Cardiac catheterization

[Protimenow]

My last few cardiac caths / angiograms were done through the wrist. Cardiac caths are both diagnostic and possibly curative (if you need a stent, they'll put one in,

If they detect a bigger problem that requires surgery, they may do it right away -- or give you the option to schedule surgery -- your medical approval form for the cath probably has language about surgery.

As far as flying after a procedure like this, I have no idea.

 

[V__]

1). How soon can you fly home after this procedure?

Don't know about flying. But driving same day is not a good idea. They use sedation to avoid you moving around. So the reflexes are not there after that...

3). I've seen the data, but what has your cardio told you about the efficacy/accuracy of catheterization as compared to CT, in terms of: coronary blockage, aortic stenosis, and aortic dilatation?

From talking to 2 cardiologists, the catheterization is the best ("golden standard"). That said, CT is rather close. And may reveal a small plaque that the catheter device didn't "see". (Happened to me, since my cardiologist ordered CT to be "more expeditious" with the pre-surgery planning.)

4). How soon can surgery be done after this procedure in an asymptomatic person? I'm guessing there may be some waiting time? (The wait for surgeons in BC is about 2 - 3 months, so this question may be a moot one, but I'm curious).

I had the surgery about 10 days after the catheterization. But that's not very surprising - the procedure was ordered by the surgeon to double-check on the plaque extent, as a part of pre-surgery planning.

V_

 

[oo0My_Valve0oo]

I had it done 2 weeks before OHS. The OHS was scheduled and this was preparation so the surgeon would know what to expect and what he might be doing in addition to replacing a valve. I had planned to keep working after the procedure and up until the weekend before the surgery on a Monday. However the doc performing the procedure told me not to return to work until after the OHS. As someone else indicated, due to the meds used you cannot drive yourself home that day. My medical organization requires you to be driven to and from such procedures. They will not admit you if your ride is not present. I suspect it is a matter of making sure they do not waste their time and space waiting for someone’s ride to show up. Cancer runs in the family and I have had more frequent screenings. A surgery center has dumped me into my ride’s vehicle so fast it is an assembly line. I did an online search and it is reported that flying is possible after ”a few days” to a week but that is something your doctor would determine considering the results and your overall condition.

 

[BionicBuddy]

I had it done 2 weeks before OHS. The OHS was scheduled and this was preparation so the surgeon would know what to expect and what he might be doing in addition to replacing a valve.

Why did your cardio and/or surgeon opt for the catheterization angio vs the CT angio?

 

[oo0My_Valve0oo]

Why did your cardio and/or surgeon opt for the catheterization angio vs the CT angio?

I did not discover this forum until I was recovering from OHS. Unlike many here I do not comprehend all of the details and speak with the language. I just went with the flow because it had been made clear OHS was inevitable and needed ASAP. Doctors described what was being done as it all unfolded but I do not remember everything.

Regarding my OHS event, meaning from first exam by PCP for symptoms directing me to have valve replaced up to and including getting a pacemaker most recently, I have had 2-3? CT’s and 2? cardiac catheterizations. I may have had a CT before the cardiac catheterization. I have had both and more than three total, I remember that much. I don’t think the cardiologist I had at the beginning made a point of saying why catherization instead of CT. They were presented individually as I was to have them done rather than in a context of one vs. the other.

Note: the cardiologist had said if they found something during the cardiac catheterization they would be repairing it during the procedure however when I was speaking with the performing doctor’s assistant prior to the CC he stated that they would leave it for the surgeon to repair because addressing it 2 weeks before surgery would mean the surgery would have to be delayed. This was one of multiple errors the initial cardiologist made. Maybe the cardiologist had scheduled the CC when a CT would have been appropriate but there was no time to reschedule so everyone followed through? This cardiologist later scheduled a stress test I could not do because I had AFib and it would produce a false negative. The technician caught the mistake as soon as she hooked me up and saw a pattern. Yet the AFib was present in 5 of my EKG’s the tech pulled up from my history. That cardiologist retired a few months later. In 2023 I received a new cardiologist. The new one is very competent, knowledgeable, thorough, enthusiastic, empathetic and generous with his time and knowledge.

 

[Protimenow]

You can drive TO the place where you have your cardiac catheterization, but not home,

When I have procedures, or am concerned that I'll be kept in the hospital overnight or longer, I take Uber to and from the procedure if I can't find a friend that I can trouble for a ride.

 

[oo0My_Valve0oo]

You can drive TO the place where you have your cardiac catheterization, but not home,

When I have procedures, or am concerned that I'll be kept in the hospital overnight or longer, I take Uber to and from the procedure if I can't find a friend that I can trouble for a ride.

Not in my area. If you have any procedure involving sedation or strong pain medication they require family, friend or a care service to and from the facility in most cases. Specifically anything like Uber, driving yourself or taking a bus are not allowed. I used to have a healthcare provider local but now there is not a hospital closer than 25 miles away. For my cardiac catheterization I had no option but to use a care service and it cost me $500 and would have been $1000 but I was misquoted and they honored their error. Believe me I tried to at least drive to the facility.

 

[V__]

The recent emails jogged my memory, so a few more comments.

I agree with oo0My_Valve0oo , that a doctor should determine the suitability of flying. My cardiologist asked me not to travel before the surgery. On the other hand, many people do exactly that going to Cleavland Clinic for the surgeries. It's possible that the advise I got was due to long flight duration (going overseas). But it feels more likely that this depends on details and symptoms.

Yes, a doctor can try to fix the blockage during the angio procedure. As I understand it, "it depends" whether they will actually want to do that. Whether agnio or OHS is better was a point of debate. Until a large-scale study from Stanfor 2-3 years ago indicated that OHS is better for the long-term outcome. The difference is not large (a couple of percentage points), but the surgeons really optimize the outcome.

That said, the acute cases of heart attack usually get agnio fixes with stenting. The CABG (OHS to do bypass) is still frequent (like, 40% in the USA), but reserved for chronic issues. My guess is that these choices are driven by availability question and the procedure time. Agnio can be done by a doctor with 2 assistants. OHS requires that a team of about 10 people (different kind of specialists) working side by side for a few hours. The team is probably not always available. And agnio is much faster - this must be important when a part of the heart doesn't get the blood supply.

If one of the surgery goals is to do "something else" and coronary arteries need fixing, they'll try combine the procedures. This is, again, to optimize the outcome.

Finally, it seems initially CABG was done with a leg vein. It's nice to use (a smooth large "pipe"). But the long-term outcome is better with using arteries, either one from an arm, or a "large mammalian" thing. The difference seems to be due to the very different physical systems. Veins experience a smooth blood flow, and may not be as good (as arteries) for the more demanding application of the pulsed blood flow in the coronary arteries. I don't know how prevalent these methods are right now. But they require different techniques, and (if I were you), I'd ask the surgeon about what he'd like to use, if you need CABG.

 

[Hyp2r]

I’ve had 2 angiograms and for both of them I had absolutely no sedation. The Cardiologist talked to me all the way through (actually there were around 10 students watching both procedures) and discussed what he was seeing.

Apart from a little pain in my wrist where he put the catheter ( a little local anaesthetic) I didn’t really feel anything.

 

[Protimenow]

For my last cardiac cath, I asked the doctor to let me see it.

He tried, but the pain in my wrist was too much for me,

 

[oo0My_Valve0oo]

I’ve had 2 angiograms and for both of them I had absolutely no sedation. The Cardiologist talked to me all the way through (actually there were around 10 students watching both procedures) and discussed what he was seeing.

Apart from a little pain in my wrist where he put the catheter ( a little local anaesthetic) I didn’t really feel anything.

Apparently use of sedation is widely varied and depends on several factors.....just going off a Google search for info. An angiogram is a visual examination like an X-ray and is noninvasive. Cardiac catheterization involves inserting a probe / catheter though a blood vessel. Many are introduced at the groin and are usually painful enough to warrant pain medication. You must remain still so many are performed under sedation.

It has been a while and I was not trying to memorize everything discussed. I prefer enough sedation that I am not aware of things as they are performed. Most patients opt for some sedation which also leads to forgetting the process by the time the sedative wears off.

An aside, I had a pacemaker implanted on 5/16/23. I still have pretty good memories of everything. I always inquire and say my preference. The surgeon had said they would knock me out but I was awake the entire time. I also felt enough of the pain that I told the surgeon I was feeling everything they were doing. I felt everything but not all of it as pain. I did not specify that. This was well into the procedure. Because I was so aware I had some idea of what they had accomplished at that point. She instructed someone to increase something intravenously but I felt no difference. What I was feeling was not intolerable but I was close enough that I did not want to risk it getting worse. It seemed like maybe 10 more minutes and they were done. I still consider that a great experience because the team was very healthy. The surgeon was very accessible. They worked together well. They had great attitudes. It was an all around good vibe.

As I write this I am remembering a cardiac catheterization in which I was awake. When they inserted the catheter I started thinking I wanted this over with and it had only just begun. Maybe it was the idea of them inserting a probe through a blood vessel itself that bothered me more than any pain. There was a point when it could have gone on and on but it ended sooner than expected. But I am not certain they did not eventually knock me out and I only remember the insertion and waking up. The other one I was knocked out at least enough that I forgot everything once the sedation wore off.

 

[Hyp2r]

Apparently use of sedation is widely varied and depends on several factors.....just going off a Google search for info. An angiogram is a visual examination like an X-ray and is noninvasive. Cardiac catheterization involves inserting a probe / catheter though a blood vessel. Many are introduced at the groin and are usually painful enough to warrant pain medication. You must remain still so many are performed under sedation.

It has been a while and I was not trying to memorize everything discussed. I prefer enough sedation that I am not aware of things as they are performed. Most patients opt for some sedation which also leads to forgetting the process by the time the sedative wears off.

An aside, I had a pacemaker implanted on 5/16/23. I still have pretty good memories of everything. I always inquire and say my preference. The surgeon had said they would knock me out but I was awake the entire time. I also felt enough of the pain that I told the surgeon I was feeling everything they were doing. I felt everything but not all of it as pain. I did not specify that. This was well into the procedure. Because I was so aware I had some idea of what they had accomplished at that point. She instructed someone to increase something intravenously but I felt no difference. What I was feeling was not intolerable but I was close enough that I did not want to risk it getting worse. It seemed like maybe 10 more minutes and they were done. I still consider that a great experience because the team was very healthy. The surgeon was very accessible. They worked together well. They had great attitudes. It was an all around good vibe.

As I write this I am remembering a cardiac catheterization in which I was awake. When they inserted the catheter I started thinking I wanted this over with and it had only just begun. Maybe it was the idea of them inserting a probe through a blood vessel itself that bothered me more than any pain. There was a point when it could have gone on and on but it ended sooner than expected. But I am not certain they did not eventually knock me out and I only remember the insertion and waking up. The other one I was knocked out at least enough that I forgot everything once the sedation wore off.

Not too sure. A coronary angiogram involves inserting a catheter into a blood vessel into either arm or groin to get into the heart where it releases dye that is tracked by x-ray. It is quite invasive. Stents can be inserted at the same time if needed.
A cardiac ablation, which I have also had, is where a catheter is inserted in the groin along with other instruments, into the heart to either burn or freeze areas inside the heart to disrupt faulty electrical signals. I definitely had sedation for this but can still remember discussing what was happening with the Cardio Electrophysiologist carrying out the procedure.

 

[oo0My_Valve0oo]

Not too sure. A coronary angiogram involves inserting a catheter into a blood vessel into either arm or groin to get into the heart where it releases dye that is tracked by x-ray. It is quite invasive. Stents can be inserted at the same time if needed....

Sorry I can comprehend many complicated things but I find medical terms and math challenging. It can be less confusing not using the terms to describe what is being done.

There is more than one which involves a catheter slid through a vein up to the heart and dye may or may not be utilized. Same with the approach which doesn't involve a catheter slid up to the heart. If a catheter is slid through the groin or arm it can be painful.

I had two procedures when a catheter was slid through my arm. At least one I received sedation requiring a ride. I have had (no tube slid through body to heart) x-rays of my heart with contrast dye and without. Those I drove to and from the hospital myself if I wasn't an inpatient.

I have not had an ablation. It sounds like what my friend had done several times years before heart conditions were on my radar. All failed to attain the objective. She was left with little stamina and constantly fatigued. She had to switch from full to part time. She retired as soon as possible.

 

[carolinemc]

Sorry I can comprehend many complicated things but I find medical terms and math challenging. It can be less confusing not using the terms to describe what is being done.

There is more than one which involves a catheter slid through a vein up to the heart and dye may or may not be utilized. Same with the approach which doesn't involve a catheter slid up to the heart. If a catheter is slid through the groin or arm it can be painful.

I had two procedures when a catheter was slid through my arm. At least one I received sedation requiring a ride. I have had (no tube slid through body to heart) x-rays of my heart with contrast dye and without. Those I drove to and from the hospital myself if I wasn't an inpatient.

I have not had an ablation. It sounds like what my friend had done several times years before heart conditions were on my radar. All failed to attain the objective. She was left with little stamina and constantly fatigued. She had to switch from full to part time. She retired as soon as possible.

All you need to know it this, what takes place during the catherization and what they are mainly looking for, clogged arteries and other issues. Just try to relax. Ask your Cardio or his/her nurse to explain in layman's terms of what they are looking for in particular.

 

[Protimenow]

Actually, I want to KNOW what they're doing, HOW they'll do it, and WHY they're doing it. Ignorance isn't always bliss -- especially if my life is on the line.

When I had my last attempted ablation, I was awake much of the time and appreciated that I could see what was going on. They didn't find a bad area so they gave up their search for something that wasn't there -- my arrhythmias were caused by cardiomyopathy, rather than something electrical.

 

[BionicBuddy]

3). I've seen the data, but what has your cardio told you about the efficacy/accuracy of catheterization as compared to CT, in terms of: coronary blockage, aortic stenosis, and aortic dilatation?

I'm answering my own question in case it may be helpful for others.

Clearly, there are very different ways of doing things regarding surgery, hospitals, in different countries, testing, etc. That's why they call medicine an art, even though guided by science.

Our cardiologist last November said hubby would need a CT angio in preparation for surgery next year (2023). In May he said the waitlist for CCTA now is 1 year, and the waiting list for CT catheterization is 8 weeks. As someone above mentioned, catheterization is the gold standard.

Because hubby is extremely healthy (except for a horrendously calcified AV) and with the cholesterol and BP readings of a teenager, the incidental findings of coronary artery disease on any type of angio would be less likely, we're hoping. And as you all know, prior to OHS, some type of angio is standard protocol in case bypass surgery is necessary.

We have opted to go to a private clinic which costs $2200 to do the less invasive CCTA if we can make the flights work out, which can be done in 2 - 3 weeks time.

Our cardio said that if the CCTA was abnormal, hubby would have to do the gold standard angio anyway.

The reason I asked this question, is because my girlfriend in New York, her husband just had OHS for a benign atrial myxoma and they did his CCTA the day before his surgery. I thought, gee, those docs in NY sure have a lot of confidence in their CCTA testing, because our cardio wants the gold standard done if the CCTA is abnormal.

Anyway, I don't know if this helps anyone, especially those in Canada, but there are sure a lot of different approaches in medicine. It's an art, to be sure.

 

[BionicBuddy]

1). How soon can you fly home after this procedure? (regarding coronary angiogram catheterization)

I'm answering my own question again. We can fly home 24 hours after procedure.

(Well we are saving ourselves $2200 to forgo CT angio at a private diagnostic clinic, as cardio wants coronary catheterization angio at this point, now that he has looked at hubby's ECG, and due to being the "gold standard").

It's so important to trust and have respect for your cardio, or work with someone you do.

I'm curious. Prior to SAVR, has anyone ever felt quite healthy (almost asymptomatic) and had an ECG that showed myocardial ischemia, not due to coronary artery occlusion, but because of the valvular problem? i.e. an ECG that showed ischemic changes, where only SAVR was needed and not concurrent by-pass surgery?

Well at least we're getting to first base July 12th with the angio. A step in the right direction to be sure. Things move slowly in Canada.

Reading all of your stories of multiple OHSs, and so many young people experiencing these challenges, many raising young children on top of that, others with little or no support during surgery and post-operatively, etc., etc., absolutely inspires me. So much strength there. Thanks.