catheterization

Heart diseases are the number one killer in the U.S. They are also a major cause of disability. If you do have a heart disease, it is important to find it early, when it is easier to treat. Blood tests and heart health tests can help find heart diseases or identify problems that can lead to heart diseases. There are several different types of heart health tests. Your doctor will decide which test or tests you need, based on your symptoms (if any), risk factors, and medical history.

Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions. For the procedure, your doctor puts a catheter (a long, thin, flexible tube) into a blood vessel in your arm, groin, or neck, and threads it to your heart. The doctor can use the catheter to:

• Do a coronary angiography. This involves putting a special type of dye in the catheter, so the dye can flow through your bloodstream to your heart. Then your doctor takes x-rays of your heart. The dye allows your doctor to see your coronary arteries on the x-ray, and to check for coronary artery disease (plaque buildup in the arteries).
• Take samples of blood and heart muscle
• Do procedures such as minor heart surgery or angioplasty, if your doctor finds that you need it

A cardiac CT (computed tomography) scan is a painless imaging test that uses x-rays to take detailed pictures of your heart and its blood vessels. Computers can combine these pictures to create a three-dimensional (3D) model of the whole heart. This test can help doctors detect or evaluate:

• Coronary artery disease
• Calcium buildup in the coronary arteries
• Problems with the aorta
• Problems with heart function and valves
• Pericardial diseases

Before you have the test, you get an injection of contrast dye. The dye highlights your heart and blood vessels in the pictures. The CT scanner is a large, tunnel-like machine. You lie still on a table which slides you into the scanner, and the scanner takes the pictures for about 15 minutes.

Cardiac MRI (magnetic resonance imaging) is a painless imaging test that uses radio waves, magnets, and a computer to create detailed pictures of your heart. It can help your doctor figure out whether you have heart disease, and if so, how severe it is. A cardiac MRI can also help your doctor decide the best way to treat heart problems such as:

• Coronary artery disease
• Heart valve problems
• Pericarditis
• Cardiac tumors
• Damage from a heart attack

The MRI is a large, tunnel-like machine. You lie still on a table which slides you into the MRI machine. The machine makes loud noises as it takes pictures of your heart. It usually takes about 30-90 minutes. Sometimes before the test, you might get an injection of contrast dye. The dye highlights your heart and blood vessels in the pictures.

A chest x-ray creates pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. It can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to heart disease.

Coronary angiography (angiogram) is a procedure that uses contrast dye and x-ray pictures to look at the insides of your arteries. It can show whether plaque is blocking your arteries and how severe the blockage is. Doctors use this procedure to diagnose heart diseases after chest pain, sudden cardiac arrest (SCA), or abnormal results from other heart tests such as an EKG or a stress test.

You usually have a cardiac catheterization to get the dye into your coronary arteries. Then you have special x-rays while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.

Echocardiography, or echo, is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart's chambers and valves are working. Doctors use an echo to diagnose many different heart problems, and to check how severe they are.

For the test, a technician applies gel to your chest. The gel helps sound waves reach your heart. The technician moves a transducer (wand-like device) around on your chest. The transducer connects to a computer. It transmits ultrasound waves into your chest, and the waves bounce (echo) back. The computer converts the echoes into pictures of your heart.

An electrocardiogram, also called an ECG or EKG, is a painless test that detects and records your heart's electrical activity. It shows how fast your heart is beating and whether its rhythm is steady or irregular.

An EKG may be part of a routine exam to screen for heart disease. Or you may get it to detect and study heart problems such as heart attacks, arrhythmia, and heart failure.

For the test, you lie still on a table and a nurse or technician attaches electrodes (patches that have sensors) to the skin on your chest, arms, and legs. Wires connect the electrodes to a machine that records your heart's electrical activity.

Stress testing looks at how your heart works during physical stress. It can help to diagnose coronary artery disease, and to check how severe it is. It can also check for other problems, including heart valve disease and heart failure.

For the test, you exercise (or are given medicine if you are unable to exercise) to make your heart work hard and beat fast. While this is happening, you get an EKG and blood pressure monitoring. Sometimes you may also have an echocardiogram, or other imaging tests such as a nuclear scan. For the nuclear scan, you get an injection of a tracer (a radioactive substance), which travels to your heart. Special cameras detect the energy from the tracer to make pictures of your heart. You have pictures taken after you exercise, and then after you rest.

NIH: National Heart, Lung, and Blood Institute

Congenital heart defects (CHDs) are problems with the structure of the heart. "Congenital" means that that the problems are present at birth. These defects happen when a baby's heart doesn't develop normally during pregnancy. Congenital heart defects are the most common type of birth defect.

Congenital heart defects can change the way the heart pumps blood. They may make blood flow too slowly, go the wrong way, or block it completely.

There are many types of congenital heart defects. They can happen in one or more parts of the heart. The most common types are:

• Septal defects ("hole in the heart") - openings in the wall between the left and right sides of the heart
• Heart valve defects - problems with the valves that control the flow of blood through the heart
• Defects in the large blood vessels that carry blood in and out of the heart

Congenital heart defects can range from very mild problems that never need treatment to life-threatening problems at birth. The most serious congenital heart defects are called critical congenital heart disease. Babies with these defects usually need surgery in the first year of life. But the symptoms of milder heart defects may not show up until childhood or adulthood.

Researchers often don't know what causes congenital heart defects. They do know that changes in a baby's genes sometimes cause a heart defect. The changed genes may come from the parents, or the changes may happen during pregnancy.

Several things may increase the chance that your baby has a congenital heart defect, such as:

• Your health before and during pregnancy, including
  • Having diabetes before pregnancy or developing it in the first 3 months of pregnancy (diabetes that develops later in pregnancy isn't a major risk for heart defects). Carefully controlling your blood sugar before and during pregnancy can lower your baby's risk of congenital heart defects.
  • Having phenylketonuria (PKU), a rare inherited disorder that affects how the body uses a protein in foods. If you have PKU, eating a low-protein diet before getting pregnant can lower your baby's risk of having a congenital heart defect.
  • Having rubella (German measles) during pregnancy.
• Your contact with certain substances during pregnancy, including
  • Smoking or secondhand smoke (breathing smoke from another smoker).
  • Certain medicines, such as angiotensin-converting (ACE) inhibitors for high blood pressure and retinoic acids for acne. If you're pregnant or plan to get pregnant, talk with your health care provider about all the medicines you take.
• Your family history and genetics. In most cases, congenital heart defects don't run in families. But your chance of having a baby with a congenital heart defect does go up if you or the other parent has a congenital heart defect, or if you already have a child with a congenital heart defect.

Congenital heart defects don't cause pain. The signs and symptoms are different, depending on the type and number of defects and how serious they are.

Common signs and symptoms of congenital heart defects include:

• Cyanosis - a bluish color to the skin, lips, and fingernails. It happens when there isn't enough oxygen in the blood
• Fatigue - your baby may be unusually sleepy and may become very tired during feedings
• Poor blood flow
• Fast or difficult breathing
• Heart murmur - an unusual sound between heartbeats

Congenital heart defects don't always cause other problems. If they do, which problems you have would depend on the type and number of defects and how serious the defects are.

Children with congenital heart defects are more likely to:

• Be smaller than other children
• Have problems or delays in mental, and emotional growth, and behavior, such as:
  • Speech and language problems
  • Attention deficit hyperactivity disorders (ADHD)

People with congenital heart defects may develop other health conditions, including:

• Endocarditis - an infection of lining of the heart and valves
• Arrhythmia - a problem with the rate or rhythm of your heartbeat
• Heart failure - when your heart can't pump enough blood to the body
• Pulmonary hypertension - high blood pressure in your lungs
• Kidney and liver disease

• Before a baby is born, your provider may use ultrasound pictures of the baby's heart to look for heart defects. This is called a fetal echocardiogram. It's done between weeks 18 and 22 of pregnancy.
• During the first few days after birth, all newborns are checked for congenital heart defects. A pulse oximeter is clipped to your baby's hands or feet to measure blood oxygen. If it shows low levels of blood oxygen, more tests will be needed to find out if your baby has a heart defect.
• To diagnose congenital heart defects in babies, children, and adults, a provider may use many tools, including:
  • A physical exam.
  • Certain heart tests to see how the heart is working.
  • Genetic testing to see if certain gene problems caused the defect.

Treatment depends on the type of congenital heart defect and how serious it is. Possible treatments include:

• Cardiac catheterization to repair simple defects, such as a small hole in the inside wall of the heart. A catheterization uses a thin tube guided through a vein and into the heart.
• Heart surgery may be needed to:
  • Repair defects in the heart and blood vessels.
  • Repair or replace a heart valve.
  • Place a device in the chest to help the heart pump blood.
  • Do a heart transplant.
• Medicine is often used if your baby has a specific type of congenital heart defect called patent ductus arteriosus.

All children and adults who have congenital heart defects need regular follow-up care from a cardiologist (a doctor who specializes in heart diseases) throughout their life, even if their defect was repaired.

Some people may need several heart surgeries or catheterizations over the years. They may also need to take medicines to help their hearts work as well as possible.

NIH: National Heart, Lung, and Blood Institute

After any operation, you'll have some side effects. There is usually some pain with surgery. There may also be swelling and soreness around the area that the surgeon cut. Your surgeon can tell you which side effects to expect.

There can also be complications. These are unplanned events linked to the operation. Some complications are infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions.

Your surgeon can tell you how you might feel and what you will be able to do - or not do - the first few days, weeks, or months after surgery. Some other questions to ask are:

• How long you will be in the hospital
• What kind of supplies, equipment, and help you might need when you go home
• When you can go back to work
• When it is ok to start exercising again
• Are they any other restrictions in your activities

Following your surgeon's advice can help you recover as soon as possible.

Agency for Healthcare Research and Quality

Angioplasty is a procedure to improve blood flow in coronary arteries that have become narrow or blocked. Your coronary arteries supply oxygen-rich blood to the heart. If you have coronary artery disease, a sticky material called plaque builds up in the coronary arteries. Plaque is made of cholesterol, calcium, and other substances in your blood. Over time, it can narrow your arteries or fully block them. When this happens, some parts of your heart don't get enough blood.

Angioplasty widens the blocked part of the artery so more blood can get through. It is also called percutaneous coronary intervention (PCI).

Doctors use angioplasty to:

• Reduce chest pain from blockages in the coronary arteries. This type of pain is called angina. There are different types of angina. Angioplasty treats certain types.
• Limit damage to the heart during or right after a heart attack. In this case, angioplasty is an emergency treatment.

Angioplasty does not cure coronary artery disease. To help prevent more plaque blockages, you'll need to take any prescribed medicines, eat healthy foods, and get regular exercise.

Most people have angioplasties in a hospital in a special room called a cardiac catheterization, or cath, lab. You will be awake and lying down. You'll get medicine to help you relax through an intravenous (IV) line. This is a small tube that goes into a vein in your hand or arm.

Angioplasty is done through a blood vessel in your arm, wrist, or groin. Your doctor will:

• Make a small opening in that area to insert a thin tube (a catheter) into a blood vessel.
• Thread the tube through the vessel to your heart, using x-rays as a guide.
• Inject contrast dye inside your arteries. The dye highlights your heart and blood vessels in the x-rays.
• Replace the first tube with another one that has a small, deflated balloon on the end.
• Guide the balloon inside the blockage and inflate it to push the plaque flat against the artery wall. This makes the artery wider and improves blood flow.
• Sometimes put a small, mesh tube into the artery to help keep it open. The tube is called a stent. Some stents have a coating of medicine that helps prevent blood clots from forming.

If you had an angioplasty for chest pain, you'll go to a recovery room for a few hours. You may stay in the hospital overnight. Your doctor will probably prescribe medicines to prevent blood clots. Most people can return to their usual activities after a week.

If you had an emergency angioplasty for a heart attack, you'll need to stay in the hospital for about a few more days.

Angioplasty is very safe. You may get a bruise, feel sore, or have some bleeding where the tubes were inserted. More serious problems don't happen very often, but they are possible. They can include serious bleeding, blood clots, and narrowing of the artery again.

NIH: National Heart, Lung, and Blood Institute

The bladder is a hollow organ in your lower abdomen that stores urine. Many conditions can affect your bladder. Some common ones are:

• Cystitis - inflammation of the bladder, often from an infection
• Urinary incontinence - loss of bladder control
• Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time
• Interstitial cystitis - a chronic problem that causes bladder pain and frequent, urgent urination
• Bladder cancer

Doctors diagnose bladder diseases using different tests. These include urine tests, x-rays, and an examination of the bladder wall with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Critical care is medical care for people who have life-threatening injuries and illnesses. It usually takes place in an intensive care unit (ICU). A team of specially-trained health care providers gives you 24-hour care. This includes using machines to constantly monitor your vital signs. It also usually involves giving you specialized treatments.

You need critical care if you have a life-threatening illness or injury, such as:

• Severe burns
• COVID-19
• Heart attack
• Heart failure
• Kidney failure
• People recovering from certain major surgeries
• Respiratory failure
• Sepsis
• Severe bleeding
• Serious infections
• Serious injuries, such as from car crashes, falls, and shootings
• Shock
• Stroke

In a critical care unit, health care providers use lots of different equipment, including:

• Catheters, flexible tubes used to get fluids into the body or to drain fluids from the body
• Dialysis machines ("artificial kidneys") for people with kidney failure
• Feeding tubes, which give you nutritional support
• Intravenous (IV) tubes to give you fluids and medicines
• Machines which check your vital signs and display them on monitors
• Oxygen therapy to give you extra oxygen to breathe in
• Tracheostomy tubes, which are breathing tubes. The tube is placed in a surgically made hole that goes through the front of the neck and into the windpipe.
• Ventilators (breathing machines), which move air in and out of your lungs. This is for people who have respiratory failure.

These machines can help keep you alive, but many of them can also raise your risk of infection.

Sometimes people in a critical care unit are not able to communicate. It's important that you have an advance directive in place. This can help your health care providers and family members make important decisions, including end-of-life decisions, if you are not able to make them.

Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back and forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures (breaks) or dislocates your vertebrae, the bone disks that make up your spine. Most injuries don't cut through your spinal cord. Instead, they cause damage when pieces of vertebrae tear into cord tissue or press down on the nerve parts that carry signals.

Spinal cord injuries can be complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, you are paralyzed below the injury. With an incomplete injury, you have some movement and sensation below the injury.

A spinal cord injury is a medical emergency. Immediate treatment can reduce long-term effects. Treatments may include medicines, braces or traction to stabilize the spine, and surgery. Later treatment usually includes medicines and rehabilitation therapy. Mobility aids and assistive devices may help you to get around and do some daily tasks.

NIH: National Institute of Neurological Disorders and Stroke

The urethra is the tube that allows urine to pass out of the body. In men, it's a long tube that runs through the penis. It also carries semen in men. In women, it's short and is just above the vagina. Urethral problems may happen due to aging, illness, or injury. They include:

• Urethral cancer - a rare cancer that happens more often in men
• Urethral stricture - a narrowing of the opening of the urethra
• Urethritis - inflammation of the urethra, sometimes caused by infection

Urethral problems may cause pain or difficulty passing urine. You may also have bleeding or discharge from the urethra.

Doctors diagnose urethral problems using different tests. These include urine tests, x-rays and an examination of the urethra with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

There are several different types of UI. Each type has different symptoms and causes:

• Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
• Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
• Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
• Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
• Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
• Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
• Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
  • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
  • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.

In adults, you are at higher risk of developing UI if you:

• Are female, especially after going through pregnancy, childbirth, and/or menopause
• Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
• Are a man with prostate problems
• Have certain health problems, such as diabetes, obesity, or long-lasting constipation
• Are a smoker
• Have a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
• A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
• Urine and/or blood tests
• Bladder function tests
• Imaging tests

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including:

• Lifestyle changes to reduce leaks:
  • Drinking the right amount of liquid at the right time
  • Being physically active
  • Staying at a healthy weigh
  • Avoiding constipation
  • Not smoking
• Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
• Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as:

• Medicines, which can be used to
  • Relax the bladder muscles, to help prevent bladder spasms
  • Block nerve signals that cause urinary frequency and urgency
  • In men, shrink the prostate and improve urine flow
• Medical devices, including
  • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
  • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
• Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
• Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
• Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your kidneys make urine by filtering wastes and extra water from your blood. The waste is called urea. Your blood carries it to the kidneys. From the kidneys, urine travels down two thin tubes called ureters to the bladder. The bladder stores urine until you are ready to urinate. It swells into a round shape when it is full and gets smaller when empty. If your urinary system is healthy, your bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2 to 5 hours.

You may have problems with urination if you have:

• Kidney failure
• Urinary tract infections
• An enlarged prostate
• Bladder control problems like incontinence, overactive bladder, or interstitial cystitis
• A blockage that prevents you from emptying your bladder

Some conditions may also cause you to have blood or protein in your urine. If you have a urinary problem, see your health care provider. Urinalysis and other urine tests can help to diagnose the problem. Treatment depends on the cause.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases