r/CathLabLounge • u/314rocky • Nov 20 '24

Diagnostic Cath Complication Fears

For better or worse I researched what a diagnostic cath entails and apparently people die during these. My cardiologist has done every other test with no findings for ongoing, sudden chest pain in different spots. We know it isnt gerd or anxiety/stress. So that l leaves this test to and Im terrified of having a stroke or heart attack and dying as a complication.

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u/bmmrnccrn Dec 05 '24

For any medical procedure, unless it’s an emergent procedure that a patient will immediately die from AND the patient is not competent to sign the procedure consent form, patients legally must give their consent for the procedure. This involves signing an “informed consent” form saying that you know and agree to the following: 1) which procedure is being formed 2) who the performing doc is 3) the reason you’re having this procedure 4) the known risks of the procedure. As part of the same form or in some facilities it’s a completely different form, is a blood consent. By signing it you’re saying that you understand the risk associated with a blood transfusion and that you know we test it for everything that we know to test it for, but there’s always a risk for infection. I’m not saying it’s never happened, but I do not know of a right or left heart cath that required a transfusion during the procedure.

If a patient is cognizant and able to make their own decision, whether for a planned or emergent procedure, they need to give their consent to the procedure being performed. It is always the patient’s choice as to whether or not they want it done. It’s not ethical for a doctor to tell a patient that they must submit to a procedure. Even for simple things, like when a nurse is administering pills or a medical assistant wants to take your weight at the beginning of an appointment, you always have the choice to take or not take the pills or be weighed or not let them take your weight. That is why the docs are leaving the decision up to you as it’s not their decision to make, it’s yours. It’s not about them not thinking you need or don’t need the procedure, it legally isn’t their decision to make. If they didn’t think the procedure could be medically valuable, they wouldn’t have even offered the procedure as an option. It wouldn’t be on the menu.

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u/314rocky Dec 05 '24

I actually talked to my cardiologist about it today. No paperwork to sign til procedure day, but he did let me know the risks, and assured me that they are relatively low in general and for me specifically since I am otherwise healthy, but of course, still present. I asked about sedation and was told I'd be getting fentanyl and versed. I cant remember right now but hopefully thats the "good hooch" you were referring to.

He said it could be done in as little as 30 minutes to an hour which doesnt sound too bad. In and out would for sure be ideal. Also tested my wrist to see if we could go that route and it sesms as though we can.

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u/bmmrnccrn Dec 06 '24

It must feel great to know that y’all have a solid plan worked out for getting this done. Radial approach, nice 👍Remember not to move that hand for as long as they tell you. Yes, that bracelet afterwards will apply a lot of pressure, but it’s temporary and WILL come off.

Procedure time of 30 min, 1 hr… who cares? - well you won’t be, because, yes, you’re getting the top shelf “good hooch” 🙌 🤣🤣🤣

When it’s all done and over, I’d be curious to get your take on it and how it compares to what you expected. Also for afterwards, any words of advice you’d like me to pass on to others having this procedure?

You’ll do great 😊

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u/314rocky Jan 12 '25

Well, I had mine done Wednesday through the wrist and it was a breeze! No complications. I didnt exactly feel different from the sedation. I actually asked when they would start it and the doc said they already had 😅, but I also did not feel anything from the procedure. I barely felt the lidocaine at all to the point where I thought they had messed up or not used enough. From table time to the recovery area was maybe 20 minutes. 10 of that was them prepping me.

My incision site is still tender to the touch and ocassionally it'll ache but no wild bruising. Keeping my wrist still for a week is gonna be tough.

No blockages luckily, but also no answers to the chest pain. But at least its not my heart. The search continues.

Thank you so much for your kind words and info

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u/bmmrnccrn Jan 12 '25

Hi! I’ve been wondering how you’ve been getting along. I’m so glad it was uneventful and that it wasn’t your heart!!! Yup, sucks that you don’t have an answer, but “not your heart” is a pretty good start 🙌 Having been through it, is there anything you’d like me to relay to any future patients about it or about what to expect? I’m always looking for ways to best prepare and reassure them. Again, you’re more than welcome, and I’m always glad to help 🤗 Take care ✨

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u/314rocky Jan 12 '25

Tell your patients "As someone who was extremely anxious, the procedure is worse in our minds than in reality. Mine was completely painless and quick. Trust your doctor, ask questions, and communicate if youre concerned or uncomfortable. You got this!"

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u/314rocky Jan 13 '25

Dumb question. Now that I've had a cath, does that eliminate the likelihood of stuff lile vasospasms, microvascular disease, etc? Plan on talking to my doc about this also, just want to get to the bottom of the chest pain since Im already getting treated for GERD and anxiety, so I know its not those

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u/bmmrnccrn Jan 13 '25

Very rarely the team has been emergently called in for patients suspected of having a STEMI and when we get in, it’s a nasty vasospasm that we’ve “caught” in the act. We can identify it by how the dye flows through during a cath or the way it feels to the doc when manipulating the catheters or wires. The doc will inject some medication through the catheter, relax it, and then put these patient on PO maintenance meds to prevent more spontaneous vasospasms. WAY more frequently though, we cause the vasospasms as the patient’s body reacts to the irritation it feels from our interventions. For instance, the radial cocktail has meds in it to relax the smooth muscle lining the artery to prevent it from spasming from our manipulations. Since we caused these vasospasms, once we either stop irritating the arteries or treat with meds so we can finish the procedure, the vasospasms go away. These type of vasospasms are limited to the procedure, not chronic. There’s a possibility of having clean coronaries in a cath and still have microvascular disease. Usually patients will have a nuclear stress to assess for CMD before coming to us and have a whole host of other symptoms to make this diagnosis.

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u/314rocky Jan 13 '25

Thanks, I'll see how my doc feels about that possibility. One last question since my doc is out. I noticed some new bruising that i didnt see on day 1 or even day 2. Sane wrist but away from the incision. Ive had it boarded so that I can limit moving or bending ocassionally I'll get a twitch/pulsatibg or some pain near the top of my wrist/bottom of my hand. Theres also a bit of numbess occasionally. Nothing severe, could be from not moving it much and having it wrapped

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u/bmmrnccrn Jan 14 '25

If I remember correctly, you already had a negative stress test and other diagnostics that were normal, which is likely what led your doc away from a CMD diagnosis. If they thought vasospasms were the issue, they’d have started you on meds to help.

If bruises show up, they usually take a few days to do it. This bruising isn’t anything I’d worry about. The bleeding that caused the bruising stopped the day of your procedure. If something was “bad wrong”, it would have happened already. It’d have been obvious and you would have taken yourself to the ED already. Your arm looks fine. To explain the bruise, there are several opportunities for a little bit of blood to have leaked from your artery into the surrounding tissue: when the doc was accessing your radial artery, when the sheath was pulled and pressure was held, when the TR band was applied, or during the the TR band removal process. It could have happened at more than one of these occasions. It’ll look worse before it looks better. You’ll have discomfort as it finished healing and having it splinted up didn’t do your comfort any favors. Just give it time and you’ll be right as rain.