All of the above procedures are used together to obtain as much information as possible so that an accurate diagnosis can be made and proper treatment provided.

What to do before your exam

Your doctor must know if you:

• have a documented or suspected allergy to any medications, x-ray contrast media, or foods
• are pregnant
• cannot be flat or on your back for extended periods of time
• have difficulty urinating, or have been told of prostate disease
• have glaucoma
• have dentures or a hearing aid (most hospitals will allow you to take these with you)
• have been taking aspirin, aspirin-containing products, or "blood thinners," such as Coumadin or warfarin, or if you have a history of excessive bleeding
• are diabetic, and if so, are on insulin
• recently have had or are presently being treated for an infection in any part of your body

As with other important diagnostic procedures, you may be asked to sign a consent form before undergoing cardiac catheterization. Ask questions and make sure you understand the procedure before you sign the consent form.

You will be admitted either the evening before or the day of the procedure. A chest x-ray, EKG, and several routine blood tests will probably be administered. You will be examined, and different locations of your pulse may be marked.

You may be asked not to eat anything prior to the procedure. When your scheduled time arrives, your premedications will be administered, you will change into a hospital gown, and you will be asked to empty your bladder.

• an x-ray technologist skilled in cardiac studies
• a specially trained nurse
• one or two cardiologists with specialized training in catheterization
• an anesthetist or anesthesiologist, if necessary

Each person in the room will be dressed in a sterile surgical gown and mask.

A needle attached to an intravenous bottle (or bag) will be placed in a vein near your wrist. You will then be moved onto the catheterization table, assisted by the nurses and technologists.

The groin or arm will be gently shaved and painted with antiseptic solution. You will then be draped in sterile towels and sheets. While the equipment is being prepared, the cardiologist will inject a local anesthetic into the place where the catheter will be inserted.

If the groin is the site of the insertion, a small incision in the skin less than 1/4" across will be made with a sharp scalpel blade. A needle will then be inserted into the vessel, followed by a flexible guidewire which is passed along the vessel into the heart under x-ray guidance. The catheter is passed over this guidewire. If the arm is the site of the injection, a small incision is usually made over the vessel on the opposite side of your elbow. The vessel is then punctured and the catheter inserted.

The catheter is positioned under x-ray guidance and by using direct blood pressure readings made through the catheter. You may be asked to take a deep breath or cough several times during the procedure. If you feel you must cough at other times during the procedure, you should tell the doctor.

A contrast medium is injected into the heart's blood vessels and heart chambers, so that they may be seen under fluoroscopy (x-ray) and so permanent x-ray pictures can be taken. When a contrast medium is injected into the coronary arteries, you may experience chest discomfort (angina). If so, tell the doctor immediately. When a contrast medium is injected into the pumping chambers of the heart, you may experience a warm flushing feeling for 30 to 45 seconds. The x-ray pictures are recorded on videotape to provide an "instant replay," and on film, from which a final diagnosis is made.

When the procedure is completed, the catheter is removed, and bleeding is controlled by applying pressure at the insertion site, using either fingers or specially designed clamps. The total time required for the procedure including preparation time ranges from about 60 to 90 minutes.

The catheterization laboratory team is trained to recognize and treat any complications. All necessary drugs and supplies are stored in the laboratory.

If the procedure was performed through the groin, a pressure bandage may be placed on the puncture site. You will be lying flat, keeping your leg straight. The head of the bed will be flat or elevated slightly; it will be raised four to six hours later. To urinate or move your bowels, you will need to use a bedpan.

If the procedure was performed through the arm, a bulky bandage will be placed over the incision. Usually, you will be allowed out of bed to sit in a chair and you may use the bathroom shortly after returning to your room.

The blood pressure and pulse in your arm or leg will be checked frequently and recorded upon your return to your room. Fluids will be provided and you will be encouraged to drink them so that the contrast medium with which you were injected can be flushed out by your kidneys. Your intravenous line may be left in place for several hours.

The bandage will be checked frequently for signs of bleeding; but any pain, bleeding, or discomfort at the puncture site or elsewhere in your arm or leg should be reported to the nurse immediately.

The data obtained on videotape must be considered preliminary, and serve primarily as a guide for the physician who performed the procedure. The x-ray requires 30 to 60 minutes for development and processing. Review of the data takes time, and consultation with your primary physician may be necessary. Preliminary results are frequently discussed at the conclusion of the procedure, with final discussion of diagnosis and treatment plans occurring within 12 to 24 hours. Many physicians prefer to discuss final results during an office visit following discharge.