DR. PHILIP S. CHUA: Vital cardiac test


            The final “arbiter,” the “Supreme Court” of cardiac tests, which will provide the uncontestable evidence of heart disease, including valvular pathology or coronary artery blockage, or any deformity of the heart, is called cardiac catheterization. It is a vital guide to decision-making for heart surgeons.

What is a Cardiac Catheterization?

Cardiac Catheterization is a medical test where radio-opaque dye is injected into the left (and as needed, also into the right) chamber of the heart and the coronary arteries of the heart to find out if there are any abnormalities of the inner walls of the heart, the heart valves, the strength of the cardiac contraction (pumping action), and any blockages in heart arteries.

How is it performed?

        The cardiologist injects an anesthetic agent (numbing medication) into an area of the skin in the groin of the patient, who has been given a sedative beforehand, and makes a 2 mm hole in the skin. Through this tiny opening, a catheter (size of a strand of spaghetti) is inserted into the femoral (groin) artery and under X-Ray fluoroscopic guidance, advances this catheter to the base of the ascending aorta (large major artery connected to the heart). Dye is injected into the coronary arteries. If there are any blockages, they will be captured on the (movie) film. Dye is also flushed into the left ventricle (in some cases, also into the right ventricle) to visualize any wall or valve abnormality and measure the Ejection Fraction (EF) (as a gauge of how powerful the left ventricle pumps blood into the circulation. If no urgent surgery is required, the patient is discharged.

How painful is the test?           

The patient feels a tiny needle stick when the anesthetic drug is injected into the skin in the groin. Thereafter, there is no pain, just a mild discomfort in the groin as the cardiologist manipulates the catheter. When the dye is injected into the coronary arteries in the actual testing procedure, the patient feels a very warm sensation in the chest and then face and head, then the abdomen. But the sensation clears out fast, in a few seconds, and not really that bothersome.

Why is this test important?

            Cardiac Cath or Coronary Angio, as the procedure is popularly nicknamed, is what could be regarded as the “supreme court” of all heart tests.  While EKG (electrocardiogram) and Stress EKG (treadmill test), or even ECHO (echocardiogram) are studies used to detect the presence of coronary artery disease, these tests are non-invasive procedures utilized as preliminary or screening diagnostic methods. If they show normal results, then chances are there are no blockages in the coronary arteries. If the results are doubtful or positive, then cardiac cath is performed to make the final determination. Following cardiac cath, the physician can say with practically 100% certainty if the patient has coronary blockages or heart valve disease or not. Hence, it is considered the “supreme court” or “court of final resort” of cardiac diagnostic tests.

What are the possible complications of this test?

            Allergy to the dye injected is one possible complication. An antihistaminic and steroid injection could be given by injection (before the procedure) for those with known allergy to the dye, or is used to counteract this allergy following the test. During the actual catheterization, there could be temporary heart irritation from the catheter in the aorta or in the heart, causing minor heart beat irregularity or slowing of the heart rate. A tiny air bubble or tiny clot could travel to other organs or to the leg, but this is very rare and more of an exception. After the procedure, and the catheter is removed from the puncture site at the groin, there could be bleeding. Usually, the oozing is very mild, and pressure applied to the area stops the bleeding. Cardiac “cath” is a widely used procedure every day all over the world and a very safe test.

Is this procedure available in the Philippines?

            Yes, this test is available in the Philippines. My cardiac surgery team from Northwest Indiana established the cardiac surgery program at the Cebu Doctors’ University Hospital in Cebu City, Philippines, in 1997.  We performed the first Triple OPCAB (Off Pump Coronary Artery Bypass) on an American gentleman from California who had severe chest pains while on vacation in Cebu. Besides bypass surgeries, heart valve operations are also performed there. Two other hospitals in Cebu also have facilities for cardiac “cath” and surgery: Perpetual Succour Hospital and Chong Hua Hospital. Dagupan City and Legazpi City also have cardiac surgery program. In Manila, the Philippine Heart Center, St. Luke’s, and Chinese General Hospital are famous for heart “cath” and surgery.

How vital is this test?

            Prior to the introduction of cardiac cath in 1958, people developed coronary artery disease, undiagnosed, and died of heart attack without much hope. It was only after this test became popular that heart lung machine, heart bypass procedure came about, one rapidly following the other in historical development. And these three technologies prospered and exploded, hand in hand, to their present state-of-the-art popularity and service to humanity. More than one million cardiac “caths” and more than 200,000 coronary bypasses are performed in the USA every year.

Should cardiac cath be done as preventive measure?

            Not as a rule. If there are no symptoms, and the patient is healthy and active, we do not recommend cardiac cath just to satisfy our or the patient’s curiosity. Besides being expensive, the test has possible risk and complications (although mild and rare) as described earlier. One exception is for big corporation executive check-ups and for airline pilots, where some companies require cardiac cath.  The other exception, which is more of a medical indication, is for persons who have a strong family history of heart attack (a genetic predisposition), who are also hypertensive, diabetic, and a cigarette smoker.

As a cardiac surgeon, I have seen countless patients with life-threatening coronary blockages, who were saved by bypass surgery, a safe and effective procedure. So, if in doubt, see your doctor, at least for a stress test, especially if you are 45 years and older. As we have said before, “Take good care of your heart; it’s the only one you’ve got.”

(Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: FUN8888.com and philipSchua.com   Email: scalpelpen@gmail.com)