Interventional Cardiology

Interventional Cardiology

Interventional cardiology refers to the diagnosis and non-surgical treatment of the heart. Procedures under interventional cardiology involve the use of thin, flexible tubes called catheters. They are threaded through veins in a minimally invasive procedure that can mean less pain, a shorter hospital stay and faster recovery. Procedures under interventional cardiology allows your doctor to inspect the status of your artery to determine a patient's risk of suffering a heart attack. On some occasions, narrowed or blocked, blood vessels may be opened up. 

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Common procedures of interventional cardiology include coronary angiography, angioplasty and stenting.

Coronary angiography (also called cardiac cath) is a procedure that takes images (angiograms) of the inside of your arteries and allowing your doctor to evaluate the function of your heart and blood vessel function. 

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Angioplasty (also called balloon angioplasty) is a procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery to dilate the blood vessels, allowing for increased blood flow.

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In most cases, angioplasty is performed in combination with the stenting procedure. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery.

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What happens during interventional cardiology procedures?

Interventional cardiology procedures are performed in the catheterization (cath) lab of a hospital. You may discuss with your doctor whether you would like to have the procedure performed in a private or a public hospital. If uncomplicated, a coronary angiogram is a day procedure, and you should expect to spend at least 6 hours in a hospital. Patients who undergo angioplasty and stenting are usually required to stay 1 night in hospital.

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To have your angiogram taken, you will be asked lie on your back on an X-ray table. Safety straps may be fastened across your chest and legs since the table may tilt during the procedure. X-ray cameras may move over and around your head and chest to take pictures from many angles.

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An intravenous line will be inserted into a vein in your arm. You may be given a sedative through the intravenous line to help you relax, as well as other medications and fluids. You will be very sleepy and may drift off to sleep during the procedure, but you will still be able to be easily awakened to follow any instructions.

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Electrodes on your chest monitor your heart throughout the procedure. A blood pressure cuff tracks your blood pressure and another device, a pulse oximeter, measures the amount of oxygen in your blood.

A small incision is made at the top of your leg or your wrist where the area was numbed by local anaesthetic. A short plastic tube (sheath) is inserted into your artery. The catheter is inserted through the sheath into your blood vessel and carefully threaded to your heart or coronary arteries. Threading the catheter shouldn't cause pain, and you shouldn't feel it moving through your body. Tell your health care team if you have any discomfort. 

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A type of dye that is made visible by an X-ray machine is injected into the blood vessels of your heart via the catheter. When this happens, you may have a brief sensation of flushing or warmth. Please inform your health care team if you feel pain or discomfort. The X-ray machine rapidly takes a series of images (angiograms), offering a look at your blood vessels, identifying any blockages or constricted areas.

Depending on what your doctor discovers during your angiogram, you may have additional catheter procedures at the same time, such as an angioplasty or a stent placement to open up a narrowed artery. Using the same sheath used for your angiogram, a specialized catheter or tube will be used to engage the relevant artery. A fine wire will then be advanced into the artery across the narrowing. This wire will be used to guide a small balloon to the site of the narrowing. The balloon is expanded to dilate the narrowing. Stenting is usually done in conjunction with angioplasty. A stent is a small metal coil which 
is usually placed at the site of the narrowing to prevent re-narrowing at this site. The balloon is then removed from the body.

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Preparing for interventional cardiology procedures 

Your doctor will provide you with specific instructions prior to the procedure. A blood test will be required. You should fast from midnight before the procedure. In general, you should continue to take all your usual medications, however, if you have diabetes, ask your doctor if you should take insulin or other oral medications before your angiogram. You should also inform your doctor if you have had an allergic reaction to the X-ray dye. Your doctor may instruct you to take certain blood thinning drugs in preparation for the procedure.

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What are the risks associated with interventional cardiology procedures?

There are small risk of complications associated with interventional cardiology procedures, coronary angiography is not usually performed until after noninvasive heart tests have been conducted. Potential risks include, radiation exposure from the X-rays used, allergic reactions to the dye or medications used during the procedure, infection and injury to the cathethrized artery. Some other potential risks include having a heart attack, stroke, arrthythmia or kidney damage.