Cardiac Catheterization

Definition
Cardiac catheterization is a procedure used to check for many cardiovascular con
ditions, especially blockages in the arteries to your heart that could cause a h
eart attack. During cardiac catheterization, a long thin tube called a catheter
is inserted in an artery or vein in your groin, neck or arm and threaded through
your blood vessels to your heart. Using this catheter, doctors can then do diag
nostic tests as part of a cardiac catheterization. Some heart disease treatments
, such as coronary angioplasty, also are done using cardiac catheterization.
Why it's done
Cardiac catheterization is done to see if you have a heart problem, or as a part
of a procedure to correct a heart problem your doctor already knows about. If y
ou're having cardiac catheterization as a test for heart disease, your doctor ca
n:

Locate narrowing or blockages in your blood vessels Find out the amount of oxyge
n in your heart Test the pressure inside your heart Take a sample of tissue from
your heart (biopsy) Diagnose heart defects present from birth (congenital heart
defects) Look for problems with your heart valves
Cardiac catheterization is also used as part of some procedures to treat heart d
isease. These procedures include:

Angioplasty with or without stent placement. Angioplasty involves temporarily in

serting and expanding a tiny balloon at the site of your blockage to help widen
a narrowed artery. Angioplasty is usually combined with implantation of a small
metal coil called a stent in the clogged artery to help prop it open and decreas
e the chance of it narrowing again (restenosis). Closure of holes in the heart.
Some congenital heart defects involving holes in the heart can be treated by thr
eading a catheter to the hole to close it, rather than having open-heart surgery
. Balloon valvuloplasty. This procedure can open narrowed heart valves by thread
ing a catheter with a balloon-like device to the part of your heart valve that's
narrowed and inflating it.
Risks
As with most procedures done on your heart and blood vessels, cardiac catheteriz
ation has some risks. Major complications are rare, though. Common risks of card
iac catheterization are:
Bruising Infection
Rare risks include:

Heart attack Stroke Damage to the artery where the catheter was inserted Irregul
ar heart rhythms (arrhythmias) Allergic reactions to the dye or medication Teari
ng the tissue of your heart or artery Kidney damage Excessive bleeding Infection
Blood clots
If you are either pregnant or planning to become pregnant, tell your doctor befo
re having cardiac catheterization performed.
How you prepare
Cardiac catheterization is usually performed in the hospital. The test requires
some preparations. To prepare for your test:

Don't eat or drink anything for eight to 12 hours before your test. Having food
or drink in your stomach can make your test results inaccurate. Cardiac catheter
ization tests are often scheduled for the morning, so you can have something to
eat and drink soon after your test. Take all your medications and supplements wi
th you to the test. It's best if you take the original bottles so that your doct
or will know the exact dose you take. Try to relax. It's common for people who a
re having a cardiac catheterization to feel anxious or nervous. It's possible th
at the test will reveal that you need surgery right away, or that you could have
a side effect from the medication. Although the potential results can be unnerv
ing, try to relax. Being nervous may cause your heart to beat more quickly or ir
regularly, giving your doctor inaccurate test results. If you are feeling anxiou
s, talk to your doctor about these feelings before the procedure.
Once you're admitted to the hospital, you'll have your blood pressure, pulse and
body temperature checked. You'll be asked to use the toilet to empty your bladd
er. You'll be asked to remove dentures and may need to remove jewelry, especiall
y necklaces that could interfere with pictures of your heart. You'll wait in a p
re-operating room until it's time for your procedure — you can often have someone
wait there with you.
What you can expect
During the procedure Cardiac catheterization is often done in a special operatin
g room called a catheterization lab. The catheterization lab has special X-ray a
nd imaging machines that normal operating rooms don't have. Cardiac catheterizat
ion is usually performed while you're awake, but sedated. An intravenous (IV) li
ne will be inserted in your hand or arm, and will be used to give you any additi
onal medications you might need during your procedure. You may also have monitor
s (electrodes) placed on your chest to check your heartbeat during the test. Jus
t before the procedure, a nurse or technician may shave the hair from the site w
here the catheter will be inserted. Before the catheter is inserted in your arte
ry, you'll be given a shot of anesthetic to numb the area. You may feel a quick,
stinging pain before the numbness sets in. After you feel numb, the catheter wi
ll be inserted. A small cut is made, usually in your leg, to access an artery. A
plastic sheath will be inserted in the cut to allow your doctor to insert the c
atheter. What happens next depends on why you're having a cardiac catheterizatio
n:

Coronary angiogram. If you're having this test to check for blockages in the art
eries leading to your heart, a dye will be injected through the catheter, and X-
ray images of your heart arteries will be taken. In a coronary angiogram, the ca
theter is usually placed in the artery in your groin or wrist. Right heart cathe
terization. This procedure checks the pressure and blood flow in the right side
of your heart. For this procedure, the catheter is inserted in the artery in you
r neck or groin. The catheter has special sensors in it to measure the pressure
and blood flow in your heart. Heart biopsy. If your doctor is taking a sample of
heart tissue (biopsy), the catheter will usually be placed in the artery in you
r neck. A catheter with a small, jaw-like tip is used to cut a small sample of t
issue from your heart. You may feel pressure as this catheter is being used, but
you likely won't feel the actual tissue being snipped. Balloon angioplasty, wit
h or without stenting. This procedure is used to open a narrowed artery in or ne
ar your heart. The catheter will likely be inserted in the artery in your groin
for this procedure. A long, flexible catheter will be thread through your arteri
es to the narrowed artery. Then, a smaller balloon catheter will be led through
the flexible catheter and inflated at the narrowed area to open it. In many case
s, your doctor will also place a mesh coil called a stent at the narrowed portio
n to help keep the artery open. Closure of heart defects. If your doctor is clos
ing a hole in your heart, such as an atrial septal defect or patent foramen oval
e, you will often have catheters inserted in both the arteries and veins of the
groin and neck. A device is then inserted into your heart to close the hole.
Balloon valvuloplasty. This procedure is done to open up narrowed heart valves.
The placement of your catheters will depend on which valve problem you have. A c
atheter is threaded across the valve. A balloon is then blown up to make the val
ve open more easily. You may feel pressure as the catheters are inserted into yo
ur body, but you should not feel discomfort from the balloon treatment itself.
Cardiac catheterization helps doctors assess blood vessels.
Although you may be sedated, you'll be awake during the procedure so that you ca
n follow instructions. Throughout the procedure you may be asked to take deep br
eaths, hold your breath, cough or place your arms in various positions. Your tab
le may be tilted at times. Threading the catheter shouldn't be painful, and you
won't feel it moving through your body. Tell your health care team if you do exp
erience any discomfort. After the procedure It usually takes several hours to re
cover from a cardiac catheterization. After your procedure is finished, you'll b
e taken on a gurney to a recovery room while the anesthesia wears off. This usua
lly takes about an hour. After you leave the recovery room, you'll go to a regul
ar hospital room. The plastic sheath inserted in your groin, neck or arm will be
removed soon after unless you've had a blood-thinning medication during your pr
ocedure. It's very important not to move the limb that your catheter's been inse
rted in, or to lift your head if your catheter is in your neck, so as not to cau
se serious bleeding. After your catheter has been removed, the technician or nur
se who has removed your sheath will apply pressure to the insertion sites, and y
ou'll need to lie flat for one to six hours after the procedure to avoid serious
bleeding and to allow the artery to heal. You'll be able to eat and drink after
the procedure. The length of your stay in the hospital will depend on your cond
ition. You may be able to go home the same day as
your catheterization, or you may need to stay overnight or longer. Longer stays
are common if you have a more serious procedure immediately after your catheteri
zation, such as angioplasty.
Results
If you're having cardiac catheterization as a test, your doctor should explain t
he results to you. Your results may show that you need surgery or another treatm
ent to correct a heart problem. If you've had a coronary angiogram, your results
could indicate that you need angioplasty or a stent, or a more major open-heart
surgery called coronary bypass surgery. In some cases, your angiogram may show
that angioplasty would likely be an effective treatment to open a narrowed arter
y. If your doctor finds this, he or she may perform angioplasty with or without
a stent placement right away so that you won't need to have another cardiac cath
eterization. Your doctor should discuss whether this is a possibility before the
procedure begins.