Cardiac catheterization

Cardiac catheterization (heart cath or just cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is coronary catheterization that involves catheterization of the coronary arteries for coronary artery disease and myocardial infarctions ('heart attacks'). Catheterization is most often performed in special laboratories with fluoroscopy and highly maneuverable tables. These 'cath labs' are often equipped with cabinets of catheters, stents, balloons, etc of various sizes to increase efficiency. Monitors show the fluoroscopy imaging, EKG, pressure waves, and more. Cardiac catheterization (heart cath or just cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is coronary catheterization that involves catheterization of the coronary arteries for coronary artery disease and myocardial infarctions ('heart attacks'). Catheterization is most often performed in special laboratories with fluoroscopy and highly maneuverable tables. These 'cath labs' are often equipped with cabinets of catheters, stents, balloons, etc of various sizes to increase efficiency. Monitors show the fluoroscopy imaging, EKG, pressure waves, and more. The history of cardiac catheterization dates back to Stephen Hales (1677-1761) and Claude Bernard (1813-1878), who both used it on animal models. Clinical application of cardiac catheterization begins with Werner Forssmann in 1929, who inserted a catheter into the vein of his own forearm, guided it fluoroscopically into his right atrium, and took an X-ray picture of it. During World War II, André Frédéric Cournand, a physician at NewYork-Presbyterian/Columbia, then Columbia-Bellevue, opened the first catheterization lab. In 1956, Forssmann and Dr. Cournand were co-recipients of the Nobel Prize in Physiology or Medicine for the development of cardiac catheterization. However, even after this achievement, hospital administrators removed Forssmann from his position owing to his unorthodox methods. Dr. Eugene A. Stead, founder of the Physician Assistant profession, also performed research in the 1940s which paved the way for cardiac catheterization in medicine today. 'Cardiac catheterization' is a general term for a group of procedures. Access to the heart is obtained through a peripheral artery or vein. Commonly, this includes the radial artery, internal jugular vein, and femoral artery/vein. Each blood vessel has its advantages and disadvantages. Once access is obtained, plastic catheters (tiny hollow tubes) and flexible wires are used to navigate to and around the heart. Catheters come in numerous shapes, lengths, diameters, number of lumens, and other special features such as electrodes and balloons. Once in place, they are used to measure or intervene. Imaging is an important aspect to catheterization and commonly includes fluoroscopy but can also include forms of echocardiography (TTE, TEE, ICE) and ultrasound (IVUS). Obtaining access uses the Seldinger technique by puncturing the vessel with a needle, placing a wire through the needle into the lumen of the vessel, and then exchanging the needle for a larger plastic sheath. Finding the vessel with a needle can be challenging and both ultrasound and fluoroscopy can be used to aid in finding and confirming access. Sheaths typically have a side port that can be used to withdraw blood or injection fluids/medications, and they also have an end hole that permits introducing the catheters, wires, etc. coaxially into the blood vessel. Once access is obtained, what is introduced into the vessel depends on the procedure being performed. Some catheters are formed to a particular shape and can really only be manipulated by inserting/withdrawing the catheter in the sheath and rotating the catheter. Others may include internal structures that permit internal manipulation (eg, intracardiac echocardiography). Finally, when the procedure is completed, the catheters are removed and the sheath is removed. With time, the hole made in the blood vessel will heal. Vascular closure devices can be used to speed along hemostasis.