Cardiac Catheterization

Definition
Cardiac catheterization is a procedure used to check for many cardiovascular
conditions, especially blockages in the arteries to your heart that could cause a heart
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 diagnostic 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 you're having cardiac catheterization as a test for heart disease, your doctor can:

 Locate narrowing or blockages in your blood vessels

 Find out the amount of oxygen 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

disease. These procedures include:

 Angioplasty with or without stent placement. Angioplasty involves

temporarily inserting 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 decrease 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 threading a catheter to the hole to close it, rather
than having open-heart surgery.
 Balloon valvuloplasty. This procedure can open narrowed heart valves by
threading 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 catheterization
has some risks. Major complications are rare, though.

Common risks of cardiac catheterization are:

  Bruising
 Infection

Rare risks include:

 Heart attack
 Stroke
 Damage to the artery where the catheter was inserted
 Irregular heart rhythms (arrhythmias)
 Allergic reactions to the dye or medication
 Tearing 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 before
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
catheterization 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 with you to the test. It's best if
you take the original bottles so that your doctor will know the exact dose you
take.
 Try to relax. It's common for people who are having a cardiac catheterization
to feel anxious or nervous. It's possible that 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 unnerving, try to relax. Being nervous
may cause your heart to beat more quickly or irregularly, giving your doctor
inaccurate test results. If you are feeling anxious, 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 bladder. You'll
be asked to remove dentures and may need to remove jewelry, especially necklaces
that could interfere with pictures of your heart. You'll wait in a pre-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 operating room called a
catheterization lab. The catheterization lab has special X-ray and imaging machines
that normal operating rooms don't have.

Cardiac catheterization is usually performed while you're awake, but sedated. An

intravenous (IV) line will be inserted in your hand or arm, and will be used to give
you any additional medications you might need during your procedure. You may also
have monitors (electrodes) placed on your chest to check your heartbeat during the
test.

Just before the procedure, a nurse or technician may shave the hair from the site
where the catheter will be inserted. Before the catheter is inserted in your artery,
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 will 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 catheter.

What happens next depends on why you're having a cardiac catheterization:

 Coronary angiogram. If you're having this test to check for blockages in the
arteries 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
catheter is usually placed in the artery in your groin or wrist.
 Right heart catheterization. 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 your 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 your neck. A catheter with a
small, jaw-like tip is used to cut a small sample of tissue 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, with or without stenting. This procedure is used to
open a narrowed artery in or near 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 arteries 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 cases, your doctor will also place a mesh
coil called a stent at the narrowed portion to help keep the artery open.
 Closure of heart defects. If your doctor is closing a hole in your heart, such
as an atrial septal defect or patent foramen ovale, 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 catheter is threaded across the valve. A balloon is then blown up
to make the valve open more easily. You may feel pressure as the catheters are
inserted into your 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 can
follow instructions. Throughout the procedure you may be asked to take deep breaths,
hold your breath, cough or place your arms in various positions. Your table 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 experience any discomfort.

After the procedure

It usually takes several hours to recover from a cardiac catheterization. After your
procedure is finished, you'll be taken on a gurney to a recovery room while the
anesthesia wears off. This usually takes about an hour.

After you leave the recovery room, you'll go to a regular 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 procedure. It's very important not to
move the limb that your catheter's been inserted in, or to lift your head if your catheter
is in your neck, so as not to cause serious bleeding.

After your catheter has been removed, the technician or nurse who has removed your
sheath will apply pressure to the insertion sites, and you'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 condition. 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 catheterization,
such as angioplasty.

Results
If you're having cardiac catheterization as a test, your doctor should explain the
results to you. Your results may show that you need surgery or another treatment 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 artery. 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 catheterization. Your doctor should discuss whether this
is a possibility before the procedure begins.