Who does the cardiac cath?

[susieq14]

Forgive me - this is not a valve question but I was hoping I could get some help from some of you who have first-hand experience with cardiac catehrization and basic cardiac knowledge.

My husband might need to have a cardiac cath and I'm wondering if there is a protocol to follow about where it should be done and by what doctor. From the posts I have been scouring it sounds like most of you had your cath a few days before your surgery at the hospital you were having your OHS. Did your cardio do your cath or were you referred to someone by your cardio? Did anyone have a cath earlier in the procedure and perhaps not related to their valve? If so did (and or should) you "shop" for the right place and doc to do the cath like you do for OHS?


To make a long story short, Joe is 61 and has been without any health issues until last year when he went on BP meds. He had a physical in April and all was good except his cholesterol numbers were not so good. PCP offered choice of statins or visit dietician, lose weight and exercise which is what he chose and I thought did a good job at. (He did lose 8 pounds) He Saw PCP on September 3 and cholesterol increased from 195 to 214 and his LDL went from 132 to 150. HDL is only 50 and triglcerides are 70. Also told PCP about experiencing some minor shortness of breath and slight chest pain whenever we went on our nightly neighborhood walks this summer and walked up this one hilly stretch. PCP sent him to see a cardiologist who then scheduled him for an echo and a nuclear stress exercise test. He had the stress test on Thursday and seemed to do okay - walked 9 minutes with no symptoms. Friday night at 8:00 pm the cardio called us and said there was a slight abnormality on the front wall of the heart and she wants to talk about a cardiac cath to determine what it is and whether a stent or surgery might be needed. She also asked him how he felt and said don't walk up any hills. He actually had an appointment to see her next Thursday for a follow-up on the tests but she said he could come in on Monday afternoon. Needless to say we are going in on Monday.

Needless to say we have been in a fog digesting this news and trying to research and prepare our questions for the cardio. Although I've been in the waiting room with a leaky mitral valve since my August 2004 diagnosis this is a little new to us although it is also a little like deja vu because 27 years ago my father was diagnosed at 62 with CAD and needed to have triple bypass.

I'm sorry to be rambling and apologize for posting about a non-valve issue. I also feel awkward posting a question on the Board since I have not been on in a very long time. needless to say any comments or suggestions will be appreciated.
Thank you,
Susie

 

[deano89]

i am in the uk but had my left right cath done at the local hospital but the same person who done my TOE ,infact all my tests were done locally then referred to specialist heart hospital when they had all the results .heart cath is no big deal just had a long lay down afterwards, i did post about what it invovled, here http://www.valvereplacement.com/forums/showthread.php?t=29678

 

[catwoman]

Susie:

In some cardio practices, one or two doctors concentrate on heart caths/TEEs & other procedures. Not sure why. May be a matter of what they prefer to do, or perhaps they were already booked with appts the day you have available for the procedure.

My heart cath was done the day before my surgery by my own cardio (his cardiologist son assisted).

When John had his heart cath done, his cardiologist had a colleague do it. His cardio doesn't do TEEs either.

My new cardiologist doesn't do TEEs, so he may not do heart caths, either.

When John had his heart cath, I was told that if they found anything, they'd immediately do a stent. I was pretty glad when the doctor came back afterwards so quickly. No problems found!

John had his TEE & cath done first in Fort Worth, then we got copies and took them to the two surgeons we consulted in Dallas. Because I switched to a cardio in Dallas for a 2nd opinion, we set up my cath the day before surgery and they did the first TEE in the OR.

 

[Adrienne]

The doctor who did mine seemed to be a doctor specialized in doing caths.

 

[MarkU]

My cardiologist did my catherization prior to my surgery. He specializes in interventional cardiology.

Mark

 

[ALCapshaw2]

My Cardiology group now has 25+ Cardiologists.

In the 'early days' each Cardio rotated duties every 6 weeks so that they would all be proficient in each area.

Now, they have 5 or 6 guys who 'live in the cath lab'. They are VERY proficient and can do a Basic (Left Side) Cath in 20 minutes. Their 'incident rate' was 1 per 1000 several years ago and is considered to be the Best in my State by some in the medical community.

FWIW, I was scared 'out of my mind' before my first one and viewed the Video provided by the hospital 3 times beforehand. Afterwards, I had one of those "is that all there is" kinds of experiences. The Cardio numbs the insertion site (something similar to novacaine) and the patient feels some 'pressure' as the insertion is made. It is Extremely Rare for anyone to feel the catheter being routed through the veins / arteries although ONE member was able to tell the Doc exactly where it was. Many of us actually enjoy watching the catheter being moved about on the monitor. It's an expensive show

There are several different means of 'closing' the wound which usually involving laying flat for a few to several hours afterwards.

NO BIG DEAL (once you've been through it

'AL Capshaw' (been there, done that)

 

[Jkm7]

My cath was done by a cardio in my cardiologist's group at their hospital which is affiliated with Mass General, where I had my surgery. My cath was done about 3 weeks prior to my surgery.

Went in about 7:30, answered the ream of questions, was prepped, had cath (easy - no pain, no problems - no blockages), rested about 3 hours and since I had a plug, was permitted to leave. Instructions to take it easy rest of day and back to all my normal activities (including driving) the next morning.

I think the skill and experience of the interventional cardiologist makes a very big difference in this procedure. Same for TEE.

 

[tobagotwo]

No question to me that experience is key to making this easier. With a heavily experienced cath person, it's quicker, they have a better understanding of how much happy juice is needed, and you're less likely to have bleeding or other issues afterwards.

Your cardiologist can refer you to an interventional cardiologist (the type of cardiologist who does cardiac catheterizations) who "lives in the cath lab" as described above. For a patient with a valve problem, the surgeon can usually refer someone.

You should ask if they'll use a collagen plug after the procedure, as it cuts down the initial healing and "lying still" time dramatically.

Best wishes,

 

[Bina]

My cath was done by a specialist at my surgeon's hospital.

 

[susieq14]

Thnak you! thank you!

all your replies are much appreciated!

so my questions for my husband's cardio (who I have never met and he saw once at his first appointment and at the stress test) tomorrow should include:

1) how many caths does the cardio she refers him to do per week? We prefer a referral to a specialist who lives in the cath lab rather than a rotating schedule.

2) what procedure is followed to "close" the wound? can we request a collagen plug?

3) what sedation will be used?

We also need to know what the plan is if something is seen on the cath? Will a stent suffice or will soemthing more be needed and who decides and how?

Agai, thanks so much!

 

[tobagotwo]

Generally, your cardiologist decides what to do based on the results of the cath as presented by the interventional cardio. The proposed course of action is going to be a result of what she sees as the most important issues and his individual physical makeup, and she won't likely have any opinions until she sees the results (other than being able to mention generalized options and conjecture). You don't really want her to decide anything ahead of time.

Your cardio should be sending copies of tests and records to your husband's GP, and vice-versa. It's important that they be on the same page, as other health issues that only the GP would have known about may affect what the cardio decides to do, and what the cardio may wish to prescribe should be known to the GP. Any prescriptions from either source should be run by your pharmacist to ensure they don't clash with medications he is already taking.

I wish you good results. It's a scary time, but if there's a problem, it's better found now than later.

Best wishes,

 

[Lisa in Katy]

My cath was done by my cardio a few months before surgery. All of the cardios at that hospital do their own caths, stents, etc. and have plenty of experience, although my cardio is known as the best in the area.

I also had a cath when I was younger at TCH. It was supervised by my pediatric cardio, who was in charge of the cath lab. I believe that most of the procedure was performed by a resident. My doc actually didn't take new patients anymore at that time, but was still my cardio because I'd been with him for a long time.

Good luck to you and your husband.

 

[Lynlw]

Since they are already saying he might need a stent, I would be sure to get an interventional card who has alot of experience with doing stents, since it would be best to have the stents placed during the cath and not discuss afterwards, if he needs stents or other interventions like ballooning something open ect. and would have to have another cath.
IF at all possible, I personally like having a card that is an interventional cath doctor, as your main card, Since they will know exactly what they saw, did ect and not get it 2nd hand. and if your card is a interventional card, you will have the same person doing all the caths and not just get which ever card is doing caths that day. Since they do remember, what issues, they had or how things looked last time that look different this time. Especially if he gets stents that might have to be reballooned in the future.
When we were looking for a new cardiologist from Justin , my MAIN concern was getting on that did alot of interventionals caths AND did the kinds of interventions Justin might need.. So to answer your question, YES if you probably need interventions like a stents, I think it is good to shop around for the best. We live in NJ and for a while when Justin's ped card wasn't practicing, we were going to travel to Boston for his caths, but right before he needed it his doc was back in the area.

 

[susieq14]

We saw the cardio today and it looks like my husband is having a cardiac catherization. Although the cardio did not say it was mandatory she highly recommended it over the alternative of increasing his statin to 80 mg and careful follow-up for the next few months followed by another nuclear stress exercise test. She is concerned because my husband's EKG was fine before the stress test but afterwards it showed left bundle branch block which means that there is probably a blockage. There is a slight possibilty of a false positive and the only way to know for sure is to do the cath or wait it out and when she does the next stress test it will be the drug-induced exercise test instead of the treadmill test because that stress test does not have any fals-positives.

As much as he does not want to admit it, he understands that the smart thing to do is to have the cath but he still needs to come to grips with it. I know it is not OHS but it is still his "mountain" to climb. I can't believe it is happening either.

Our next question which we kind of know the answer to in our heart is where to have it done. The cardio said that she would do the initial cath but if it is necessary for an angioplasty and stent, then one of the interventional cardiologists on call that day would do the angioplasty. When asked she did say that she did many of them. When we alluded to possibly going in to Boston, she said that she had privileges at Brigham and Womens but preferred not to go into Boston anymore but did say she would refer us to Brigham and Womens if we prefer.

I think I am leaning towards that scenario. Our community hospital has been doing caths and angioplasty only since 2003 and we are 26 miles from Boston.
I'm thinking it would be more advantageous to ask to go to BWH and request an interventional cardio who would do the procedure from start to finish as Lyn recommeneded?

I know I shouldn't even say this because it is not smart at all but I'm worried that the cardio will feel slighted if we chose to go to BWH and it may be awkward in the future?

In the meantime she upped his statin to 40 mg and told him to take 325 mg aspirin and advised us to make a decision sooner rather than later.

Again thanks for listening and any suggestions including the hit over the head I need to do the right thing.

 

[Lynlw]

Now THis is just MY thoughts, but
IF it were ME personally or my loved one, I wouldn't want one person to start the cath and need someone to "help" if you/he needed intervention, especially since that looks like a possibility (unlike a routine cath before surgery) and honestly since you ARE only 26 miles from Boston, I wouldn't worry about her feelings, correct me if I'm wrong, but didn't your husband just start seeing her? He could always switch to whoever he chooses to do the cath, if she made you feel uncomfortable in any way. Caths are usually VERY safe but things Can go wrong, and I would probably go to the best who has alot of experience doing interventions, then if he doesn't need a stents or anything, that's not a problem, but it is better than waiting for the guy on call to finish the cath another doctor started.
I will keep your husband in my prayers, I know it isn't OHS, but anytime they start talking about doing anything with your heart, it IS scarey.

ps I'm sorry I can't personanlly recomend anyone, even tho I said we almost went to Boston for Justin's cath, because that doc there was one of the best, but he just works out of Childrens Hospital.

 

[Jkm7]

IMO..... go to Boston.

Your cardio will 'get it'. And if not, she should. It isn't like your DH has had a very long relationship with this cardio.

When you have access to some of the best in the nation, why fool around with less?
JMHO.....


As compared to OHS, having a cath (angioplasty) and stent placed, is so much easier. Whole different hemisphere. Certainly not minimizing it but trying to put it into perspective. Not to say it isn't worrisome. I would worry about a cardio who doesn't feel confident to do the whole procedure. Why wouldn't she place the stent if it were needed? Scares me a little. If it was me, I would want the skilled interventionist who can handle the situation. What if, (tiny chance), there is some emergency?

Is there a chance there are two arteries with 80% or more blockage? If so, Bypass may be a better choice. This is important to the level, you may wish to consult for second opinion at Brigham. Two opinions are very reasonable. Bypass is rarely done for only one blockage.

Also, if it is to be angioplasty, be sure to discuss whether he wants a drug eluding or bare stent. There is a difference.

All BEST wishes.

 

[Adrienne]

I agree with Lyn that you should go to Boston.

 

[westie]

Who does the cardiac cath?

.
someone who makes lots of money!

 

[susieq14]

I just called the cardio's office and told the receptionist that we want to book a cath and we want it done at BWH. Phew!

We talked it all out last night and this morning Joe gave me the go-ahead.

I knew it made sense to go to BWH but it was soooo very hard to discuss that option with the doctor yesterday. And you're right Lyn and Judy we do not have a long-standing relationship with this doctor - Joe only saw her at his first consult, the stress test and yesterday's follow-up but it was still a toughie! But you are all correct that we have to do what is right for us and not the doctor and not choosing to go to one of the best hospitals that people come to from far away that is practically in our backyard doesn't make sense.

The receptionist will call me this afternoon after the doctor returns to the office with instructions about setting an appointment. So while I wait for that call I will try to do some research about the different stents. Judy -Thanks for that heads-up as that was not something I paid attention to in my original research.

Also the cardio said yesterday that if she did the cath the procedure would be that if it was a small blockage and only one it would be fixed with the stent but if there were multiple blockages or if it was a long blockage, then bypass would be necessary.

Thanks again for the information and the support!

 

[Gail in Ca]

I have always had my caths done by my cardio at the time. He now only does them and doesn't see patients. They were all done at the hospital. I only had a complication 1 time, when I had it done and the nurses were on strike. The scab nurse I had gave me a fluid overload after the procedure, and I ended up in CHF, and then having emergency 2nd OHS a few days later. Not fun! And I haven't had another cath since then.