Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
CPT4 code
Name of the Procedure:
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization.
Summary
This procedure involves inserting a catheter into the coronary arteries to perform an angiography, a type of imaging that visualizes the blood vessels. It also includes injecting a contrast dye to highlight the arteries on the x-ray images. Additionally, a catheter is placed in the right side of the heart to measure pressures and assess heart function.
Purpose
The procedure addresses the diagnosis and assessment of coronary artery disease, heart valve problems, and other heart conditions. It helps in visualizing blockages or abnormalities in the coronary arteries and provides vital information on heart pressures and blood flow.
Indications
- Symptoms like chest pain (angina), shortness of breath, or unexplained fatigue.
- Abnormal results from stress tests or other cardiovascular tests.
- Evidence of heart disease from other diagnostic tools.
- Preoperative assessment for heart surgery or procedures.
Preparation
- Fasting for 6-8 hours before the procedure.
- Adjustments or temporary discontinuation of certain medications, especially blood thinners.
- Pre-procedure blood tests and imaging studies.
Procedure Description
- The patient is typically awake, with a local anesthetic applied to the insertion site (usually the groin or wrist).
- An intravenous (IV) line is placed to administer medications and fluids.
- A catheter is threaded through a blood vessel to the coronary arteries.
- A contrast dye is injected to make the arteries visible on x-ray images.
- Additional catheterization in the right heart is performed to measure pressures and assess cardiac function.
- Images are taken and interpreted by the cardiologist to determine any abnormalities.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is performed in a hospital's cardiac catheterization lab.
Personnel
- Interventional cardiologist (primary physician performing the procedure)
- Radiologic technologist
- Cardiac nurses
- Anesthesiologist or sedation nurse (if applicable)
Risks and Complications
- Bleeding or bruising at the insertion site
- Allergic reactions to the contrast dye
- Blood vessel damage
- Heart attack or stroke (rare)
- Infection at the catheter site
- Arrhythmias (irregular heartbeats)
Benefits
- Accurate diagnosis of coronary artery disease and other heart conditions
- Immediate visual assessment of blood flow and heart function
- Essential information for planning treatment options or surgeries
- Potential for immediate intervention (stent placement) if a blockage is found
Recovery
- Monitoring in a recovery area for several hours post-procedure
- Instructions on care for the insertion site
- Avoiding heavy lifting and strenuous activities for a few days
- Follow-up appointments for results discussion and further treatment planning
Alternatives
- Non-invasive imaging tests like CT angiography or MR angiography
- Medical management with drugs and lifestyle changes
- Echocardiography or stress tests
- Pros of the described procedure include a more definitive diagnosis and potential for immediate treatment; cons are higher risk and invasiveness compared to non-invasive alternatives.
Patient Experience
- Mild discomfort or pressure at the insertion site.
- Sensation of warmth or flushing during dye injection.
- Pain management with local anesthetic and possible sedation for comfort.
- Post-procedure soreness at the insertion site, manageable with over-the-counter pain relief.