Cardiac catheterization
Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization; CAD - cardiac catheterization; Coronary artery disease - cardiac catheterization; Heart valve - cardiac catheterization; Heart failure - cardiac catheterization
Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. The catheter is most often inserted from the groin or the arm.
Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants.
Cardiac catheterization is used to study the various functions of the heart or to obtain diagnostic information about the heart or its vessels. A small incision is made in an artery or vein in the arm, neck, or groin. The catheter is threaded through the artery or vein into the heart. X-ray images called fluoroscopy are used to guide the insertion. When the catheter is in place, dye is injected to visualize the structures and vessels within the heart.
Millions of Americans are living with heart disease and some of them don't even realize they have it. Heart disease is the number one cause of death; above cancer, diabetes, and injuries. That's why it's important to get it diagnosed and treated quickly. Fortunately, we doctors have a lot of tests and treatments at our disposal to combat heart disease. One procedure that is both a test AND a treatment is called cardiac catheterization. It can show your doctor how healthy your heart and blood vessels are, and treat heart valve problems, clogged arteries, and heart defects. Let's talk today about cardiac catheterization. So, why would you even need cardiac catheterization? Well, doctors use cardiac catheterization to diagnose and evaluate common heart and blood vessel problems, like chest pain or an abnormal stress test due to coronary artery disease, heart valve conditions like a leaky or narrowed valve, a high blood pressure condition in the lungs, blood clots in the lungs from an embolism, and an enlarged heart. You'll need to have this procedure in a supervised hospital setting. You may need to stay overnight at the hospital the night before the test, or you may be admitted the morning of the procedure. The whole cardiac catheterization procedure takes about 30 to 60 minutes. You'll be given medicine to help you relax, but you'll be awake during the procedure. First, the doctor will insert an intravenous, or IV line into one of the blood vessels in your groin or neck. Through this IV line, your doctor will pass a thin, flexible tube called a catheter. That tube will be threaded into either the left or right side of your heart. The doctor will use an x-ray as a guide to see where the catheter is going. While the catheter is in place, your doctor can check how well the blood is flowing into and out of your heart, and through the arteries around your heart, collect blood samples from your heart, measure the oxygen level in your heart, and even take a tiny piece of heart tissue, called a biopsy, when there's a situation of unexplained heart failure. Cardiac catheterization is a safe procedure when performed by an experienced medical team. But, some possible risks include bleeding, infection, and blood clots. A heart attack or a stroke can happen in very rare situations. But, remember, it's done in a closely supervised setting in a hospital. After a cardiac catheterization, your doctor should have a pretty good idea of what's causing your heart, valve, or blood vessel problem. Knowing exactly what the problem is can help your doctor find just the right way to treat your particular problem.
How the Test is Performed
You will get medicine before the test to help you relax.
The health care provider will clean a site on your arm, neck, or groin and insert a line into one of your veins. This is called an intravenous (IV) line.
A larger thin plastic tube called a sheath is placed into a vein or artery in your leg or arm. Then longer plastic tubes called catheters are carefully moved up into the heart using live x-rays (fluoroscopy) as a guide. Then the doctor can:
- Collect blood samples from the heart
- Measure pressure and blood flow in the heart's chambers and in the large arteries around the heart
- Measure the oxygen in different parts of your heart
- Examine the arteries of the heart
- Perform a biopsy on the heart muscle
For some procedures, you may be injected with a dye that helps your provider to visualize the structures and vessels within the heart.
If you have a blockage, you may have angioplasty and a stent placed during the procedure.
The test may last 30 to 60 minutes. If you also need special procedures, the test may take longer. If the catheter is placed in your groin, you will often be asked to lie flat on your back for a few to several hours after the test to avoid bleeding.
You will be told how to take care of yourself when you go home after the procedure is done.
How to Prepare for the Test
You should not eat or drink for 6 to 8 hours before the test. The test takes place in a hospital and you will be asked to wear a hospital gown. Sometimes, you will need to spend the night before the test in the hospital. Otherwise, you will come to the hospital the morning of the procedure.
Your provider will explain the procedure and its risks. A witnessed, signed consent form for the procedure is required.
Tell your provider if you:
- Are allergic to seafood or any medicines
- Have had a bad reaction to contrast dye or iodine in the past
- Take any medicines, including Viagra or other drugs for erectile dysfunction
- Might be pregnant
How the Test will Feel
The study is done by cardiologists and a trained health care team.
You will be awake and able to follow instructions during the test.
You may feel some discomfort or pressure where the catheter is placed. You may have some discomfort from lying still during the test or from lying flat on your back after the procedure.
Why the Test is Performed
This procedure is most often done to get information about the heart or its blood vessels. It may also be done to treat some types of heart conditions, or to find out if you need heart surgery.
Your doctor may perform cardiac catheterization to diagnose or evaluate:
- Causes of congestive heart failure or cardiomyopathy
- Coronary artery disease
- Heart defects that are present at birth (congenital)
- High blood pressure in the lungs (pulmonary hypertension)
- Problems with the heart valves
The following procedures may also be done using cardiac catheterization:
- Repair certain types of heart defects
- Open a narrowed (stenotic) heart valve
- Open blocked arteries or grafts in the heart (angioplasty with or without stenting)
Risks
Cardiac catheterization carries a slightly higher risk than other heart tests. However, it is very safe when done by an experienced team.
The risks include:
- Cardiac tamponade
- Heart attack
- Injury to a coronary artery
- Irregular heartbeat
- Low blood pressure
- Reaction to the contrast dye
- Stroke
Possible complications of any type of catheterization include the following:
- Bleeding, infection, and pain at the IV or sheath insertion site
- Damage to the blood vessels
- Blood clots
- Kidney damage due to the contrast dye (more common in people with diabetes or kidney problems)
References
Dangas GD, Mehran R. Coronary angiography and intravascular imaging. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 21.
Kumbhani DJ, Bhatt DL. Percutaneous coronary intervention. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 41.
Kern MJ, Seto AH, Herrmann J. Invasive hemodynamic diagnosis of cardiac disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 22.
Kern MJ, Kirtane AJ. Catheterization and angiography. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 51.
Version Info
Last reviewed on: 5/8/2022
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
