Last Friday I had a right heart catheterization at the Heart Hospital of Austin, to determine whether I have pulmonary hypertension (I do, mildly for now) and to make sure the little hole they found in my heart didn’t need repair (it didn’t). It was a pretty unique experience. I’m not in a hurry to repeat it anytime soon, but it was interesting and only a little painful. Here’s how it worked:
1. They started an IV in my left arm for fluids and for a “sedative” they’d give me during the test. More on the “sedative” later. They put the IV in a vein near my elbow, and for some reason it was the most painful IV I’ve ever had…actually, the only really painful one I’ve ever had. Every time I slightly moved my arm I’d hiss in pain, and when the blood pressure cuff tightened every 10 minutes or so, I saw stars. Worst of all, these nurses had never met me before and had no way of knowing that I was Mrs. Tough Guy and would normally never complain about needles or IVs, so they probably assumed I was being a baby.
-3 points for bad IV, -4 points for making me look like a baby, but +1 point for the promise of the happy drugs I’d be getting later.
2. After about 90 minutes of paperwork, fluids, Q&A, and increasingly nervous waiting, a different nurse comes in to place an IV in my right arm. I was curious about whether it would hurt, because it was going in the same spot as the one in my left, but this guy was a pro and I barely felt it. I told him he was awesome. He cheered.
+3 points for good IV, +3 points for affirmation of Mrs Tough Guy status, and -3 points for a nervousmaking wait.
3. With both IVS in place, I was ready to roll. They wheeled my bed into the cath lab and transferred me to the table. Once I was in the room, and saw how it would work, I felt more calm. My head was on the left and this pic is almost identical to the room I was in except it had just one giant screen, not three smaller ones. It was, I’d guess, a 50″ screen. The blue and white thing hanging over the table is an x-ray machine that provides live imaging of what they’re doing, so they get the cath into your heart and not your brain, or spleen.
They had me lay flat on my back on a cushioned board that went on the table, then covered me to the chin with delightful, warm blankets. The only parts of me sticking out of the blankets were my head and my right arm, which was taped down to a board that stuck out at an angle from my body. I was pretty comfortable, though for some reason I felt like the blood was rushing to my head, and I asked for another small pillow.
+3 points for warm blankets, -2 points for feeling like I was upside down, +3 points for giant monitor, and +10 points for live x-ray to navigate the blood vessels.
4. My cardiologist prefers to do catheterizations through the radial artery in the arm, though other doctors often do it through the groin or sometimes the neck. Doing it through the arm makes for a much faster recovery; inserting through the groin means you have to lay flat for 6 hours after the procedure. This way, if there were no complications, I’d get to go home an hour or so afterward.
A Swan-Ganz catheter is basically a long wire with a balloon at the end that takes measurements. I couldn’t feel what they were doing to my arm at first, but apparently they inserted a sheath into the IV site and then fed the tub through it until it reached my heart.
+15 points for shorter recovery, +3 points for not being able to feel them messing around with my IV.
5. While one person was setting up my catheter arm, another nurse administered the “sedative”, Versed. I was promised a sleepy, warm, fuzzy experience and instead I felt…nothing. I waited a few minutes and asked when it should kick in, and they looked at each other before saying that I should have felt it pretty much immediately. They gave me another half dose, then said they couldn’t give me any more without affecting my respiration and skewing the test. Still nothing. So, instead of feeling warm and fuzzy I was completely alert. Apparently I’m in the minority of people who don’t sedate easily from Versed. Lucky me!
-7 points for being alert
6. After that it was fairly quick. I was able to see everything on the giant monitor. At first I wasn’t sure if it would make me nervous to watch, but it was really fascinating. Thanks to the IV I could see the catheter as it snaked its way around my heart. Here’s what it looked like, pretty much, except live action, so I could see myself breathing and my heart beating:
I was really glad to be able to see what was going on, because when they pushed the catheter through the valves between chambers of my heart and up into the pulmonary artery, my heart fluttered and skipped around a little. If I hadn’t been able to see what was happening, I might have wondered if things were going wrong.
I could feel the catheter all the way up my arm until it reached the top of my chest, but I couldn’t actually feel it in my heart, except for the flutters. The only thing that actually hurt was the catheter moving inside my upper arm. Sometimes when they pushed the cath in further it really hurt, but only briefly. Still, I’d rather my arm hurt than my chest – it wasn’t scary, just painful.
I lay perfectly still because I didn’t want my movements to cause any mishaps, so they thought I was asleep for a while. I could hear my cardiologist listing off the measurements, and explaining things to the tech, and once in a while I’d say, “Oh, that’s interesting!” and they’d laugh because they’d sort of forgotten I wasn’t asleep. I mentally took note of the pressures in my pulmonary artery to tell Frank later, so I could look them up at home to see what the situation was without having to wait for the report.
And that was it! Before long, he’d retracted the cath and pulled it out, they put pressure on the site for 10 minutes, and wheeled me back to my room, where I (finally) got very sleepy. Sheesh. (When the nurse went to get Frank and my parents, she smiled and told him, “Well, I couldn’t knock her out!” Sheesh.)
+15 for super fascinating experience, -8 for pain in arm, -2 for getting sleepy 30 minutes after the procedure, +50 for finally having some answers