Heart Catheterization: Essential Questions for Patients

Q: Heart Catheterization: Essential Questions for Patients

Hello： 1. <br>An exercise electrocardiogram (ECG) is used to assess whether there are signs of myocardial ischemia. <br>Under normal circumstances, one should be able to run for 8 to 10 minutes; if symptoms arise within 2 minutes, it likely indicates severe cardiovascular obstruc

Inquiry about cardiac catheterization?

Hello Dr.
Huang,
My father is 70 years old, 170 cm tall, and weighs 76 kg.
His medical history includes liver cancer (diagnosed 7 years ago, has hepatitis B, is on medication, has undergone electrocautery, embolization, arterial chemotherapy, and partial liver resection, and will continue to require treatment for liver cancer), hypertension (on medication for 7 years, with occasional high blood pressure), and high cholesterol (just started medication 3 months ago).
Our family follows a light diet, has no exercise habits, and does not smoke or drink alcohol.

Since January of this year, he has experienced soreness and pain in the left chest and left back, with the pain radiating, shortness of breath while walking, discomfort when lying flat (preferring to lie on his side), difficulty falling asleep, and sweating during sleep.
Yesterday, he visited a cardiologist and underwent a stress echocardiogram, ultrasound, portable ECG monitoring, and blood tests.
During the stress test (after running for 2 minutes, his complexion changed, and he had to stop immediately, taking one medication), the physician indicated that he has angina and there are blockages.
A cardiac catheterization has been scheduled for next week to determine if a stent is necessary.

The rapid arrangement of the entire treatment process raises concerns about the severity of his condition, which is why the cardiovascular examination is scheduled for next week.
Since our family is not well-informed about cardiac catheterization, we are unsure what questions to ask the doctor.
Therefore, I have the following questions for your consultation.
Thank you!
Q1: Is it necessary to perform invasive cardiac catheterization? Some friends and relatives have undergone CT or MRI scans before their catheterization, but this time the doctor did not schedule those and went directly to the catheterization.
Are CT or MRI scans necessary?
Q2: The doctor has prescribed oral medication; what dietary and lifestyle considerations should we be aware of at this time?
Q3: Since my father needs further treatment for liver cancer (embolization, electrocautery, arterial chemotherapy, or immunotherapy, with embolization originally scheduled for late March), I found that there are drug-eluting stents covered by insurance and those that are self-paid.
After the procedure, he will need to take antiplatelet medication.
Which type of stent would be more suitable for him? Will placing a stent interfere with his liver cancer treatment? If so, how long would he need to wait before resuming treatment?

Diane, 40~49 year old female. Ask Date: 2023/03/10

Dr. Huang Yinghe reply Cardiology

Hello: 1.
An exercise electrocardiogram (ECG) is used to assess whether there are signs of myocardial ischemia.
Under normal circumstances, one should be able to run for 8 to 10 minutes; if symptoms arise within 2 minutes, it likely indicates severe cardiovascular obstruction, and arranging for a cardiac catheterization may be necessary.
2.
Hypertension and high cholesterol are risk factors for cardiovascular disease.
According to the recommendations from the Taiwanese Society of Cardiology, the following lifestyle guidelines should be followed: S (Salt restriction): Reduce salt intake to avoid increasing kidney burden and fluid retention, which can help lower blood pressure.
A (Alcohol limitation): Limit alcohol consumption.
Men should consume less than 30 grams of alcohol per day, while women should consume less than 20 grams.
B (Body weight): Weight loss can reduce the burden on the heart.
C (Cessation of smoking): Quitting smoking reduces vascular irritation and decreases the risk of cardiovascular disease and stroke.
D (Diet adaptation): Increase the intake of fruits and vegetables while reducing foods high in fats, red meats, and sweets; limit consumption of coffee and strong tea.
E (Exercise adoption): Engage in at least 30 minutes of aerobic exercise daily, at least five times a week.
3.
Regardless of whether a standard metallic stent covered by health insurance or a drug-eluting stent is used, it is essential to take two antiplatelet medications for at least one month post-procedure.
If a stent is absolutely necessary, it is generally not advisable to undergo invasive procedures during the antiplatelet medication period due to increased bleeding risk.
Please inform your father's cardiologist about his liver cancer and related treatments, as sometimes it is necessary to discuss treatment plans with relevant specialists to avoid disrupting the treatment course.
The above is a general management guideline and is not specific advice for your father's individual situation, nor can it replace an actual consultation with a physician.
Your father has multiple complex health conditions, and cardiac catheterization is a significant decision; it is advisable to discuss this thoroughly with the attending physician.

Reply Date: 2023/03/10

More Info

Heart catheterization, also known as coronary angiography, is a crucial diagnostic procedure used to evaluate coronary artery disease (CAD) and other heart conditions. Given your father's medical history and current symptoms, it's understandable that you have several questions regarding this procedure and its implications.

Q1: Is heart catheterization necessary?
In your father's case, the rapid progression to scheduling a heart catheterization indicates that the healthcare team is concerned about the potential severity of his condition. Symptoms such as chest pain, shortness of breath, and the results from the stress tests suggest that there may be significant blockages in the coronary arteries. While non-invasive imaging techniques like CT or MRI can provide valuable information, they may not always be definitive in assessing the need for intervention. Heart catheterization allows for direct visualization of the coronary arteries and can also facilitate immediate treatment, such as angioplasty or stenting, if significant blockages are found.

In many cases, if a patient presents with symptoms suggestive of CAD and has abnormal stress test results, a heart catheterization is warranted to confirm the diagnosis and assess the extent of any blockages. Therefore, while CT or MRI can be useful, they are often not necessary if the clinical picture strongly indicates the need for catheterization.

Q2: Dietary and lifestyle considerations
Given your father's health conditions, particularly hypertension and high cholesterol, dietary modifications are essential. Here are some recommendations:
1. Heart-Healthy Diet: Encourage a diet rich in fruits, vegetables, whole grains, and lean proteins. Foods high in omega-3 fatty acids, such as fish, can be beneficial. Limit saturated fats, trans fats, and cholesterol by avoiding fried foods, processed snacks, and fatty cuts of meat.

2. Sodium Intake: Since your father has high blood pressure, reducing sodium intake is crucial. Aim for less than 2,300 mg of sodium per day, or even lower if advised by his healthcare provider.

3. Regular Exercise: While it may be challenging due to his current symptoms, incorporating light physical activity as tolerated can help improve cardiovascular health. Always consult with his doctor before starting any exercise program.

4. Medication Adherence: Ensure that he takes his prescribed medications consistently, as these will help manage his blood pressure and cholesterol levels.

Q3: Stent options and implications for cancer treatment
When it comes to stent placement, there are generally two types: bare-metal stents (BMS) and drug-eluting stents (DES). The choice between these options depends on various factors, including the extent of coronary artery disease, the patient's overall health, and the potential for future treatments.

1. Drug-Eluting Stents: These stents release medication that helps prevent the artery from becoming blocked again. They are often preferred in patients with a higher risk of restenosis (re-narrowing of the artery). However, they require long-term use of antiplatelet medications, which can complicate future treatments for other conditions, such as liver cancer.

2. Bare-Metal Stents: These may be considered if there is a concern about the need for future surgeries or treatments, as they typically require a shorter duration of antiplatelet therapy.

Regarding the timing of cancer treatments after stent placement, it is crucial to discuss this with both the cardiologist and the oncologist. Generally, patients are advised to continue antiplatelet therapy for at least 6-12 months after stent placement to reduce the risk of stent thrombosis. Coordination between the two specialties is vital to ensure that your father's cancer treatment can proceed safely without compromising his cardiovascular health.

In conclusion, heart catheterization appears to be a necessary step in your father's care, given his symptoms and medical history. It is essential to maintain open communication with his healthcare team to address any concerns and ensure a comprehensive approach to his treatment plan.

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