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Cardiac Catheterization

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Frequently Asked Questions

Radial Artery

Patient Information - Patient FAQ’s

What is angioplasty?
What is a catheter?
What is a coronary artery stent?
What is a stent?
What kinds of stents are there?
Could I have my stent the same day as my cardiac catheterization?
Who performs the procedure?
How does the doctor know if there are blockages in my arteries?
What is the recovery process?
Are there benefits to having a catheterization done through the wrist?
Who is a candidate for catheterization through the wrist?
What can I expect after the catheterization?
When should I call the doctor?
What is Coumadin?
Why am I taking Coumadin?
What do I need to do when on Coumadin?
Why do I need blood tests when I am on Coumadin?
When do I need to call my doctor?

What is angioplasty?
There is a possibility that your doctor will detect a blockage in an artery that, in many cases, can be fixed using a non-surgical technique called angioplasty. Angioplasty is a procedure used to “open up” or widen a narrowing in your coronary artery. A catheter with a small balloon at the tip is placed in an artery that is clogged. The balloon is inflated and deflated several times which compresses the fatty deposits (also know as plaque) against the artery wall and increases blood flow. Most commonly, this is followed by a coronary stent insertion.

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What is a catheter?
A catheter is a thin, flexible tube that is inserted into either your groin or wrist. The tube is gently guided up to the heart and its vessels. Once the catheter arives at the proper site, a contrast die is released so that the doctor can get a closer look at the arteries that supply your heart with blood.

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What is a coronary artery stent?
After your narrowed artery has been opened, your doctor can insert a coronary stent. This permanent device is shaped like a small tube and is made of various metal alloys and holds the artery open. It will help to improve blood flow to the heart muscle and relieve symptoms of angina or chest pain. Stents can be “bare metal” or “drug-eluting.” A bare metal stent is a vascular stent without a coating. It is a mesh-like tube of thin wire. This is reserved primarily for patients who may be undergoing surgery in the near future, for patients with a history of bleeding or if one is allergic to Plavix or Aspirin. A drug-eluting stent is coated with a medication that gets released into surrounding tissue. This increases the chance that the artery will stay open. The medicine stays only in the area of the stent and does not go into the blood system. Your doctor will prescribe Aspirin and Plavix to keep your stents open after your procedure. This medication is essential to your stent and should NOT be discontinued unless you speak with your cardiologist. You can expect to be on these medications for at least one year, sometimes for longer. Never stop taking these drugs without speaking with your cardiologist.

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What is a stent?
A stent is a small metal mesh tube that is permanently placed at the site of the coronary artery blockage. The stent comes pre-mounted on a balloon angioplasty catheter. With the use of contrast (dye) and fluoroscopy (X-ray) the stent is moved through the blood vessel and directed to the narrowed area. The balloon is then inflated which expands the stent to match the size of your artery. After the stent is placed, the balloon is deflated, and the catheter is removed. The stent stays in place to hold the artery open, which improves blood flow to the heart muscle. Your body heals to the stent over time.

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What kinds of stents are there?
“Drug-eluting” stents are stents coated with a medicine that is slowly released over time to prevent “over-healing.” The medicine stays only in the area of the artery and does not go into the blood system. However, “bare-metal” stents are not coated with medicine as the name suggests.

Your doctor will put in the type of stent(s) that would be best for you, after careful review of your medical status as well as other technical factors.

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Could I have a stent the same day as my cardiac catheterization?
You will need to have a cardiac catheterization first to find any coronary artery blockages. Most patients have their cardiac catheterization and then have stents placed during the same procedure, while others may have stents at a later time. If you have several arteries with blockages, your doctor may choose to do the angioplasty or stent procedures at different times. Your doctor will discuss this with you.

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Who performs the procedure?
During a cardiac catheterization, a cardiologist and a technologist are in the room; a second technologist works in the adjacent control room. A registered nurse is present when a balloon procedure or intervention is performed. Your primary care doctor is usually not present; however the cardiologist performing the procedure will inform your doctor of the results.

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How does the doctor know if there are blockages in my arteries?
By using x-rays and contrast dye, doctors are able to see blockages in the arteries, as well as their size, location and severity.

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What is the recovery process?
After a diagnostic catheterization, you will be sent to the recovery room where manual pressure is applied at the insertion site for up to 30 minutes to prevent bleeding and swelling. In some cases, an arterial closure device may be used. Your blood pressure, pulse and circulation will be checked often during this time. You may be given fluids to help flush the dye through your body. You will be asked to sit for a couple of hours and, when appropriate, you will be asked to walk around. If you had a diagnostic catheterization procedure (no intervention) you may be discharged at this time. If you had angioplasty or a stent to open your arteries, you are required to stay in the hospital overnight, so that you can be monitored. Rarely, patients need to remain in the hospital for more than one night.

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Are there benefits to having a catheterization done through the wrist?
Yes. In some patients, performing a cardiac catheterization through the wrist (radial artery) decreases the risk of bleeding complications. In addition, some angioplasty procedures may require powerful blood thinners, which are safer to use when the radial artery approach is chosen. Patients who have catheterizations performed through the wrist are able to sit up immediately and may be discharged from the hospital within an hour or two (if no intervention is required).

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Who is a candidate for catheterization through the wrist?
Your physician will determine which entry site is best, but entry through the wrist may be a preferred option for the following patients:

  • Patients who take blood thinners such as Coumadin.
  • Patients who have had groin complications from previous cardiac catheterizations.
  • Patients who have peripheral vascular disease (blockages in leg arteries).
  • Patients who are overweight.
     

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What can I expect after the catheterization?
If you are having a catheterization as an outpatient, you should plan to have a ride home from the hospital following your catheterization. If you have a catheterization while you are in the hospital, you will return to your hospital room after recovering in the cardiac cath area. Your physician will go over your plan of care. Following your procedure, our staff recommends the following:

  • No strenuous activities or heavy lifting for at least 48 hours and up to three weeks, if you had an angioplasty or stent
  • No unnecessary stair climbing for 48 hours
  • Apply pressure as directed if bleeding occurs and call your doctor. If you are unable to reach your doctor go directly to the emergency room.
  • You may shower and remove the band-aid 24 hours after the procedure. Avoid soaking the insertion site in water for seven days. (No bathing or swimming)
  • If the site becomes red, warm to touch, drains or a firm, hard swelling appears, call your doctor.
  • The site may have some bruising, tenderness or a small lump. These tend to disappear within a short period of time
  • Notify your doctor of any chest pain once you return home.
  • Do not drive for 24 hours following your procedure.
  • Schedule a follow-up appointment with your doctor (primary or cardiologist) within 1-2 weeks.
     

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When should I call the doctor?
Call your doctor if you have any of the following symptoms:

  • Discomfort in the neck, jaw, arm, or chest
  • Shortness of breath
  • Dizziness, weakness or fainting
  • Leg pain or numbness
  • If there is a change in the insertion site such as bruising, swelling or numbness, or if you develop a fever
  • If you have chest pain, call your doctor immediately, or call 911, depending on the severity of the pain.
     

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What is Coumadin?
Coumadin (also called Warfarin) is a pill that is prescribed for people who have blood clots or who are at risk of forming blood clots. It can lower your risk of heart attack, stroke, or even death by decreasing the ability of your body to form clots. Some patients take Coumadin for a short amount of time, and others need to take it forever. Your doctor will tell you how long you need to take Coumadin.

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Why am I taking Coumadin?
Your doctor may prescribe Coumadin if you:

  • have blood clots
  • have diseases of your heart or blood vessels
  • are on bedrest or are less active after an operation
  • have an irregular heart beat
  • have implanted medical devices, such as mechanical heart valves
     

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What do I need to do when on Coumadin?

  • Take your Coumadin exactly as ordered, and at the same time of each day.
  • Never take two pills to “catch up,” even if you missed a pill.
  • Get your blood tested on a regular basis.
  • Keep your eating and exercise habits the same, so your doctor will be less likely to need to change your dosage of Coumadin.
  • Tell your doctor if you plan to change your eating habits, like if you change to a vegetarian diet, or if you go on a special diet plan.
  • Tell dentists and doctors that you take Coumadin before planning procedures.
  • Do not take Coumadin if there is any chance that you may be pregnant.
  • Protect yourself from injury that could lead to bleeding.
  • Use a soft toothbrush.
  • Wear gloves when gardening.
  • Wear shoes when outdoors.
  • Be careful when shaving.
  • Ask your doctor about contact sports.
  • Check with your doctor to see if you can drink alcohol.
  • Consider wearing an information bracelet, such as a medic-Alert bracelet, that says you take Coumadin.
  • Carry an information card with you that lists you take Coumadin.
     

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Why do I need blood tests when I am on Coumadin?
Regular blood tests (also called lab tests) are needed when you are on Coumadin to keep your blood-thinning level safe. If you need more Coumadin, it is because your blood clots too much. If you need less Coumadin, it is because your blood takes too long to clot, and you bleed longer. The lab tests are called Prothrombin-time (PT) and international normalized ratio (INR).

It is important that you stay in contact with your doctor about your Coumadin dose. When you first start taking Coumadin, you could have blood tests several times a week. Over time, your dosage of Coumadin will be more regular, and your doctor will be able to test your blood less often, usually every 4-6 weeks.

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When do I need to call my doctor?
Call your doctor if you have any of these signs of bleeding:

  • bleeding from a cut that does not stop after pressure is applied
  • bleeding from your gums, nose or ears
  • menstrual bleeding that is heavier than usual
  • reddish, or dark brown colored urine
  • bowel movements that look red, black or tarry
  • coughing or throwing up blood or coffee-ground color liquid
  • unusual pain, bruising, or swelling
  • unusual headache
     

Foods that have a large amount of Vitamin K can change the way Coumadin works. The key word is consistency when it comes to foods with Vitamin K. You do not need to go out of your way to eat or to stay away from foods with Vitamin K, but you do need to try to eat the same amount of these foods from day to day.

Foods that contain high amounts of Vitamin K include: greens, such as spinach, kale, collards, seaweed, turnip greens, mustard greens, and dark lettuce, broccoli, brussel sprouts, avocado (guacamole), canola and soybean oil, tofu, and green tea.

If you have any questions about Vitamin K and foods, check with your doctor.

Many medicines interact with Coumadin. Tell your doctor about all medicines that you take, and check before you take any new medicines. This includes prescribed medicines, like antibiotics and over-the-counter medicines, such as: acetaminophen (Tylenol), aspirin, ibuprofen (Advil, Motrin, and Aleve), vitamins, herbal supplements, stomach medicines like antacids, laxatives, and cold and cough medicines. This is because you could be more likely to bleed or clot if you take certain medicines while taking Coumadin.

Reference: www.medlineplus.gov

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