed through the catheter to the site of the obstruction. The balloon is inflated to compress the plaque against the walls of the artery, flattening it out so that blood can once again flow without obstruction. Since a balloon-tipped catheter is used, this is also referred to as a "balloon angioplasty." Laser Angioplasty — During this procedure, the obstruction is removed from an artery with the use of laser energy that is sent through a special metal-tipped catheter. The blockage is vaporized and then cleared from the body. Atherectomy — During atherectomy, the cause of obstruction in an artery is removed in one of three different ways: 1. Soft plaque is shaved from the artery wall, stored in the catheter tip, and then removed from the body when the catheter is withdrawn. 2. Hardened plaque is removed with a rotary implement called a rotablator. As the name implies, this implement “roto-rooters” hardened plaque from the artery. The particles are microembolized and eliminated from the body through the circulatory system. 3. A thrombus, simply described as a blood clot, can also obstruct the blood flow in an artery. A transluminal extraction catheter (TEC) is a suctioning device that removes the thrombus by vacuum extraction. Stent Implantation — A coronary stent is an expandable mesh tube (about one-half inch long) that is placed in an artery to maintain the free flow of blood through the vessel following an angioplasty or atherectomy. The mesh-like tube is inserted (while collapsed) into the artery by mounting it onto a balloon-tipped catheter. Once it is positioned in the area where the plaque was compressed or removed, the balloon is inflated, which then expands the stent and implants it against the coronary artery walls. Valvuloplasty — Valvuloplasty is a non-surgical technique used to treat valve disorders, such as valvular stenosis, which is the narrowing of a heart valve. To correct this condition, the valve is dilated by means of a balloon tipped catheter, which is inflated and deflated several times to expand and widen the valve opening. Return to Top Patient Preparations for a Cardiac Catheterization   Fasting Requirements: You will be instructed not to eat or drink anything after midnight prior to your procedure.   Medication Considerations: If you are diabetic, it is important for you to discuss with your physician how to adjust insulin and food intake prior to your procedure. If you are taking prescription medications, you should discuss with your physician whether you should continue to take your medications on the day of your procedure. Patients who take blood thinners, such as Coumadin, will be advised by their physicians to stop taking this medication for a period of time prior to their cardiac catheterization.   Transportation upon Discharge: Since you will be sedated during your procedure, you must have someone with you to drive you home, unless you are staying overnight. You should pack a small bag of overnight essentials in the event you do stay overnight. Most patients who undergo a routine angiography will be able to go home the same day after spending some time in the Cardiac Day Accommodation Room (CDAR). If your physician performs an interventional procedure, you will stay overnight for observation during your recovery period. Return to Top What to Expect During a Cardiac Catheterization Procedure   You will be awake during the procedure; however, you will be given sedation to make you drowsy.   Your heart rate, rhythm, and blood pressure will be continuously monitored.   The area where the sheath will be inserted will be numbed with a local anesthetic medication. While the sheath is being inserted you may feel slight pressure.   The catheter is inserted through the sheath and threaded to the heart. While the catheter is moving through your body you should feel no pain.   Dye may be injected into the arteries that supply blood flow to your heart. You may experience a warm, tingly sensation as the dye goes through the arteries.   When x-ray pictures are taken, you will be asked to take deep breaths and hold your breath for a few seconds. You may also be asked to cough a few times.   If the dye is injected into your left ventricle, which is the pumping chamber of the heart, you may experience a "hot" sensation all over your body that will pass quickly.   If a balloon tipped catheter is used during your procedure, you may experience slight chest discomfort or a change in your heart rate as it is inflated. This feeling will pass quickly when the balloon is deflated.   The estimated time that it takes for cardiac catheterizations are: 30 to 45 minutes for a routine angiography; one to two hours for coronary intervention procedures (angioplasty, laser angioplasty, atherectomy or stent implantation); and one to two hours for a valvuloplasty. Return to Top What to Expect During Recovery Once you are back in your room, instructions will vary depending on the type of cardiac catheterization that was performed.   A nurse will continue to monitor your heart rate, blood pressure, and pulses near the insertion site, which will be continually observed as well.   You will be instructed to lie flat with your head slightly elevated at a 30-degree angle. For a routine angiography, this time period will last for two to six hours. A longer time period is required for interventional procedures.   If the insertion site was in your groin, you will be asked to not move your leg, which prevents bleeding.   It is important that you drink plenty of fluids to help flush the dye out of your body.   The sheath will be removed several hours later or the next morning, depending on the type of procedure. Some patients will have a closure system placed in the insertion site by their cardiologist, in which case, there will not be a sheath to remove.   If a sheath needs to be removed, direct pressure will be applied to the insertion site for approximately 20 minutes to prevent any internal bleeding. Sometimes a sandbag is then placed on the site for this purpose. Your vital signs will continue to be monitored during this time. You will again be instructed to lie flat with your head slightly elevated for several hours and not to move your leg if the insertion site was in your groin.   Once the bleeding has stopped, a dressing (bandage) will be applied.   Upon discharge, most patients require only minimal restriction of their daily activities. Return to Top What Signs And Symptoms Should Be Reported Immediately? You should immediately inform your nurse if you feel weak or dizzy; are short of breath; begin bleeding; or experience any discomfort or sudden pain at the insertion site or in the chest, neck, jaw, arms or upper back. Your physician will discuss with you the risks of undergoing a cardiac catheterization, which are considered small. However, it is an invasive procedure, which is why you will be closely monitored during your recovery period. Most of the complications associated with cardiac catheterization are minor with no long-term effects. Bruising to the area where the catheter was inserted may occur but is only temporary. Some patients experience nausea and vomiting or an allergic skin reaction. Others may experience temporary heartbeat irregularities. More serious complications are rare; they include damage to blood vessels, blood clots, infection, abnormal heart rhythms, heart attack or stroke. Receiving Results Detailed written reports are sent to your referring physician(s), but you will be told the results immediately following the procedure while you are still in the Cardiac Catheterization Laboratory. The cardiologist who performed your procedure will then meet with your family member(s), who will be invited to wait in the Family Lounge located on 4 Main. The Family Lounge is equipped with a television and a refreshment area where free coffee and tea are available. A public phone is also located in the lounge and rest rooms are nearby. Scheduling of Your Procedure A cardiac catheterization is scheduled by the office staff of your referring cardiologist or physician. They will inform you of the date and time of your scheduled procedure and will also arrange your pre-admission testing (blood work and an EKG) Return to Top Educational Resources and Web Links   American Heart Association