Angiogram (Cardiac Catheterisation)
The test to detect the presence of coronary artery disease is called “coronary angiography.” It is most commonly referred to as a cardiac catheterisation.
The two terms are used interchangeably.
The procedure is performed under local anaesthetic and involves inserting a short plastic
tube with a one way valve called a sheath into an artery in the groin, wrist or elbow. Your doctor will select the site usually the right groin.
Through the sheath, thin flexible hollow tubes called catheters are threaded over a guide wire and positioned under X-ray in the heart and/or coronary arteries.
A liquid contrast (X-ray dye) is injected through the catheter and X-ray video pictures are taken. The test reveals if any of the coronary arteries are narrowed or blocked by plaque (fatty) deposits. At the same time the pumping chamber and valves on the left side of the heart are examined for any abnormalities.
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
PTCA involves opening a narrowed or blocked segment of coronary artery by insertion of a small balloon catheter via the femoral artery in the groin (or occasionally the brachial artery located in the arm). This is performed under sedation and local anaesthetic.
A fine guidewire is introduced through a guide into the coronary artery. A balloon catheter is then inserted over the wire and positioned across the narrowed / blocked segment. The balloon is then inflated. This procedure opens the narrowed artery
by compressing the fatty material (plaque) against the wall of the artery and restores blood flow to the area of the heart previously deprived by the narrowed or occluded artery.
It is not uncommon to experience some angina during inflation of the balloon as the coronary artery is temporarily occluded and the heart muscle is deprived of oxygen.
This only lasts for a very brief period of time and resolves as soon as the balloon is deflated.
At the same time a stent may be placed in the coronary artery. A stent is a small stainless steel mesh tube that supports the coronaryartery and maintains patency.
Understanding How the Heart Works:
The heart consists of 4 chambers. The upper two chambers (atria) fill the lower chambers ventricles) which pump blood to the lungs and body. The heart’s natural ‘beat’, the sino-atrial (SA) node, is located in the right atria. In order for the heart to beat, this node sends regular impulses to the atria and stimulates the atria to contract and empty blood into the ventricles. The impulse then continues down a pathway to the atrio-ventricular (AV) node where the impulses spread down the ventricles causing the ventricles to contract and pump blood to the lungs and body.
What is a Permanent Pacemaker:
A permanent pacemaker is required when there is a disturbance in the heart’s ability to transmit electrical impulses. This may result in the heart beating too slow and / or too fast or irregularly. The effect of the heart rhythm disturbance could possibly cause symptoms such as dizziness, fatigue, fainting spells or shortness of breath.
A permanent pacemaker delivers electrical impulses to the heart via one or two flexible insulated wires to restore normal function and rhythm.
In brief, the Doctor will inject local anaesthetic into the chest wall. A small pocket will be made under the skin and the electrodes (wires) are introduced into the right side of the heart via a vein. The electrodes are positioned under x-ray and tested. The pacemaker is then attached and the skin is sealed with dissolvable stitches.
Implantable Cardioverter Defibrillator (ICD)
Your Cardiologist has recommended you have an ICD inserted, your ICD acts as a pacemaker but also has the ability to deliver shock to your heart to terminate life threatening heart rhythms with a brief period of rapid pacing or a shock.
An ICD is required when there is a disturbance in the hearts ability to transmit electrical impulses. This results in the heart beating too slow or irregularly. The effect of the heart rhythm disturbance could possibly cause symptoms such as dizziness, fatigue or generally feeling unwell.
Tour ICD acts as a pacemaker but also has the ability to deliver a shock to your heart to terminate life threatening heart rhythms.
The Anaesthetist will give you a general anaesthetic for the entire procedure so any shocks delivered during testing of the device will not be felt.