Left heart catheterization
Catheterization - left heart
Left heart catheterization is the passage of a thin flexible tube (catheter) into the left side of the heart. It is done to diagnose or treat certain heart problems.
How the Test is Performed
You may be given a mild medicine (sedative) before the procedure starts. The medicine is to help you relax. The health care provider will place an IV into your arm to give medicines. You will lie on a padded table. Your doctor will make a small puncture on your body near one of your arteries. A flexible tube (catheter) is inserted into and through the artery. It will be placed in your wrist, arm or your upper leg (groin). You will most likely be awake during the procedure.
Live x-ray pictures are used to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be injected into your body. This dye will highlight blood flow through the arteries. This helps show blockages in the blood vessels that lead to your heart.
The catheter is then moved through the aortic valve into the left side of your heart. The pressure is measured in the heart in this position. Other procedures can also be done at this time, such as:
- Ventriculography to check the heart's pumping function.
- Coronary angiography to look at the coronary arteries.
- Angioplasty, with or without stenting, to correct blockages in the arteries is then performed.
The procedure may last from less than 1 hour to several hours.
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 to Prepare for the Test
In most cases, you should not eat or drink for 8 hours before the test. (Your provider may give you different directions.)
The procedure will take place in the hospital. You may be admitted the night before the test, but it is more common to come to the hospital the morning of the procedure. In some cases, this procedure is done after you have already been admitted to the hospital possibly on an emergency basis.
Your provider will explain the procedure and its risks. You must sign a consent form.
How the Test will Feel
The sedative will help you relax before the procedure. However, you will be awake and able to follow instructions during the test.
You will be given local numbing medicine (anesthesia) before the catheter is inserted. You will feel some pressure as the catheter is inserted. However, you should not feel any pain. You may have some discomfort from lying still for a long period of time.
Why the Test is Performed
The procedure is done to look for:
- Cardiac valve disease
- Cardiac tumors
- Heart defects (such as ventricular septal defects)
- Problems with heart function
The procedure may also be done to evaluate and possibly repair certain types of heart defects, or to open a narrowed heart valve.
When this procedure is done with coronary angiography to examine the arteries that feed the heart muscle, it can open blocked arteries or bypass grafts. This can be because of a heart attack or angina.
The procedure can also be used to:
- Collect blood samples from the heart
- Determine pressure and blood flow in the heart's chambers
- Take x-ray pictures of the left ventricle (main pumping chamber) of the heart (ventriculography)
A normal result means the heart is normal in:
The normal result also means arteries are normal.
What Abnormal Results Mean
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;129(Suppl 2):S49-S73. PMID: 24222018
Kern MJ, Seto AH, Hermann 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.
Dengas 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.
Last reviewed on: 10/5/2022
Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.