Cardiac Catheterization - Transesophageal echocardiogram (TEE) - Cardiac Computed Tomography Angiography (CCTA) - Cardiac MRI
How to Prepare for the Procedure
The Day Before the Procedure
The doctor will explain how the procedure will be performed, the risks, benefits, and the expected duration of hospital stay.
Informed consent will be obtained.
Routine blood tests and an ECG will be performed if they have not been done previously.
Inform the doctor about:
Any allergies (especially to iodine, X-ray contrast dye, or any pain relief medications).
Any history of stomach ulcers, recent strokes, or any previous bleeding.
Any plans for upcoming surgeries (such as eye, knee, or dental surgeries).
Any history of impaired kidney function.
It is recommended to shave the hair in the groin and pubic area, and also the right arm if there is abundant hair.
The Day of the Procedure
Arrive at the hospital at the scheduled time and check in at the admission or reception desk where the staff will make you comfortable in your room.
Fasting: You can drink water and have a light breakfast (such as cereal, eggs, toast, Milo) up to 4 hours before the procedure. Food will be provided after the procedure.
Medications: Bring all your medications with you.
Clothing: Come in casual, comfortable clothes and bring your toiletries and an extra set of clothes and underwear.
Where the Procedure Will Be Conducted
The test is usually performed as a day surgery procedure in the cardiovascular lab in the catheterization section of the radiology department (not in an operating room).
During the Procedure
The procedure is divided into two parts. The first part is gaining vascular access and the second part is obtaining images of the coronary arteries.
A local anesthetic is injected into the skin of the wrist or groin, causing a temporary tingling sensation. Once the site is numb, a small plastic sheath (2-3 mm) is inserted into the radial/femoral artery.
Through this small sheath, a catheter is inserted into the heart under X-ray guidance.
You should feel no more than minor discomfort in your arm as the catheter is moved up your arm, and sometimes a warm sensation in your body during the procedure.
This usually takes about 5 minutes to complete.
Before the Procedure
You will be asked to empty your bladder before the procedure.
You will wear a hospital gown and be brought to the catheterization department where your cardiologist and a specialized team of cardiac technicians, radiographers, and nurses will be ready to perform the procedure.
The nurse will record your height, weight, blood pressure, and insert an IV cannula into a vein in your arm.
You will lie on a movable X-ray table equipped with X-ray cameras and heart monitors.
Three electrodes will be placed on your chest and connected to an ECG monitor that will record the electrical activity of your heart during the test.
A mild sedative may be given to make you feel sleepy.
You will be covered with a sterile drape and the nurse will clean your wrist or groin (depending on the access site chosen by your cardiologist) with a cold antiseptic solution.
Facts About the Catheterization
It is a half-day procedure.
On the morning of the procedure, you will be asked to arrive at the day ward fasting for 6 hours.
The actual coronary angiography procedure takes about 30 to 45 minutes.
If the results are normal, you will be discharged home after 4-6 hours in the day ward.
If stents are placed, you will need to stay one night in the ICU and another day in the general ward (if necessary).
It is not a surgical operation.
The procedure is done under local anesthesia. A mild sedative may be given if you are anxious.
The catheterization is not painful. The initial injection of the local anesthetic into the skin may be slightly uncomfortable, but the subsequent insertion of the diagnostic catheter should cause no more than minor discomfort and no pain.
------------------------------------------------------------------------------------------------------------------------------------------
What is a Transesophageal Echocardiogram (TEE)?
A transesophageal echocardiogram (often called "TEE") is an imaging test that captures pictures of the heart as it beats. During an echo, a doctor uses a thick wand called a "transducer" to send sound waves to the heart. These sound waves create images that show the size of the heart chambers, how well the heart pumps, and how the heart valves function.
"Transesophageal" means that the doctor places a tube with the transducer down the throat and into the esophagus. The esophagus is the tube that carries food from the mouth to the stomach.
How to Prepare for a TEE Test
Your doctor or nurse will provide instructions on how to prepare.
Before the procedure, your doctor will perform an examination and ask about your medical history. This includes questions about any health problems you have or had in the past, previous surgeries, and any medications you are taking. Inform them about:
Any allergies you have
Any bleeding problems you have – certain medications, herbs, and supplements can increase the risk of bleeding. Some health conditions also increase this risk.
If you have difficulty swallowing food or liquids
If you have trouble moving your neck
If you have dentures, dental devices, or loose teeth
In some cases, your doctor may decide not to perform the TEE based on your medical history or examination. If this is the case, they will discuss your other options with you.
If you are cleared for a TEE, you will also receive information about:
Fasting – This means not eating or drinking anything for a period of time. Ask your doctor or nurse about your fasting schedule. For example, they may ask you to avoid eating or drinking anything (except clear liquids) for at least 6 hours before the procedure and to stop drinking clear liquids at least 3 hours before the procedure.
Taking medications before the test – If you normally take medications, ask your doctor or nurse if you can take them as usual before the test. You should also ask if it's okay to take them with a small sip of water.
What assistance you will need after the TEE if you are going home – For example, you might need someone to drive you home or stay with you for some time as you recover.
------------------------------------------------------------------------------------------------------------------------------------------
What is a cardiac CT scan?
A cardiac CT angiography (CCTA) scan is a noninvasive test that uses X-ray to take images of your heart and blood vessels. A computer combines the images to create a three-dimensional (3D) image of your heart.
A CCTA scan is used to help find the presence of and percent of narrowing (stenosis) in the coronary arteries and blood vessels that supply blood to the heart or other parts of the body.
Multidetector CT, or MDCT, scans work fast and are very detailed. They can produce better images with lower radiation exposure.
Why do people have a CCTA scan?
You may need a CCTA scan when other tests, such as a chest X-ray, electrocardiogram (ECG), echocardiogram (echo), or stress test, don’t give your health care team enough information about your heart.
The test can help your health care team gather additional information on:
- Your heart’s structure and how well your heart pumps blood.
- Scarring of the heart muscle caused by a heart attack.
- Fluid in the pericardial sac that covers the surface of the heart.
- The amount of plaque buildup and narrowing of your coronary arteries.
- Any abnormalities in the large blood vessels leaving the heart.
- Your risk for a heart attack.
Can it help show if you have heart disease?
When contrast dye (iodine) is given during the CCTA scan, it can show blockages in your heart arteries. This is useful to see if chest discomfort comes from lack of blood flow to the heart muscle due to blocked heart arteries (angina). If the heart arteries are normal, your health care team can confidently look into other causes of chest pain that aren’t related to the heart.
With contrast dye, the CCTA scan can also check if coronary artery bypass grafts remain open following heart bypass surgery or detect congenital heart defects (problems present at birth) and how your ventricles are working.
Can I have a CCTA scan instead of a coronary angiogram?
CCTA scan is not a substitute for a coronary angiogram (PDF) or cardiac catheterization. Coronary angiography is the gold standard method for showing blockages in the coronary arteries. It also gives specific information about how your heart is working. In some cases, a CCTA may be done instead of a coronary angiogram. This is based on patient factors as well as the imaging capabilities of the hospital or outpatient center.
What are the risks?
A CCTA scan exposes you to radiation. Further studies on safety and possible risks are warranted. Talk with your health care team about safety and risks for any test you’re undergoing.
Tell your health care team if you’re pregnant. If the test is not urgent, ask them about delaying it until after your pregnancy. Also, if you have kidney problems, you may not be able to receive contrast dye. Your health care team will measure your kidney function before the test and may give you medications to help protect your kidneys from potential damage.
Some people have allergic reactions to the contrast dye that’s sometimes used in the test. Before the test, tell your health care professional if you’re allergic to dyes, iodine or shellfish. Depending on the type of reaction you have previously had, certain medications like antihistamines and steroids may be given before the test to greatly reduce the chance of an allergic reaction. In the case of a severe allergic reaction, contrast dye will not be used and instead a test that doesn’t require contrast may be used.
How do I prepare for the CCTA scan?
Talk to your health care professional about how long to fast before the test.
What happens during the test?
Technicians perform the CCTA scan in hospitals or special outpatient clinics.
- Electrodes will be attached to your chest to monitor your ECG. The ECG also helps the computer connected to the CT scanner create clear pictures of your heart.
- When you're ready, the table slowly moves inside the machine. The scanner arches around you but doesn’t touch you.
- If a contrast dye is used, it's injected through an intravenous line placed in an arm vein.
- You may also be given medicines that widen your heart arteries or slow down your heartbeat. These medicines make it easier to see any blockages in the heart arteries.
- The technician will watch you closely through a window. You can talk to him or her through a two-way intercom.
- The technician will ask you to hold your breath for short periods.
- CT scanning takes about 5-10 minutes.
What happens after the CCTA scan?
- Your health care professional will let you know when to resume normal activities.
- After the health care team gets a written report of the test results, they will make an appointment to discuss the results and next steps with you.
------------------------------------------------------------------------------------------------------------------------------------------
What is a cardiac MRI?
A cardiac MRI is a test that uses a magnetic field and radiofrequency waves to make detailed pictures of your heart and arteries.
Why do people have cardiac MRIs?
A cardiac MRI is usually requested if someone has more advanced or complex heart conditions. It is often ordered after other tests have been done.
It can be used to look at:
- Blood vessels and how blood flows through them
- How much blood the left ventricle can pump out to the body
- Heart structure and function
- Valve disease or shunts
A cardiac MRI can help your health care team diagnose heart conditions including:
What are the risks of a cardiac MRI?
A cardiac MRI is a safe and painless test for most people. People with a metal device inside their body shouldn’t have a cardiac MRI unless the device is certified as MRI safe. Such devices may include:
- Pacemakers and implantable cardioverter defibrillators
- Inner ear implants
- Neuromuscular stimulators, such as those used for pain management or muscle rehabilitation.
- Implanted drug infusion pumps
- Some intrauterine devices (IUDs)
- Brain aneurysm clips that are not approved for MRI
- Some dental implants (check with your dentist to make sure they aren’t magnetic)
The MRI staff will ask you to answer questions to help them find out if you have anything in your body that would prevent you from having an MRI. You should avoid cardiac MRI if you have metal fragments in your body. Metal fragments in the eyes can be dangerous because the magnet may move the metal, causing eye damage or blindness.
For some cardiac MRIs, a special contrast dye (without iodine) may be used. This dye is not usually given to people with advanced kidney failure. If you have kidney problems, your health care team will check your kidney function before the test.
Ask your health care team about the safety of a cardiac MRI if you:
- Are pregnant, especially during the first three months
- Are breastfeeding
- Have tattoos or permanent (tattooed) makeup. You might feel some mild discomfort or a burning feeling on your skin from the metal in the darker inks of the tattoo.
- Have been told you have kidney problems
How do I prepare for a cardiac MRI?
- You may be asked to not eat or drink anything for four to six hours before the MRI.
- It’s very important to remove all objects containing metal or electronics before the test. This includes rings, earrings, hairpins, dentures, watches and hearing aids.
- Don’t bring your credit or debit cards into the MRI room. The machine might erase or damage the magnetic strip on the cards.
- If you have implants or clips in your body, have your health care professional write a note to indicate if they are safe for MRI.
What happens during an MRI?
A radiologist or MRI technologist usually performs the scan. It usually takes place in a hospital, clinic or imaging center.
- You’ll lie on a table that slides into the MRI machine. The machine looks like a long metal tube.
- You’ll need to lie still during the exam. Movement can blur the images.
- Your technologist will watch you from another room. You can speak to them by microphone.
- The MRI machine will create a strong magnetic field around you. Radio waves will be directed at the area of your body to be imaged.
- During the MRI, the magnet produces loud tapping or thumping sounds and other noises. You may be given earplugs, or you may listen to music with headphones to help block the noise.
- You might have an IV line in your hand or arm for injecting dye into your veins. This produces better images of your tissues and blood vessels.
- An MRI usually lasts between 30 and 60 minutes, though it may be longer.
Tell your health care professional if you are uncomfortable in close spaces. They may prescribe a sedative to help you stay calm during the test. Some clinics have machines with shorter magnets or wider openings to make you more comfortable.
What happens after my MRI?
You can usually go back to your normal activities right away.
- If you had a sedative, you’ll stay at the MRI center until the effects wear off. You’ll need someone to drive you home.
- A radiologist will review the images and send your health care team a report so they can discuss the test results with you.