A look inside the heart with cardiac catheterization
"Let me know when you start," says Jerry Resnick of Moorestown.
Reginald Blaber, MD, medical director of Virtua Health's cardiac catheterization lab replies: "We've already approached your heart." Dr Blaber just threaded a small tube known as a coronary catheter through the maze of arteries inside Mr. Resnick.
What is cardiac catheterization?
What is coronary artery disease?
Other diagnostic tests
What is cardiac catheterization?
Dr. Blaber was performing an outpatient diagnostic test known as cardiac catheterization. This safe, effective procedure provides vital information about the heart, and it's relatively painless. "Patients receive sedation and pain medication so they shouldn't feel the catheter enter the leg," explains Barbara Sampieri, RN, who has been a nurse for more than eight years. "There are no nerves endings inside vessels, so patients can't feel the catheter inside them."
As Dr. Blaber proceeds, he turns his attention to three large monitors. These screens show him real-time x-ray video of the heart in action as well as every aspect of the heart from blood pressure, to his pulse, to the oxygen levels in his blood.
The cardiologist adjusts his view with the simple touch of a joystick - similar to the ones used on video games. As he makes his adjustments, a large camera circles the patient's chest to give Dr. Blaber the desired angle. A small line enters the screen. It's the catheter, and it's in position. Dr. Blaber removes the stabilizing wire from inside the catheter and injects a small amount of dye that contains iodine, which makes the catheter visible on the x-ray.
The heart continues to pump as the eyes of the skilled cardiologist are locked on the coronary arteries, which are filled with contrast die during each injection. He is looking for blockages. He methodically repeats the process, checking each artery. The test ends with one last injection of dye to examine the overall contractible efficiency of the heart. The doctor removes the catheter and seals the wound with a new collagen plug, which allows the Mr. Resnick to leave the hospital in two to three hours as opposed to six to eight hours with past methods.
"Cardiac catheterization is the gold standard for diagnosing coronary artery disease - the leading killer of men and women in the United States," says Dr. Blaber, who trained at Hahnemann University School of Medicine and Walter Reed Army Medical Center. "It's the most definitive way to tell the extent of disease in the coronary arteries."
What is coronary artery disease?
Coronary artery disease can be difficult to diagnose without the help of high-tech tests such as a cardiac catheterization. Coronary artery disease occurs gradually when fatty matter in the blood combines with inflammatory cells, proteins and calcium to form plaque. This substance builds up on the inner walls of the three major arteries located on the heart's surface. The plaque can cause the vessel to narrow, which slows or stops blood flow. These blockages deprive the heart of oxygen and cause damage in the way of heart attack or cramping of the muscle known as ischemia.
One of the mysteries of coronary artery disease is that symptoms vary greatly in type and severity. Dr. Blaber explains that for some people, the signs appear in one quick dramatic event. For others, they gradually build over time. Some people experience chest pain described as discomfort, pressure, aching or burning. Some feel pain in the left arm, neck, jaw or back. Others have shortness of breath, irregular heartbeats, dizziness and perspiration.
Other diagnostic tests
When a person goes to the doctor with symptoms of heart disease, a cardiologist may perform a number of tests before ordering a cardiac catheterization. The first is typically an electrocardiogram, a painless test that records the electrical activity of the heart through small electrodes placed on the body.
The next step is to see how the heart performs under exertion since coronary artery disease isn't always evident when the patient is at rest. This usually involves a stress test in which the patient runs on a treadmill while the heart is monitored through electrodes placed on the body. An alternative is a medication-induced stress test. Medication is used to stress the heart, simulating exercise.
Dr. Blaber explains that at peak exertion, images of the heart can be viewed by injecting a nuclear isotope called cardiolite or with a detailed ultrasound known as echocardiography. Any abnormality can suggest significant blockages in the coronary arteries. The cardiologist and the patient review the results of the tests and decide whether cardiac catheterization or medical therapy is the appropriate next step.
Virtua provides cardiac catheterizations in a digital Cardiac Catheterization Lab at Virtua Marlton. It's one of many services Virtua offers those with heart conditions including new medications, cardiac rehabilitation, holistic heart programs, and support groups such as
Heart & Soul.