What really happens in the cardiac cath lab?

On September 13, I had a cardiac catheterization procedure.  This is the third time I have had this procedure since my heart problems began.  I gave you a preview of this process in an earlier blog post.  But at the time, I had to base my commentary mostly on information found on websites.  This is because I was sedated during the previous two procedures, and the effects of the sedation wiped out most of my memory in terms of what happened.  But this time around – no sedation and lots of memory!  So now I can tell you the complete and even most minute details of what really happens in the cath lab.

As always, there was some drama in just making sure I got to the procedure with no hiccups.   My sister was supposed to accompany me, and was taking the train to Northern Virginia the day before the procedure.  But they we started to see forecasts for Hurricane Irma, which looked to be on track through several of the Southern cities that the train would travel through.  So we decided that I should look for a back-up.  Our foresight turned out to be spot on, as two days later we learned that her train was cancelled.  
​

Fortunately, one of my retired church friends was available to accompany me to the hospital.  I think because he and his wife know that I was filled with anxiety over getting to the hospital and getting through the procedure, he texted me the night before confirming the time that he would pick me up.  Such a thoughtful gesture to show me that I was not forgotten!

We got to the hospital a few minutes early, and the check-in process was very smooth.  I spent less than a minute in the cath lab waiting room before a nurse came to take me back to the examination area to prepare for the procedures. 

The nurses and technicians who prepped me for the procedure were great – efficient, polite and upbeat.  And as always, someone needs to revamp the fashions for patients.  The first hospital gown I tried on had no left string at the top – how was I supposed to close it?  As is the case with every hospital and doctor’s office I frequent, the gowns were “one size fits all.”  I don’t know who the “all “ is supposed to be in that category, but it sure as heck ain’t me.  Unless what they are saying is that one size fits all the different facets of Melanie that might come out in a given day – the anxious Melanie, the funny Melanie, the logical Melanie.  Perhaps all three of us could fit inside the gown?

Almost immediately after I arrived in the prep area, a technician took my blood pressure.  Of course, it was incredibly low - starting out at 87 over 30-something.  A nurse or technician took it a number of times but while it went up a little it stayed low throughout the morning.  It was about this time that I concluded that the reason I was required to have an adult accompany to the procedure was not just to show that I had someone who could drive me home.  The accompanying adult was necessary to confirm that despite my extremely low blood pressure, I was not dead.  He was able to confirm that I was quite alive, and had talked incessantly from the time we left my driveway until we were in the hospital waiting room.  In fact, my accompanying adult could confirm that I was not a zombie – or if I was a zombie, then I must be a zombie on a caffeine high! 

My cardiologist was on vacation, so the procedure was performed by one of his colleagues.  When he came in to see me, I picked up on what I thought was some guarded concern about the blood pressure.  I also raised a question regarding the blood work, which showed that one number relating to the kidney function seemed a bit out of range, and had actually doubled since the last reading.  I think there may have been some concern that the low blood pressure and the kidney reading could be signs that my heart failure was progressing.  Before we began the procedure, the cardiologist mentioned that he would be writing up a report for my doctor over at INOVA Fairfax who I was scheduled to see in a week.

The cardiologist told me he was going to try to do the catheterization through a vein in my right arm.  He would numb the area but would not sedate me.  He asked if this would cause any anxiety.  I think I said something like no more than the usual.  I didn’t want to tell him that I was less scared about real physical procedures that might be uncomfortable or even a little painful.  No, I become obsessive over things that probably have not happened like:  Gosh, when we parked in the garage, did I fail to close the vehicle door all the way and is the interior light on and draining the vehicle battery?  Trust me, compared to the worry over imagined things, the procedure would be a piece of cake.

It sounded to me like the arm vein was the way to go.  I didn’t freak over the lack of sedation because I figured (1) if there were any possibility of pain or discomfort they would not be doing the procedure without sedation, and (2) I would likely be able to leave the hospital sooner if I didn’t have to recover from sedation.  The cardiologist did say that if there was a problem in trying to get the catheter through the arm vein, they would then try to go in through my neck.  He said it sounds scary, but it isn't a problem and then they would use an anesthetic.  Oh  I almost forgot - there was a something like 1 in 10,000 risk that my  heart might be nicked during the procedure.  But really - having been through procedures and listening to the risk analysis in the past , I realized that this was a very low risk.

A nurse started to wheel me down the hospital corridor towards the cath lab.  I had requested to use the bathroom so we stopped there.  When I came out, I had a new nurse driving my hospital bed into the lab.  I don’t know – maybe it’s like the race car circuit where they have to change pit crews periodically.  Anyway, the new nurse wheeled me into the procedure room.  There was a very nice cath lab nurse waiting for me.  She introduced me to the two 2 technicians who would help the doctor during the course of the procedure and help make the necessary measurements.

There was music on and I said I liked the music because it was modern and lively so they kept that music coming in the entire time I was there.  I think I may have even heard Bastille and some of  my other favorite bands playing while I was in the cath lab.  I also recall that the technicians and the doctor were talking about the Police Academy movies.  One technician knew all the names of each movie in the series, and mentioned that they made 6.   I could not remember seeing one much less six of those movies, so I asked ”Really, they actually made six of those movies?”.  Someone, I think maybe the doctor said “They should have stopped at 2.  (Actually they made 7 Police Academy movies.  You think that working for a law enforcement agency, I might have known that?)

At this point, the cath show began.  The doctor told me when he was about to put the needle in to start the catheter and that there would be a pinch.  There was a pinch but no worse than having blood drawn. There was no pain per se.  My arm just felt a bit sore as the catheter traveled up to the heart.  There was an x-ray machine above me that they lowered closer to my chest.  The cardiologist asked me if I was okay with that and I said yes.  He asked me if he could bring it lower and I said bring it as low as you want.  He said the closer they could get to my body, the less pictures they would have to take.

At this point, I had to make an important decision.  Would I burden the cardiologist with a bunch of questions as the procedure unfolded, or would I just err on the side of caution and keep quiet and try to maintain an air of calm?  I decided that my usual tendency to become a curious chatterbox could elevate the risk of the cardiologist nicking my heart.  So I decided to just shut up and practice my yoga breathing while they were pushing the catheter up to the heart.  It helped, because all of a sudden I heard him say it was all the way in.  The next part was taking the picture and measuring various pressures with the pulmonary and other arteries.  Then the procedure was over.  The worst part was the blood pressure cuff on my left arm.  It just seemed incredibly tight.

Because there was no anesthetic the doctor told me that I could probably leave in about 20 minutes.  He came back into my room and I can't remember exactly what he said.  But I got the impression the results were good.  My friend who had accompanied me to the procedure was there at the time, and I learned later that the doctor had also visited with him in the waiting room while I was getting wheeled back to the recovery area.  My friend also got the impression that the results were good, especially since the cardiologist told him that I did not need to be worried about the kidney number.  I remember when the doctor talked to both of us, he kept mentioning the fact that I had reserves.  I did not know what that meant but it sounded good.   I did mention to the cardiologist that I am an overachiever when it comes to exercise and diet.  I told him the exercise routine I do each day and he said "keep overachieving".

In the meantime, when I got home and was relaxing, I remembered the comment about reserves.  So I looked for reserves on the web.  I came up with heart rate reserves, cardiac reserves, preserved ejection fraction and join the Army Reserves (I did not make this last one up, really!).  Rather than drive myself crazy trying to figure out what reserves were (and rather than calling my local Army recruiter), I decided to just wait for my appointment with the heart failure doctor the next week.

When I met with the heart failure doctor, he went over the results between the cardiac cath I had in September 2014 versus the one I had in September 2017.  The results were higher, and it appeared that this was a good thing.  I also checked on the status of my left ventricle.   While at one point, the left ventricle had been dilated, for the last year and a half, it had gone back into the normal range.  The heart failure doctor is very pleased with this, as am I.  He also mentioned that I have so much going for me in terms of the fact that all we have to concentrate on is my  heart.  Other patients have damage to other organs, like lungs or kidneys. 

I have to manage my expectations, reminding myself that I have good results for someone who sees an advanced heart failure doctor.  I don't want to set myself up to think it's like Look Ma, no more heart failure, as I doubt that will ever be the case.  

I also have to get my mind ready for the next test in about 6 weeks.  This will be another treadmill stress test.  Don't ask me why, but I hate this test.  Maybe it is because I fell off a treadmill once when I blacked out, and I still channel that fear.  Maybe it's because I have to do some pulmonary tests ahead of time that simulate hyperventilating.  Maybe it's because I have had one of the technicians freak out in the past over my blood pressure.  Maybe it's because I found that my results have been slipping each time rather than getting better.  I know that this is probably just an issue of mind over matter, so I'm going to give thought on how to overcome the mental stress.

​But the good news overall from the cardiac cath is this.  The results of that particular test were good.  So I am able to find some positive news in my heart failure condition.  So maybe it will help prepare me for the next test if I can keep in mind that I seem to be holding my own and so far, no damage to other parts of my body.  I am truly blessed.