Invasive testing
A reference guide so you know what to expect.
If you are having tests or procedures done at St. Luke's, please
read this before your visit.
Invasive testing
Invasive testing
Angiography (Carotid, Peripheral, Heart)
Angiography may be used to examine blood vessels and/or chambers of the heart. It reveals blockages and damage to the arteries. Angiography involves inserting a catheter (a thin, flexible tube) through a tiny incision into an artery in the upper thigh or arm. The area where the catheter is inserted is numbed with a local anesthetic prior to the procedure. Once inside the blood system, the catheter cannot be felt by the patient. The catheter is navigated through the bloodstream using X-ray technology to the area to be examined. This may include the carotid arteries in the neck that supply the brain with blood, peripheral blood vessels outside the heart in the extremities or coronary arteries of the heart itself.
An IV may be inserted in the arm or hand so that fluids and medication can be given during the procedure. The patient may be hooked up to an electrocardiogram monitor, as well. A contrast dye, which appears on X-rays, is injected through the catheter. The X-ray images taken are called angiograms. There are pros and cons to the procedure, but they vary by patient and should be discussed with the physician. However, an angiogram is usually very safe and is typically necessary to determine the best heart treatment for the patient. Angiography may be performed in conjunction with cardiac catherization. Discuss with the physician what medications can be taken prior to the test. The test takes about 60 minutes to perform.
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Cardiac Catherization
A cardiac catherization involves inserting a catheter (a thin, flexible tube) through a tiny incision into an artery, typically in the upper thigh (but sometimes in the arm or neck), and guiding it through the bloodstream to the heart. Once inside the blood system, the catheter cannot be felt by the patient. Dye may be injected through an IV to visualize coronary arteries and look for blockages. Cardiac catherization is performed to gather information about the condition of the heart muscle and coronary arteries, the pumping ability of the heart, blood pressure within the heart and the sensitivity of the heart. In infants or children, catherization may be used to examine or treat congenital heart defects. In some patients, the catheter may have a tiny balloon at the tip, which is inflated to open blocked arteries. This is a form of angioplasty.
Before cardiac catherization, female patients may be tested for pregnancy because the procedure is not recommended during pregnancy. No food or drink is permitted from the night before the catherization until after the procedure has been performed. Sometimes the patient will be on a special diet for a short time prior to the test. The area where the catheter is inserted is numbed with a local anesthetic prior to the procedure. The test lasts about 30 minutes, but the entire appointment may take several hours.
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Intravascular Ultrasound
Intravascular ultrasound is used in conjunction with cardiac catherization. Cardiac catherization involves inserting a catheter (thin, flexible tube) through a tiny incision into an artery, typically in the upper thigh (but sometimes in the arm or neck), and guiding it through the bloodstream to the heart. With intravascular ultrasound, the catheter maneuvers a miniature ultrasound probe through the arteries of the heart. The probe sends and receives high-frequency sound waves. The sound waves are interpreted by a computer to provide cross-sectional images of the inside of the arteries.
The procedure details the extent of coronary artery disease in which cholesterol and plaque build up on the inner surfaces of the artery walls. Coronary artery disease can lead to heart attack and stroke. Intravascular ultrasound helps determine whether further treatment, such as bypass surgery or angioplasty is necessary.
Directions are provided about what food, drink or medication can be taken before the test. Electrode sensors are attached to the patient's chest and connected to an electrocardiogram machine to measure the heart's electrical activity. The area where the catheter is inserted is numbed with a local anesthetic. An IV is inserted into a vein in the hand or arm so that medication, such as a mild sedative, can be given during the procedure. The patient remains awake during the procedure, which usually takes about an hour. The test may involve an overnight stay in the hospital. Arrange for transportation home the next day.
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Electrophysiology study (EP study)
An EP study employs a catheter (thin, flexible tube) to sense the heart's rhythm, which is controlled by natural-occurring electrical activity. An IV is inserted into the patient's hand or arm so that fluid and medication, such as a mild sedative, can be administered during the test. However, the patient will be awake during the procedure so that he or she can describe symptoms of an abnormal heart rhythm.
After a local anesthetic is applied to the upper thigh, a tiny incision is made and a series of catheters are inserted and guided by X-ray imaging through the bloodstream to the heart. The procedure is used to determine, the cause, location of origin or the best treatment for a heart rhythm disorder or arrhythmia. The test records the electrical activity of the patient's heart while the physician safely reproduces the disorder and tries different medications to control it. The procedure typically takes two to four hours to complete. An EP study may involve an overnight stay in the hospital.
Prior to the test, do not eat or drink anything from midnight before until after the study is completed. Discuss with the physician if certain medications should be temporarily discontinued or taken prior to the test. A sip of water may be taken with approved medications.
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Myocardial Biopsy
This procedure is typically used to diagnose inflammation of the heart muscle or to confirm that the body is rejecting a transplanted heart. It involves inserting a catheter (thin, flexible tube) that has a grasping device at one end. The catheter is inserted into an artery in the neck and guided through the bloodstream by X-ray to the heart's right, lower chamber. The grasping device obtains a tiny piece of heart muscle that is then analyzed in a laboratory. Directions are provided about what food, drink or medication can be taken before the test.
The procedure takes up to an hour to perform. An IV will be inserted into a vein in the patient's hand or arm so that fluids and medication can be administered as needed. The area on the neck is numbed with anesthetic where the catheter is inserted. Medication to help the patient relax may be given through the IV, but he or she remains conscious during the procedure.
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