Have you ever been inside a cardiac catheterisation laboratory?

No? That's good, it means that you never have the need to be inside a cath lab, unless you're one of the team. Rest assured that hopefully, the need for it will not happen in the near future or never at all in this lifetime. 

But for those who have had problems with their heart arteries, heart rates, valves...problems like angina, heart attacks, irregular rhythms, heart valve abnormalities and the like, some diagnostic tests and management warrant a visit to this part of the hospital, may it be in a Heart Attack Centre or a general hospital. 

An example is an angiogram, it can be done now in general hospitals, so long as the patients are not complicated with their medical history, not needing specialised care.

Ready for a patient.

What is an angiogram?

Plainly said, it is the procedure where the arteries of the heart are visualised through an x-ray, where access to the arteries can be from the radial or femoral artery via a long and thin tube to the heart using a dye. The process can be seen via the monitors above the patient, facing the doctors on the right side of the patient. It's very rare that the access is to the left side of the patient, but it have happened before if the access is difficult on the right arm or groin.

These monitors the patient's vital signs, heart rhythms, and visualisations of the arteries from different angles.

The team is compose of different personnels liasing with the team leader, mostly with the consultant doing the procedure. Different team members with the doctors and nurses like the physiologist, x-ray technician who have their own own expertise working together in providing a safe procedure and care to the patient. 

Angioplasty or by-pass

Outside the exclusion criteria of a heart attack, any patient admitted with chest pain will be considered an angiogram. Unless a heart attack is ruled out, the number of angiograms that we do everyday is a lot, compared to other Heart Attack Centers (HAC) in London.

Interestingly, the coronary arteries can be likened to the roots of a tree, like having 3 major bigger roots protruding from the bottom trunk. The angiogram will show patency or blockages, and if any artery is blocked, Angioplasty is done through the process of opening the blocks through an inflated balloon. 

The Left coronary arteries: the LAD runs to the Left front of the heart and the Circumflex (Cx) runs to the Left side going to the back of the heart.

The Right Coronary Artery runs to the right side to the back.

I have taken these photos from our cath lab wall as references I assume for our students. A bit plain but very helpful to those with no cardiac background.

Back to angioplasty, it is an immediate treatment to a heart attack but it is not always the case. The severity of the blockage or the numerous blockages will warrant different approaches in their management. One of them is a surgical operation, a by-pass. This is outside the scope for this post.

Working in the Heart Attack Center

As a cardiac nurse, my experience is mostly preparing patients before the procedure, in an emergency or as an elective and after care after an angiogram, plus and minus angioplasty. Level 2 patients include unwell patients awaiting such procedures, including by-pass. Our ward is also a stepdown of patients from the intensive care unit. 

My other roles depends on the shift's allocation, the area where i am based and where i do extra works within the scope of my experiences in cardiac nursing, may it be interventional nursing or arrhythmia nursing.

Trivia: Do you know that the interventional cardiology doctors are called PLUMBERS?

All images are mine, taken with my Samsung Galaxy S7.