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Transradial Approach for a Heart Cath Explained
Dr. Jeffrey Schussler discusses heart disease and explains the trans radical approach for a heart cath.
Featured Speaker:
Jeffrey M. Schussler, MD, FACC, FSCA
Interventional Cardiologist Dr. Jeffrey Schussler on the Medical Staff and the Medical Director at Baylor Scott & White Heart & Vascular Hospital in Dallas for the Critical Care Unit and also Cardiac Rehabilitation. Dr. Schussler has published many articles and speaks across the country. Transcription:
Transradial Approach for a Heart Cath Explained
Bill Klaproth: So, what is a heart catheterization and why would someone need this special procedure? Well, let's learn more about this procedure for patients diagnosed with heart disease, with Interventional Cardiologists, Dr. Jeffrey Schussler on the medical staff and the Medical Director at Baylor Scott and White Heart and Vascular Hospital in Dallas for the critical care unit and also cardiac rehabilitation. This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. I'm Bill Klaproth. Dr. Schussler. Thank you so much for your time. So first off, why would someone need a heart catheterization?
Dr. Schussler: That's a good question. First, we need to talk about what it actually is. So when we talk about catheterization, it's putting a tube into the person's body and specifically for us into the heart, and we can do several things, including measure the pressures in the heart. We can look at the function of the heart, and we look at the arteries of the heart to see if there are blockages. So the number one reason that people have a heart catheterization is usually a heart attack. So these are not scheduled procedures that can happen day night, weekends, you name it. Holidays. Someone comes in, they're having chest pain, they're having a heart attack. And we put a catheter up into the arteries of the heart, hopefully to open up the artery. And in some cases even save their life. Some people who aren't having a heart attack, but are having chest pain. And we think it's because of a blockage. It's another good reason to do a heart catheterization, to see if the blockages are there, not quite as dramatic a situation and it's not usually life-threatening, but we can make them feel better by opening up arteries. And then there's a host of other reasons. If the heart functions low, if they've got pressures in the lungs that are high, that we can do these procedures.
Host: So now that a patient has heard that they need a heart catheterization, where traditionally a catheter is inserted into an artery in the groin, what would prompt an interventional cardiologist to consider a trans radial cath? In other words, when would an interventional cardiologist consider a trans radial heart catheterization?
Dr. Schussler: Heart catheterizations have been done traditionally from the leg through the femoral artery. And we've been doing these procedures for the better part of 40 50 years. Interestingly, a long time ago, they were trying to figure out what's the best way to get to the heart. There's lots of roads to the heart. And you can actually go in from an artery in the elbow. You can go in from the artery in the groin. You can go in from an artery in the wrist. The catheters themselves have shrunk quite a bit over the years. And so it wasn't as feasible or as doable to go from the wrist years ago. And it's become a lot more easier to do that. When there's lots of different choices, you always have to ask, so is there a quicker way, a safer way, a easier way for both the patient and the physician to do it? Doesn't mean that one way is necessarily worse. Sometimes there's some advantages to doing it one way or the other.
Host: So, explain to us if you're not going through the groin, where does a trans radial cath go?
Dr. Schussler: The radial artery is an artery that goes right by the thumb. So when we're talking about trans radial, it's through the wrist, if you've ever seen people feel the pulse, when they're, you know, someone's on the ground and then check their pulse, they check in the neck, they check on the wrist by the thumb. That's the artery that we can go through to do a heart catheterization from the wrist.
Host: Got it. All right. So how long is the procedure then? How long will the patients stay in the hospital after the procedure in general? And if they do the trans radial cath, is that less than when you go through the groin?
Dr. Schussler: So, the procedure itself, depending on what you find is usually anywhere from 15 to 20 minutes, if all we do is take a look, I can be up to an hour, hour and a half, sometimes a little longer. If we find blockages or things to fix the time varies. It's not usually many hours. It's usually on average half an hour to an hour and a half. The big difference between trans radial and transfemoral is the aftercare. When we do a heart catheterization from the groin, lots of people have had family members where they've had heart catheterizations, where afterwards, they put a sandbag on your groin, just kind of old-school or they put a big clamp on the groin, or even what's probably best and more traditional is holding pressure with your hands to keep the area from bleeding after we remove all the equipment, cause you know, we have to make a hole to get into the artery.
And so, after all the equipment's out, there's a hole that's left. And while a clot is forming someone or some mechanism has to hold pressure. So from the groin, it can cause problems. If you have bleeding in that area, you can hide a lot of blood in the leg or in the pelvis. When you go from the wrist, it's actually a little easier to get control of the site. If there's bleeding or swelling, you can put your whole hand around somebody's wrist most times, and most people can see swelling very easily. And so after a heart cath is done, it's sometimes easier to hold pressure and to keep the patient from having bleeding issues.
Host: And as we talk about the heart catheterization, what is the exact purpose of this? I know that you also will go in and put stents in. I take it the heart cath comes first?
Dr. Schussler: The catheterization itself is really talking about putting the tubes in. And then once we actually have the tubes into the arteries of the heart, we inject contrast so that we can see the arteries. If there is a blockage, we can then sometimes feed in very small wires and very small balloons. And also a stent. Stent is just a little metal tube that goes into the arteries, and it's like a scaffolding that pushes the plaque. If they find blockages, it pushes that blockage aside. So yes, the intention, if you have a heart attack, most people get what's called a stent to push open the blockage and let the blood flow through. And the way we get to the arteries is through these catheters. And that's what the catheterization is for.
Host: So, the heart cath goes in first for evaluation, and then it's there to make possible, if you do have to place a stent or a balloon?
Dr. Schussler: Correct. So doing a heart catheterization just refers to looking, doing angioplasty, simply refers to fixing and putting in a stent is the actual device that we use to fix the arteries of the heart.
Host: So, then what are the risks associated with this procedure?
Dr. Schussler: The risks of doing a heart catheterization. It's a laundry list of bad things that can happen. And whenever I talk to a patient about doing this, I say, look, you know, it's a pretty safe procedure, but the things that can go wrong include things like dying, having a stroke, damaging the leg. If we go through the leg, damaging the arm, if we go in through the arm, we can cause bleeding around the heart. We can puncture the heart. We can damage the lungs. You can have a reaction to the contrast. We can even damage the kidneys. That's sort of the number one through 10, roughly list of things that can go wrong. Theoretically, the reality is, is that the chances of something dire happening during a heart catheterization is on the order of one in a thousand. And usually when someone needs a heart catheterization, there's a good reason to do it.
The risk of not doing the heart catheterization is a lot higher than the risk of doing the heart catheterization. The one thing that we do see more often than not about one in a hundred people have some kind of bleeding complication related to the fact that A, we're putting a hole in an artery and B, a lot of people are on blood thinners around the time of their procedure because they are either having a heart attack or they're on aspirin, etcetera. So bleeding is the most common risk and bleeding is the thing that we seem to see less of when you do the heart cath through the trans radial approach versus femoral, which is the groin artery.
Host: Yeah, that's a really good point. If you need to have this done, you probably have bigger problems than the risks of having the heart cap.
Dr. Schussler: It's not like we do these things just for fun and on a whim. There should be a really good reason that we're going to make a hole in your artery and feed tubes up to your heart. But again, if you're having a heart attack, it's a no brainer. Clearly your life is at risk right then and there and there shouldn't be a lot of discussion. There are other things, you know, people are having chest pain that may or may not be cardiac. And they go through the normal sequence of other procedures and their doctor, and they have decided that they need further information. And that's when they decide to do the heart catheterization, it's not just, Hey, you know, do you have a free hour or two? Why don't we just do this for fun?
Host: So, let's talk more about recovery. Exactly what is that like? And is there a recommendation for cardiac rehabilitation after this type of heart catheterization?
Dr. Schussler: Two things, there's the immediate aftercare. So if you have a heart catheterization from the leg, usually you have to be on bed rest for a few hours. It's not a long time, but four to six hours generally. Remember a lot of this depends on what they found, what they did. Cause if they found blockages and put a stent in, you're going to be on more potent blood thinners. If you do have it from the wrist, the nice thing about doing it that way is we don't have to put a clamp on your leg. You can sit up right away. Usually they can feed you within 30 minutes. And so it's not like you want to go dancing, but you don't have quite as many restrictions if you have it from the wrist. The rehab questions a little bit more pertaining to, or not. You had blockages. So if you did a heart cath and they found blockages that required a stent, we always recommend going to cardiac rehab, where they teach you how to change your diet, change your lifestyle, quit smoking if you smoke, manage your diabetes and exercise. If they found blockages that suggested you needed something like open heart surgery, well then for sure, you know, after you have your surgery and again, that's for another talk, but after you have your surgery, we always recommend cardiac rehab for the same reasons. It sort of gets you back on your feet, get you moving again and teaches you better behaviors to try and not let these things happen in the future.
Host: Right. Preventative medicine is always the best way to go. And then last question, Dr. Schuessler and thank you so much for your time. Any other advice or guidance or anything else we should know about a heart catheterization?
Dr. Schussler: Biggest thing is just having discussions with your doctor. If you're having chest pains, particularly if you're having chest pains with activities, exercise, etcetera, that's something you need to bring up with your physician. You might need to be referred to a cardiologist and then there's tests that they can do. Some people come in and they have very classic symptoms for what we call anginal, which is really chest pain related to the heart. And if you're having what sounds like classic anginal symptoms, then directly to heart cath may be the right next step. Sometimes people come in with chest pain that is clearly not their heart, in which case they may decide not to do any tests whatsoever. And then there's sometimes in between where they think doing things like stress tests may be helpful. Sometimes cat scans of the heart can look at the arteries and see and decide whether or not further invasive testing is really necessary.
Host: Well, Dr. Schuessler this has really been informative. Thank you so much for your time and your expertise today.
Dr. Schussler: Thank you very much.
Host: That's Dr. Jeffrey, Schussler a medical director and on the medical staff at Baylor Scott and White Heart and Vascular hospital Dallas. And thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff, please call 1 844-279-3627 or visit Baylorhearthospital.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk again soon. Baylor Scott and White Heart and Vascular hospital, Dallas and Fort Worth joint ownership with physicians.
Transradial Approach for a Heart Cath Explained
Bill Klaproth: So, what is a heart catheterization and why would someone need this special procedure? Well, let's learn more about this procedure for patients diagnosed with heart disease, with Interventional Cardiologists, Dr. Jeffrey Schussler on the medical staff and the Medical Director at Baylor Scott and White Heart and Vascular Hospital in Dallas for the critical care unit and also cardiac rehabilitation. This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. I'm Bill Klaproth. Dr. Schussler. Thank you so much for your time. So first off, why would someone need a heart catheterization?
Dr. Schussler: That's a good question. First, we need to talk about what it actually is. So when we talk about catheterization, it's putting a tube into the person's body and specifically for us into the heart, and we can do several things, including measure the pressures in the heart. We can look at the function of the heart, and we look at the arteries of the heart to see if there are blockages. So the number one reason that people have a heart catheterization is usually a heart attack. So these are not scheduled procedures that can happen day night, weekends, you name it. Holidays. Someone comes in, they're having chest pain, they're having a heart attack. And we put a catheter up into the arteries of the heart, hopefully to open up the artery. And in some cases even save their life. Some people who aren't having a heart attack, but are having chest pain. And we think it's because of a blockage. It's another good reason to do a heart catheterization, to see if the blockages are there, not quite as dramatic a situation and it's not usually life-threatening, but we can make them feel better by opening up arteries. And then there's a host of other reasons. If the heart functions low, if they've got pressures in the lungs that are high, that we can do these procedures.
Host: So now that a patient has heard that they need a heart catheterization, where traditionally a catheter is inserted into an artery in the groin, what would prompt an interventional cardiologist to consider a trans radial cath? In other words, when would an interventional cardiologist consider a trans radial heart catheterization?
Dr. Schussler: Heart catheterizations have been done traditionally from the leg through the femoral artery. And we've been doing these procedures for the better part of 40 50 years. Interestingly, a long time ago, they were trying to figure out what's the best way to get to the heart. There's lots of roads to the heart. And you can actually go in from an artery in the elbow. You can go in from the artery in the groin. You can go in from an artery in the wrist. The catheters themselves have shrunk quite a bit over the years. And so it wasn't as feasible or as doable to go from the wrist years ago. And it's become a lot more easier to do that. When there's lots of different choices, you always have to ask, so is there a quicker way, a safer way, a easier way for both the patient and the physician to do it? Doesn't mean that one way is necessarily worse. Sometimes there's some advantages to doing it one way or the other.
Host: So, explain to us if you're not going through the groin, where does a trans radial cath go?
Dr. Schussler: The radial artery is an artery that goes right by the thumb. So when we're talking about trans radial, it's through the wrist, if you've ever seen people feel the pulse, when they're, you know, someone's on the ground and then check their pulse, they check in the neck, they check on the wrist by the thumb. That's the artery that we can go through to do a heart catheterization from the wrist.
Host: Got it. All right. So how long is the procedure then? How long will the patients stay in the hospital after the procedure in general? And if they do the trans radial cath, is that less than when you go through the groin?
Dr. Schussler: So, the procedure itself, depending on what you find is usually anywhere from 15 to 20 minutes, if all we do is take a look, I can be up to an hour, hour and a half, sometimes a little longer. If we find blockages or things to fix the time varies. It's not usually many hours. It's usually on average half an hour to an hour and a half. The big difference between trans radial and transfemoral is the aftercare. When we do a heart catheterization from the groin, lots of people have had family members where they've had heart catheterizations, where afterwards, they put a sandbag on your groin, just kind of old-school or they put a big clamp on the groin, or even what's probably best and more traditional is holding pressure with your hands to keep the area from bleeding after we remove all the equipment, cause you know, we have to make a hole to get into the artery.
And so, after all the equipment's out, there's a hole that's left. And while a clot is forming someone or some mechanism has to hold pressure. So from the groin, it can cause problems. If you have bleeding in that area, you can hide a lot of blood in the leg or in the pelvis. When you go from the wrist, it's actually a little easier to get control of the site. If there's bleeding or swelling, you can put your whole hand around somebody's wrist most times, and most people can see swelling very easily. And so after a heart cath is done, it's sometimes easier to hold pressure and to keep the patient from having bleeding issues.
Host: And as we talk about the heart catheterization, what is the exact purpose of this? I know that you also will go in and put stents in. I take it the heart cath comes first?
Dr. Schussler: The catheterization itself is really talking about putting the tubes in. And then once we actually have the tubes into the arteries of the heart, we inject contrast so that we can see the arteries. If there is a blockage, we can then sometimes feed in very small wires and very small balloons. And also a stent. Stent is just a little metal tube that goes into the arteries, and it's like a scaffolding that pushes the plaque. If they find blockages, it pushes that blockage aside. So yes, the intention, if you have a heart attack, most people get what's called a stent to push open the blockage and let the blood flow through. And the way we get to the arteries is through these catheters. And that's what the catheterization is for.
Host: So, the heart cath goes in first for evaluation, and then it's there to make possible, if you do have to place a stent or a balloon?
Dr. Schussler: Correct. So doing a heart catheterization just refers to looking, doing angioplasty, simply refers to fixing and putting in a stent is the actual device that we use to fix the arteries of the heart.
Host: So, then what are the risks associated with this procedure?
Dr. Schussler: The risks of doing a heart catheterization. It's a laundry list of bad things that can happen. And whenever I talk to a patient about doing this, I say, look, you know, it's a pretty safe procedure, but the things that can go wrong include things like dying, having a stroke, damaging the leg. If we go through the leg, damaging the arm, if we go in through the arm, we can cause bleeding around the heart. We can puncture the heart. We can damage the lungs. You can have a reaction to the contrast. We can even damage the kidneys. That's sort of the number one through 10, roughly list of things that can go wrong. Theoretically, the reality is, is that the chances of something dire happening during a heart catheterization is on the order of one in a thousand. And usually when someone needs a heart catheterization, there's a good reason to do it.
The risk of not doing the heart catheterization is a lot higher than the risk of doing the heart catheterization. The one thing that we do see more often than not about one in a hundred people have some kind of bleeding complication related to the fact that A, we're putting a hole in an artery and B, a lot of people are on blood thinners around the time of their procedure because they are either having a heart attack or they're on aspirin, etcetera. So bleeding is the most common risk and bleeding is the thing that we seem to see less of when you do the heart cath through the trans radial approach versus femoral, which is the groin artery.
Host: Yeah, that's a really good point. If you need to have this done, you probably have bigger problems than the risks of having the heart cap.
Dr. Schussler: It's not like we do these things just for fun and on a whim. There should be a really good reason that we're going to make a hole in your artery and feed tubes up to your heart. But again, if you're having a heart attack, it's a no brainer. Clearly your life is at risk right then and there and there shouldn't be a lot of discussion. There are other things, you know, people are having chest pain that may or may not be cardiac. And they go through the normal sequence of other procedures and their doctor, and they have decided that they need further information. And that's when they decide to do the heart catheterization, it's not just, Hey, you know, do you have a free hour or two? Why don't we just do this for fun?
Host: So, let's talk more about recovery. Exactly what is that like? And is there a recommendation for cardiac rehabilitation after this type of heart catheterization?
Dr. Schussler: Two things, there's the immediate aftercare. So if you have a heart catheterization from the leg, usually you have to be on bed rest for a few hours. It's not a long time, but four to six hours generally. Remember a lot of this depends on what they found, what they did. Cause if they found blockages and put a stent in, you're going to be on more potent blood thinners. If you do have it from the wrist, the nice thing about doing it that way is we don't have to put a clamp on your leg. You can sit up right away. Usually they can feed you within 30 minutes. And so it's not like you want to go dancing, but you don't have quite as many restrictions if you have it from the wrist. The rehab questions a little bit more pertaining to, or not. You had blockages. So if you did a heart cath and they found blockages that required a stent, we always recommend going to cardiac rehab, where they teach you how to change your diet, change your lifestyle, quit smoking if you smoke, manage your diabetes and exercise. If they found blockages that suggested you needed something like open heart surgery, well then for sure, you know, after you have your surgery and again, that's for another talk, but after you have your surgery, we always recommend cardiac rehab for the same reasons. It sort of gets you back on your feet, get you moving again and teaches you better behaviors to try and not let these things happen in the future.
Host: Right. Preventative medicine is always the best way to go. And then last question, Dr. Schuessler and thank you so much for your time. Any other advice or guidance or anything else we should know about a heart catheterization?
Dr. Schussler: Biggest thing is just having discussions with your doctor. If you're having chest pains, particularly if you're having chest pains with activities, exercise, etcetera, that's something you need to bring up with your physician. You might need to be referred to a cardiologist and then there's tests that they can do. Some people come in and they have very classic symptoms for what we call anginal, which is really chest pain related to the heart. And if you're having what sounds like classic anginal symptoms, then directly to heart cath may be the right next step. Sometimes people come in with chest pain that is clearly not their heart, in which case they may decide not to do any tests whatsoever. And then there's sometimes in between where they think doing things like stress tests may be helpful. Sometimes cat scans of the heart can look at the arteries and see and decide whether or not further invasive testing is really necessary.
Host: Well, Dr. Schuessler this has really been informative. Thank you so much for your time and your expertise today.
Dr. Schussler: Thank you very much.
Host: That's Dr. Jeffrey, Schussler a medical director and on the medical staff at Baylor Scott and White Heart and Vascular hospital Dallas. And thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff, please call 1 844-279-3627 or visit Baylorhearthospital.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk again soon. Baylor Scott and White Heart and Vascular hospital, Dallas and Fort Worth joint ownership with physicians.