Overview of Cardiac Catheterization Risks and Complications
Cardiac catheterization is a common heart procedure done over a million times a year in the U.S. As with any procedure that requires invading the body (invasive), there can be possible complications. Thankfully, thanks to advancements in the tools used and the skill of the doctors, as well as newer techniques, there has been a significant decrease in these complications.
When we use the term ‘cardiac catheterization’, it could mean a procedure on either the right or left side of the heart, or possibly both. This procedure can be used to diagnose or treat heart conditions. Interventional cardiologists, specialists in treating heart conditions with minimally invasive procedures, can perform a range of interventions as required. In this summary, we will lightly touch on the typical risks and complications associated with a normal, diagnostic cardiac catheterization procedure.
Why do People Need Cardiac Catheterization Risks and Complications
Cardiac catheterization is a procedure that can be used either to diagnose or treat heart conditions. It’s like a test or treatment method for the heart. Here are some issues your doctor might check or treat with this procedure:
* Coronary artery disease, which happens when the important blood vessels that supply your heart with blood, oxygen, and nutrients become damaged or diseased.
* Measuring the flow and pressure of blood in the right and left sides of your heart. This can show how well your heart is pumping blood.
* Checking how well the left side of your heart (the left ventricle) is working. The left ventricle is the main pumping chamber of your heart.
* Checking and treating cardiac arrhythmias, which are problems with the rate or rhythm of your heartbeat.
* Checking and treating valvular heart disease, which involves one or more of the four heart valves that aren’t functioning correctly.
* Looking at issues with the pericardium (the sac around your heart) and the myocardium (the muscle of your heart).
* The procedure is also used to assess congenital heart diseases, which are problems with the heart’s structure and function due to abnormal heart development before birth.
* Checking for reasons a person might have heart failure, which means the heart isn’t pumping blood as well as it should be to meet the body’s needs.
When a Person Should Avoid Cardiac Catheterization Risks and Complications
There’s no kind of situation where a cardiac catheterization absolutely cannot be performed. Most of the time, whether or not someone can get this procedure depends on why they need it and what other health issues they have. If the chance of something going wrong during the procedure is too high and the risks outweigh the benefits, the doctor may suggest using different tests or treatments to get the information they need. Skilled doctors can often change how they do the procedure to get the best results for their patients while minimizing potential risks. It’s important for the doctor to know exactly what medical information they’re trying to find out before planning this procedure.
Who is needed to perform Cardiac Catheterization Risks and Complications?
A cardiac catheterization procedure is a kind of heart test. It happens in a special room at a hospital, called a cardiac catheterization laboratory. This test uses a technology called fluoroscopy, which is a type of x-ray, to guide the doctor and position a special thin tube (called a catheter) in the right spot inside your heart.
To make sure everything goes safely, the doctor performing the test gets help from registered nurses and radiologic technologists. They are skilled healthcare professionals who specialize in helping with these procedures.
Not to worry, the procedure doesn’t hurt. You’re usually awake but relaxed because the team provides you with sedation, a type of medicine that helps you relax or fall asleep. They also use a local anesthetic to numb the area where the catheter goes in. Some more complex procedures may need you to be more deeply asleep, and this requires an anesthesia team to assist.
Some types of cardiac catheterization can even be performed in your hospital room instead of the lab. These include common procedures, like a right heart catheterization (checking the right side of your heart) or inserting a temporary pacer wire (a wire to help control your heartbeat).
Preparing for Cardiac Catheterization Risks and Complications
Before a heart catheterization procedure is performed, the heart doctor, also known as a cardiologist, will conduct a detailed review of the patient’s medical history and perform a thorough physical check-up. This helps the cardiologist understand exactly what they need to be looking for during the procedure.
The doctor will determine how to best carry out the procedure based on the patient’s specific needs. This may involve using either a vein or artery, or sometimes both, to insert the catheter. The goal of the physical examination is to determine if the patient is a good candidate for the procedure.
The doctor will also need to know about any allergies to medications that the patient may have. Additionally, some routine lab tests will be carried out. These standard tests usually include a complete blood count (it checks the types and numbers of cells in the blood), basic metabolic panel (a group of blood tests that provides information about the body’s metabolism), prothrombin time (a test that measures how long it takes for your blood to clot), an electrocardiogram (a tracing of the heart’s electrical activity), and a chest X-ray.
Patients who have previously shown an allergic reaction to the dye used in the procedure will need to take some corticosteroids and antihistamines, which are medications to prevent or relieve allergy symptoms. For patients with chronic kidney disease, extra care will be taken in planning, and they will be urged to hydrate properly in order to prevent further kidney damage.
How is Cardiac Catheterization Risks and Complications performed
When a patient undergoes a cardiac catheterization, which is a procedure to check the heart’s function, a doctor needs access to an artery. There are two common spots used for this: the large artery in the thigh known as the common femoral artery, and the radial artery, which is found in the wrist.
When using the thigh, the doctor tries to access a midpoint on the femoral artery which is usually at the center of the femoral head, which is basically the round top of the thigh bone. This artery crosses a ligament in the groin region and the doctor can locate it by imagining a straight line between two bony landmarks: the top of the pelvis and the pubic bone. Some hospitals use X-ray or ultrasound technology to improve accuracy and reduce the risk of complications when accessing this artery. It’s critical to access the artery at the proper spot to achieve sufficient control over bleeding. If puncture is too high, there is an increased risk of bleeding into the space at the back of the lower abdomen, and if too low, there may be risk of formation of an abnormal connection between an artery and a vein.
When using the wrist, doctors mostly access the radial artery, even though other arteries in the forearm may also be used in certain situations. Before they use the radial artery, they do tests to make sure there is good blood flow to the hand. The Allen test and Barbeau test are used to check this. For these tests, pressure is applied to both the radial and ulnar arteries until the palm becomes pale, then pressure is released from the ulnar artery. The pinkness returning to the hand indicates that the blood supply to the hand via the ulnar artery and the arch of the palm is good. The Barbeau test is similar but uses a device placed on the thumb that measures oxygen levels in the blood.
In coronary angiography, a process to see the blood vessels in the heart, using the radial artery or the wrist approach, has been increasing in popularity as opposed to using the femoral artery or the thigh approach since 1989. This is because studies have shown some benefits of the wrist approach, including lower rates of death and serious bleeding, less complications at the access site, shorter hospital stays and similar rates of stroke, a condition where the blood flow to the brain is cut off. Also, the procedure is generally more comfortable for the patient when the wrist is used, causes less restrictions after the procedure and can reduce the time spent in the hospital.
Possible Complications of Cardiac Catheterization Risks and Complications
The heart catheterization procedure is generally safe with less than 1% chance of major complications and a very small mortality rate of 0.05%. However, the risk can change depending on several factors, such as the patient’s health, age, the state of their blood vessels, the nature of their ailment, the exact procedure being carried out, and the skill level of the doctor performing it. Complications can range from minor ones like discomfort at the spot of catheterization to major ones like life-threatening conditions.
One common issue seen after heart catheterization is hematoma or bleeding from the aorta (the main artery in the body). Hematomas usually form after poor blood control following catheterization and they’re usually harmless. However, sometimes, they can quickly expand causing unstable blood pressure that requires immediate treatment. This risk is lower with transradial access (entering through the wrist) as compared to transfemoral (from the thigh). Doctors suspect aortic bleeding if there’s a sudden change in the patient’s heart rate and blood pressure, even if there’s no visible swelling in the groin. This happens in less than 0.2% of the cases and is confirmed by immediate imaging or a CT scan.
Pseudoaneurysm is another issue that may occur, where a hematoma communicates with the artery and creates a pulsating lump. They usually happen after catheterization in the superficial femoral artery (the artery in the thigh area). Most small pseudoaneurysms of less than 2 to 3 cm in size heal on their own and can be monitored. Bigger ones are typically treated using ultrasound guided compression, injecting clot-inducing agents, or may require surgical intervention.
A rare complication post-surgery might be the formation of an arteriovenous fistula i.e., a connection between an artery and a vein. In such cases, there might be a continuous whooshing sound and might require surgery as it does not heal naturally and might even grow with time.
Other complications might include artery blockage causing clot and embolism or an unexpected tear called dissection which might need immediate surgery if it cuts off blood supply to any part of the body. Other post-surgery complications might include complications from accessing the radial artery from the hand which is mainly hand ischemia i.e., lack of blood supply to the hand and artery spasm i.e., a sudden narrowing of the artery.
Death is an extremely rare complication, with incidence being less than 0.05% in diagnostic procedures. The risk increases with age, severity of preexisting heart disease, and other serious heart conditions. Heart attacks and strokes following the procedure are also extremely rare, with an incidence of less than 0.1%.
Another highly rare issue is tearing and perforation of major vessels in the heart, which can be more common in surgical procedures as compared to diagnostic ones. Particles from broken down plaque deposit in arteries may also cause cholesterol embolism, which can cause discoloration of fingers and toes, neurological issues, kidney damage, and sometimes vision problems in case of retinal artery occlusion.
To conclude, whilst every procedure carries some degree of risk, the likelihood of serious complications in a heart catheterization is very low and the benefits frequently exceed the possible complications. Therefore, it is generally considered a safe procedure.
What Else Should I Know About Cardiac Catheterization Risks and Complications?
With the introduction of smaller tubes, a method that uses the wrist rather than the groin area, and better-trained professionals, the risks and complications connected with heart examinations done with a small flexible tube (known as cardiac catheterization) have significantly reduced. However, it’s essential that every procedure is performed carefully to further reduce any possible risks. This procedure, despite its inherent risks, is commonly used and can be life-saving.