Procedures in Cardiology: Cardiac Catheterization for Diagnosis and Treatment of Heart Disease

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Guest: Dr. Eric Powers - Director, Acute Coronary Syndrome Center

Host: Dr. Pamela B. Morris

Dr. Pamela B. Morris: I am Dr. Pamela Morris. This is Heart Sounds and I am talking today to Dr. Eric Powers, Director of the Acute Coronary Syndrome Center at the Medical University of South Carolina in Charleston, South Carolina. Dr. Powers, a lot of patients with chest discomfort need to undergo diagnostic procedures to help their doctor better understand what could be the cause of their chest pain. One of these is a heart catheterization or cardiac catheterization, could you explain to us a little bit about what that procedure can help their doctor to understand?

Dr. Eric Powers: The heart catheterization is a test, which gives great detail about exactly what is wrong with the heart or whether or not the heart is in fact not diseased. By great detail, I mean that this test looks at the arteries who supply blood to the heart and can show exactly the status of those arteries whether there are blockages, whether there are several arteries, which are blocked and also exactly what kind of treatments would be best suited for that particular patient.

Dr. Pamela B. Morris: Now, I know that the catheterization is done in a room that looks very much like an operating room and all of the personnel are dressed in gowns and sterile gloves, is this is like surgery, does it require anesthesia, is it painful?

Dr. Eric Powers: The way these tests are usually done is through a small tube, which is placed into a blood vessel, usually placed in the groin area, sometimes in the arm, and sometimes in the side of the neck as well. This requires local anesthesia, it does not require general anesthesia. It is not particularly uncomfortable. The discomfort is really that associated with placing the local anesthetic into the area where a needle and then a small tube will be placed.

Dr. Pamela B. Morris: Though the patient is awake during this procedure and in no discomfort, do -- are they able to discuss the results and the findings with the doctor as the procedure goes along?

Dr. Eric Powers: Yes the patients are awaked during the procedure. We give enough medication so the patient will be relaxed, but in general, patients are awake and we can discuss the results as we are proceeding with the patient. So, yes the patient can be very much involved with any decisions that are made during the procedure.

Dr. Pamela B. Morris: Now, one of the decisions I understand that is sometimes made is whether or not in interventional procedure like a stent or balloon is necessary, is that a decision that’s made at the time of the procedure or does the patient return to their room and do it at a later date, how are those decisions made?

Dr. Eric Powers: Usually if an intervention such as a balloon procedure or the placement of the stent, usually if one of those is going to be done, it’s done right at the same time as the diagnostic procedure. The way this usually happens is that prior to the catheterization, we will discuss with the patient what the possible findings would be and among those possible findings would be a blockage or blockages in the artery supplying blood to the heart, which would be best treated by a balloon or a stent, so we usually have that conversation before the procedure takes place. If as the procedure then proceeds if it turns out that that is the right thing to do, what we would typically do is tell the patient that we had found a blockage or blockages that would be treated by balloons or stents and then we would go ahead and perform that treatment. Now, there are certain exceptions that rule that sometimes when we will be doing the diagnostic part of the procedure where we will identify blockages or a blockage in which the best treatment for it is not certain, meaning it might be treated just with medications or might be treated with balloons and stents or in fact it might be treated with bypass surgery. If there is uncertainty concerning what the best treatment is or if there are some other issues, which need to be discussed, we can certainly stop, have that discussion at later time and then do the appropriate treatment once those discussions have taken place.

Dr. Pamela B. Morris: What is the recovery time involved after just a diagnostic catheterization and also what would be the recovery time after you have had a stent placed?

Dr. Eric Powers: Ordinarily, the duration of the test itself now before the recovery, the duration of the test usually is anywhere from 15 minutes to an hour. After the procedure is complete, we usually have patients lie down fairly still for several hours after the procedure. What this means is that after a typical diagnostic heart catheterization, patients are back up and able to leave the hospital in approximately four hours. If an intervention is done, we usually keep patients in the hospital overnight and discharge on the following day.

Dr. Pamela B. Morris: One of the things I think that is always a concern to patients in this day in time are some of the potential complications of medical procedures, what are some of the risks associated with a heart catheterization?

Dr. Eric Powers: Every medical procedure has potential complications and risks and so a decision to do a catheterization takes into account both a possible benefit that the patient can get from the procedure, but also the risks and possible complications. I am happy to say that the risk of a serious complication with a heart catheterization procedure is very, very low and by very, very low I mean it’s the risk of having a significant complication is much less than 1 in a 100, much less than 1% and probably is more in the range of 1 in 500 or 1 in a 1000 that a significant complication may occur.

Dr. Pamela B. Morris: Well, thank you so much for discussing this procedure here with us today.

Dr. Eric Powers: You’re welcome.

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