Indications for cardiac catheterization
Cardiac catheterization is done along with a myocardial biopsy to determine if heart disease is the cause of certain symptoms. Diseases that can be diagnosed or evaluated by severity include narrowing of the coronary arteries (coronary artery disease), changes in Heart valve , Andcongenital heart defects Heart infections (myocarditis). Moreover, such an examination of the myocardium can be performed after heart transplantation in order to identify possible tissue rejection.
What are the indications for myocardial biopsy by examining cardiac catheterization?
There are basically three different conditions that may be an indication for a myocardial biopsy.
- If myocarditis is suspected, a sample of heart muscle tissue is required. In this way, it is possible to establish the presence of a chronic or acute viral disease of the heart.
- Myocardial biopsy after heart transplant A myocardial biopsy can be used to determine whether the body has rejected the new organ. Therefore, a myocardial biopsy procedure is vital for heart transplant patients in many cases.
- If so-called storage heart disease is suspected, a myocardial biopsy is used.
A number of diseases are summarized under the term storage disease. These diseases are characterized by the fact that various substances are deposited in the cells or organs of the body. As in amyloidosis. In this disease, insoluble protein fibers are deposited in the cells. These fibroblasts and tissue components are responsible for preventing the heart from working as intended.
In addition to the case of storage of protein bodies (amyloidosis), a myocardial biopsy is also ordered if the following deposits are suspected: iron, copper.
Some other diseases can also be an indication for cardiomyopathy. For example, if a patient has cardiomyopathy, the doctor may order a heart muscle biopsy. The so-called cardiomyopathy is a group of heart muscle diseases that cause electrical and/or mechanical functional disturbances of the heart muscle. Also in the case of atrophy of the heart muscles, which is called muscular dystrophy that reduces the efficiency of the heart muscle, the above examination method can be used. This also confirms whether there is congenital thickening of the heart muscle.
If heart disease is present or suspected, the patient is first questioned (history) and a detailed physical examination is performed. In particular, the heart is examined with a stethoscope. An electrocardiogram (EKG) and blood pressure measurement are done, possibly over a 24-hour period. Imaging procedures (such as chest wall ultrasounds and x-rays) are used. With certain test results, further diagnostic measures are carried out.
Depending on the symptoms and results of the examination, a right heart catheterization scan or a left heart catheterization scan will be done. Local anesthesia is usually used for both procedures.
Using a right heart catheter (intravenous catheter), a hole is made in the groin or in the elbow fold. The catheter is pushed through the vein in question into the right ventricle of the heart or into other vessels (such as the pulmonary artery). Occasionally, a balloon may also be inserted into the catheter, which is inflated so that the tip of the catheter is moved to the right heart by blood flow (overflow catheter).
A left heart catheter (arterial catheter) is inserted through an artery in the groin or in the leg against blood flow to the left ventricle.
Various examinations may be performed with the catheter in place. In the cardiovascular system, pressure or pressure differentials can be determined at the respective site. Blood may be drawn for a blood test, particularly to determine the levels of oxygen in the heart chambers. Contrast media may also be injected for an X-ray examination (angiography) to check and evaluate the function of the heart's arteries and valves. An examination of the coronary arteries (coronary angiography) and the right half of the heart and pulmonary artery or the left half of the heart and aorta (main artery) may be done. displayed.
Furthermore, with the catheter in place, a stress test can be performed in which the pressure values are determined and the heart muscle's pumping function is checked, for example when pedaling a bicycle in a supine position.
For a myocardial biopsy (taking a small sample of heart tissue), tissue samples are taken using a special right heart catheter, and rarely also with a left heart catheter, because the blood pressure on the right side of the heart is much lower than the blood pressure on the right side left. As a result, a biopsy can be performed in the right heart area with much less risk than the left one
The catheter contains biopsy forceps to remove tissue. X-rays provide the necessary vision during the procedure. Using biopsy forceps, four to seven samples of tissue are taken. These specimens are small, usually no larger than a pinhead. Sampling takes place at different points. The patient may be given a contrast agent in order to ensure better vision.
During myocardial sampling, the patient should not feel any pain. A biopsy of the entire myocardium usually takes half an hour to an hour.
After each catheter examination, the punctured skin area is closed and a pressure bandage placed. If a short incision is made (eg at the bend of the elbow) to insert the catheter, the site may be closed with a suture.
Samples are placed in small glass or plastic tubes filled with formalin - this liquid makes the removed tissue durable. In this way, samples can be sent to the responsible laboratory. The obtained heart muscle tissue samples are subjected to histological examination (histopathology).
What happens after a myocardial biopsy by examining the cardiac catheterization?
After successfully taking tissue samples, the doctor removes the catheter and the sheath completely. The puncture site is provided with a bandage that the doctor or nurse presses firmly for about five minutes. The patient should then wear a compression bandage in the venous entrance area for two to three hours. This is how long the patient stays in bed.
Before the patient can leave the hospital, an ultrasound of the heart is done about an hour later. This will rule out possible damage to the vital organ or be able to identify it in time. Finally, there is a risk of injury to the heart during tissue removal, and you may need to stay in the hospital for monitoring and follow-up in the intensive care unit.
Excessive physical exertion should be avoided for a week., bed rest is not often required.
In the event of symptoms that may indicate a complication, a doctor should be contacted as soon as possible.
There are relatively few complications with myocardial biopsy with cardiac catheterization. In some cases, the tissues surrounding the operation can be injured, for example when the wall of a vein is penetrated. Sometimes the heart can be punctured or the heart valve is damaged as well.
An irregular heartbeat can sometimes occur that often goes away on its own. Bleeding and bruising (hematoma) is possible. In exceptional cases, this can lead to life-threatening conditions, for example when bleeding around the heart (pericardial effusion) occurs. Nerve injuries can lead to numbness or paralysis, among other things. Rarely, the lungs can be accidentally punctured, causing air to build up in the chest (pneumothorax), which obstructs breathing. The catheter itself can also be damaged, for example the tip of the catheter can break off and travel with the bloodstream causing problems. Catheters can cause blood clots to form (thromboembolism), which sometimes occur and can lead to circulatory disorders, such as pulmonary embolism (pulmonary infarction). The use of iodine-containing contrast media can increase the activity of the thyroid gland. Finally, inflammation and allergic reactions cannot be ruled out either.
Warning after myocardial biopsy by examining cardiac catheterization
Myocardial biopsy often provides an accurate diagnosis of the disease in question and its severity. Then determine the treatment plan depending on the results of the examination. However, we may get an inadequate or incorrect result with cardiac catheterization. However, as a general rule, it makes more sense to undergo screening than to risk serious heart disease undetected.
Preparing for a myocardial biopsy by examining the cardiac catheterization
The patient must be on an empty stomach before performing a myocardial biopsy by examining the cardiac catheterization. This means that you should not drink or eat anything from midnight until the end of the procedure. The doctor in charge may ask the patient to take some medications before the operation. It is necessary to follow these instructions. It is also important to clarify on a case-by-case basis to what extent the patient should stop taking anticoagulant drugs before a myocardial biopsy.
Before the procedure, the physician in charge should know the following:
If the patient has a tendency to bleed
If the patient has suffered in the past from a disease that increased the tendency to bleed
If you are taking anticoagulant medication
Before the procedure Metformin, a medication used to treat diabetes, often has to be stopped before the procedure because it can cause problems with the contrast agent. Other medications may also have to be removed.
A few hours before the examination, the patient must stop smoking and drinking alcoholic beverages.
Jewelry, contact lenses, removable dentures, and the like should be removed before the procedure. Cosmetics should also not be used.
Is a heart biopsy painful?
You should not feel any pain. A very small amount of heart tissue the size of a pin tip is taken for biopsy.
How long does this procedure take?
The process takes 30 to 60 minutes.