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What is a catheterization | Medical tests

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It is a technique that allows to study and treat certain diseases of the heart, as lesions of the coronary arteries.

Catheterization

Cardiac catheterization is a technique performed by cardiologists that allows to study the blood vessels supplying the heart, which are the coronary arteries. It consists of introducing a long wire, Catheter, called through a peripheral to the heart artery. Once inside coronary arteries a radiocontrast is instilled, and x-ray, we can see the vessels drawn in the image.
Thanks to this technique we study the anatomy of the coronary arteries, identify blockages, studying arrhythmias, or surgery. This test, for example, has meant a radical change in the management of the cardiac infarct, allowing that it saved hundreds of people with obstructive atheroma plaques in the coronary arteries.
This test was invented in 1927 by Portuguese Dr. Egas Moniz, the same doctor who developed the principles of angiography. In the first catheterisms simple, very sharp and rigid catheters were used so that they could move forward to upstream of the bloodstream without forming thrombi. Today, thanks to the Seldinger technique and anticoagulant drugs can be used flexible catheters, which are less likely to tear the walls of the arteries. Routes of entry as far away as the arteries in the groin or arm are currently used to get from there to the heart.
The complications of cardiac catheterization are rare. The few that happen often in relation to associated interventions, most with catheterization in itself. This test carried out in all cases by cardiologists experts who have the necessary training to carry out, and its use avoids having a cardiac surgeon to operate open heart. It is, therefore, an "operation by the groin".

When a cardiac catheterization is done

Cardiac catheterization He is performed when you want to study coronary arteries or heart to reach for one of the following reasons:
Unstable angina pectoris: when a person pain in the chest due to lack of mild blood flow in the coronary arteries is called angina pectoris. This angina can be stable and not pose an immediate danger, or have features of instability (pain at rest, appearance in the last month, etc.) and be on the verge of infarction. Catheterization should be to study the coronary and reopen some obstructions if there are any.
Myocardial infarction: occurs when a coronary artery is completely blocked the muscle of the heart, myocardial infarction. It is a very serious situation, and in many cases must be urgent cardiac catheterization to reopen the blocked artery.
Study of arrhythmias: not only catheter is used to reach the coronary arteries also can reach the internal cavities of the heart, the Atria and the ventricles. There can electrically stimulate the heart walls to trigger arrhythmias, which are detected simultaneously with an electrocardiogram and catheter itself. In fact, certain arrhythmias may be treated by catheterization, since you can burn the producer of arrhythmias heart tissue, and thus delete it so that I don't have any more problems.
Repair of heart valves: there are some surgical procedures that can be performed by cardiac catheterization, such as valvular stenosis, which through the catheter can be open and allow blood to pass.
Replacement of heart valves: one of the most innovative advances of recent years is the ability to put a new valve in the place of a defective valve. It is the so-called TAVI (Transcatheter Aortic Heart Valve).
Identification of vascular disorders: cardiac catheterization can help detect abnormal vessels or insufficient coronary arteries for the irrigation of the heart.
Surgery planning: in some special situations it is necessary to perform a cardiac catheterization to study the anatomy of the coronary circulation in the area that will be performed. Today is studied to replace this test with computed tomography (CT) thanks to advances in its definition of images.
Diagnosis and treatment of cardiac malformations: catheterisation can help the diagnosis of certain cardiac malformations, although most are already diagnosed by echocardiography. Some specific pathologies can be solved by Cath as small vsds (CIV).

How catheterization

You make the catheterization, firstly they will ask you if you're in agreement with submit to this test and you will be asked to sign the informed consent, where you will read what is. You cited for another day and explain how you have to go. If it's an emergency situation may be decided to put you to the test directly, since in such cases the most important is to save your life.
Can you enter the night before, or not. If you go directly in the morning you should not forget to remain in fasting eight hours earlier. Go to the quiet and accompanied, hospital with enough time to not have to stress yourself before the test. Before entering the room where the test you will be ask you that you change your clothes and give you a batin's hospital. Once inside you will see multiple monitors and a table where you tumbarás you face up.
Before starting the intervention you will you a sleeve on the arm to control blood pressure, several electrodes on the chest to control heart rate, and a vein in the other arm via in case you need to inject some drug. Tea will introduce the catheter by the iliac groin artery, although sometimes it chooses to use radial artery of the arm, or the subclavian artery in the shoulder. The area that is puncture is shaved and should be cleaned with antiseptic to maintain correct measures of asepsis. Not you shaving you the area before in your House, you can encourage local infection.
In the shave zone a little local anaesthesia prick before puncturing the main artery. Puncionada once, check that it has reached correctly; the best way to be sure is to check that it leaves bright red arterial blood with pulse (bleeding of all forms is minimal). Then will be a thin hollow tube through the needle, and then remove the needle leaving the tube inside the artery, and through this tube is inserted the catheter, which is like a flexible wire. Each catheter has a different curvature depending on the region of the heart that you want to achieve. At various times are made with low radiation x-rays to see where is the catheter.
When the catheter is in the area of the heart to study are you instil the radiocontrast. At this time it is normal that you feel heat, and even hot flashes; It is a normal feeling. Once studied the anatomy of the area will decide whether or not to intervene at the time. For example, in the case of the study of angina pectoris (which is one of the most frequent catheterization) is seen as the arteries have small notches on the edges of your drawing. This are atheroma plaques that partially obstruct blood flow, and it can expand the caliber of the artery with a small dock around.
Interventions carried out in the heart will go completely unnoticed by you. In no time you will notice anything except the feeling of flushing of the radiocontrast. When finished the catheter will be removed, and the area where the catheter went be pressed for several minutes (between 10 and 20 minutes) to facilitate coagulation of the wound; It should then be cleaned and covered with a bandage.
Finally, will you to another room to rest, and will keep you under surveillance a while. Then you will be taken to a hospital room, or you can go to your House taking care with the puncture wound.

Complications of catheterization

Complications in the catheterization are not very frequent. Some that occur occasionally are:
  • Upset, nausea and vomiting.
  • Fainting and loss of consciousness.
  • Cardiac arrhythmias.
  • Tears in arteries through which passes the catheter.
  • Alterations of blood pressure suddenly.
  • Allergic reaction to the x-ray contrast medium.
  • Cardiac or cerebral infarction.
  • Internal bleeding or pericardial.
  • Local clots and embolisms.

Preparing for catheterization

If they are going to perform a catheterization, these are the issues that you must take into account:
Duration: the duration of catheterization is variable. It can last from a few minutes to more than one hour. It tends to take longer when it was decided to intervene on the coronary arteries or other cardiac disorders.
Income: it may be necessary to enter the night before the test. After the test usually will stay a few hours in observation, and sometimes it is necessary to enter a night in the hospital.
Is necessary to be accompanied?: Yes, it is recommended to carry a passenger. Catheterization is not without risk, and is better then there is someone to take home and remain at your side a few hours.
Drugs: you must tell your doctor all the medicines you take regularly and will decide which suspend or maintain. Sometimes the doctor will recommend you take medication that will help to carry out the test, but should be assessed for each patient on an individual basis. Drugs that are usually recommended for testing are antiplatelet.
Food: must remain in fasting eight hours prior to the test.
Clothes: you can go to the Medical Center with the same clothes every day. For the test ask you that you take it off and will put a robe of income, which is more comfortable and hygienic.
Documents: it is recommended to carry the personal medical history, although the doctor will already have it with him. Before you undergo the test you will sign the informed consent with which you agree to make yourself the technique, and meet potential risks, which are rare. They will also make you a series of basic tests before the catheterization, such as an electrocardiogram or a blood analysis; take the results with you if you have taken them.
Pregnancy and breast-feeding: the catheterization is relatively contraindicated in these situations. If there is a minimal chance of being pregnant not you should submit to this test, since exposure to X rays and the radiocontrast may harm the fetus. Usually the doctor performed a pregnancy test prior to women who do not deny being pregnant. In rare cases it can be an emergency catheterization.
Breastfeeding does not imply a direct contraindication, but it is better to avoid the test until the end the period of breast feeding, unless it is strictly necessary.
Contraindications: pregnancy would be a relative contraindication to perform this test. It should not be if you have chronic kidney damage, since the radiocontrast can disable them, although this can be prevented by hydration and medication. People who have an active infection nor should undergo this test if it is not strictly necessary.

Catheterization results

Nothing else performed the catheterization because you can see their results. When the coronary arteries are clean they are well outlined, without nicks and loss of contrast. Because a diagnosis is possible at the time of the test, also interventions that solve the problem detected in a direct and effective way can carry out.
At other times, the study should be more detailed. This happens mainly in studies of arrhythmias, where slight alterations of the test may be misinterpreted, and hence the better the cardiologist carried it carefully study the results of the catheterization, and assess them in relation to the rest of the evidence that you made.
The most common is the cardiologist announce you the diagnosis and the results of the test just after making it (in some cases even as it takes place). But it also requires a few days after catheterization have a consultation with the cardiologist. There it will detail you what were the final results of the catheterization and will inform you a diagnosis and long-term treatment (if necessary). In addition, verify that all went well and that your evolution was favorable.
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