How many heart tests can there be?

Earlier this year, my heart failure doctor told me that he wanted me to do another right heart catheterization.  As always, I panicked a bit because I always assume that the need for more tests means that I am not doing as well.  I cannot seem to get it through my head that if I’m still exercising and only having dizzy spells occasionally, I am doing well and there is no need to push the panic button.

Indeed, from what my heart failure doctor said, it appears that this is just one of several routine tests that they can do to assess the levels of pressure within my heart and between my heart and lungs.  I actually have had this test several times:  Once when I initially fell off the treadmill in 2012, and again in 2014 when the doctors wanted to see if I was a candidate for a heart transplant.
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Because the test evaluates pressure in the heart and lungs, it is also known as a pulmonary artery catheterization.  According to the Johns Hopkins Medical website, the procedure requires the doctor to guide a special catheter (a small, hollow tube) called a pulmonary artery (PA) catheter to the right side of the heart. The tube is then passed into your pulmonary artery. This is the main artery that carries blood to your lungs. The doctor will observe blood flow through the heart and measures the pressures inside the heart and lungs.

As the catheter advances toward the pulmonary artery, the doctor will measure pressures along the way, inside the chambers on the right side of the heart. This includes the right atrium and right ventricle. The doctor can also take indirect measurements of pressures on the left side of the heart. The cardiac output—the amount of blood the heart pumps per minute—is also determined during a right-heart catheterization.  All of these measurements are used to diagnose heart conditions and to determine an appropriate course of treatment.

I will have to fast for about 6 or 8 hours before the procedure is performed.  I will be given a sedative, but supposedly will be awake throughout the procedure.  I am emphasizing the word “supposedly” because I have had a cardiac catheterization in 2012 and in 2014.  I may have been awake during the procedure, but they must have given me something to erase my memories because I do not remember anything.  We’ll see if there is anything that I can remember for the third time around – it might make a great blog post!

Having been through a number of procedures like this in the last few years, I don’t even know if the doctor needs to give me post-procedure instructions.  I think I have them down by heart.  Once the procedure is over, I will not be allowed to drive myself back home because I was under sedation.  I will be benched from activity for a period of time.

I found the discharge instructions I was provided in 2014.  And there it is in the first instruction – the advice that always bums me out:  No strenuous exercise or lifting greater than 20 pounds for 3 to 5 days.  Hopefully I will be able to at least walk at a moderate pace outside to get fresh air and space, or maybe even on a treadmill at a moderate pace and no incline should the weather be bad.  I suspect planking might not be wise, it involves lifting my body up off the floor in a push up position.  Not weight lifting exactly, but probably does involve some bearing of weight (my body and all the water it is retaining!).   

No tub baths or swimming for 10 to 14 days.  No big deal.  I take showers and am not a swimmer.  Another one that I can handle easily: Minimize stair climbing for 3 to 5 days.  And if course, if the site starts to bleed, apply firm pressure, call 911 and lie down.  If the site is draining, cover with sterile gauze and call the doctor.

Here is the one that might actually be the hardest for me to follow.  When coughing, sneezing, or laughing, support the site with your hand.  I think that the last thing it would even dawn on me to do is to put my hand on the site where the probe was inserted.   I’ll just try to watch boring movies and stay inside so that my seasonal allergies aren’t activated.

The one strange thing I remember is that when I had the procedure in 2014, I was given a laminated card.  I was told that I would have to keep this card with me for the next 90 days (like in my wallet, or in a pocket, or wherever medical personnel could find it).  It said that some special new type of closure had been used to close up the wound in the groin where the catheter had been inserted. 

This made me wonder.  If I were to black out, would the EMTs look at me and say: Hey Joe, it looks to me like this woman had a cardiac catheterization in the last 90 days.  I bet that the doctor used one of those new types of closures on her.  Let’s check and see if she has a card in her wallet that says that.   I suspect that a lot of people forget about the card within the first day, or it gets tossed out when they get home.  But because I am so rule oriented, of course I kept it in my wallet for the entire 90 days after the procedure.

In my medical folders, I also found the report from the 2014 procedure.  It listed a lot of figures regarding pressure readings, etc.  that are totally Greek to me.  There is a picture of the heart, and in several pathways of the heart I see that the doctor wrote the word “normal”, which I assume is a good thing.  From what my sister reported from the chat with my doctor, there was nothing urgent found in the test.  In fact, it was this test, along with the blood tests and treadmill stress test that convinced the doctors that I was not in need of a heart transplant.

​So while I would like to be using an upcoming fall day for more fulfilling endeavors, like shopping or having lunch with a friend, I do understand the need for the right cardiac catheterization.      I just hope I remember more of the procedure this time.  The descriptions here are more from websites.  I’d like to be able to know, and to describe to you, what really happens as the doctor surfs the explore the world of Melanie’s heart and lungs!