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.
Left heart catheterization involves the passage of a catheter (a thin flexible tube) into the left side of the heart to obtain diagnostic information about the left side of the heart or to provide therapeutic interventions in certain types of heart conditions. The test can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by X-ray (fluoroscopy).
Cardiac catheterization and coronary angiography are most commonly performed to diagnose and examine the severity of coronary artery disease. They are the gold standard for diagnosing coronary artery disease. Coronary artery disease is caused by narrowing or blockage of the coronary arteries due to the formation of atherosclerotic plaques in the walls of these arteries, thus restricting blood flow to cardiac muscle. Coronary artery disease is the main cause for angina, myocardial infarction (or heart attack), and heart failure. Coronary artery disease must be present in varying degrees in all three of the clinical diagnoses of acute coronary syndrome (ACS). Patients present in one of three ways: unstable angina, myocardial infarction without ST segment elevation (NSTEMI), and myocardial infarction with ST segment elevation (STEMI). In patients with congestive heart failure and left ventricular dysfunction, cardiologists use cardiac catheterization to obtain critical information on the condition of the heart, and therefore, decide on appropriate therapeutic interventions. In congestive heart failure, the heart fails to pump blood adequately to maintain blood circulation in the body. This results in congestion of blood, and therefore, edema in tissues of the body, such as, in the lungs, liver, feet, and ankles. Liver congestion is a large part of congestive heart failure as well. Left ventricular dysfunction refers to a condition where there is decreased movement of the left ventricle, resulting in dilation of the ventricle and weakening of the cardiac muscle. Left ventricular dysfunction may progress into congestive heart failure. Cardiac catheterization can help cardiologists evaluate the underlying cause of symptoms associated with left ventricular dysfunction and congestive heart failure, measure the extent of dysfunction in the left ventricle, measure the pressures inside the right side of the heart to evaluate fluid status, and measure cardiac output. Cardiac catheterization is also indicated for patients with myocardial infarction. Myocardial infarction refers to damage and death to an area of the myocardium, usually caused by coronary artery disease. Cardiac catheterization allows cardiologists to assess the extent of damage caused to the heart muscle, and to decide on a therapeutic approach for the underlying cause of the infarction. Cardiac catheterization may be also used to evaluate patients with cardiomyopathies. Cardiomyopathies refer to a group of diseases, with or without a known cause, that primarily affect cardiac muscle function. In patients with valvular heart disease, cardiologists use cardiac catheterization to assess the functioning of cardiac valves. Cardiac catheterization allows the identification of structural anomalies in the valves, and the evaluation of hemodynamic consequences of these anomalies, such as blood flow and oxygen levels in different parts of the heart. This helps cardiologists evaluate the risk and benefits of a surgical approach to treatment. In some cases, cardiac catheterization can also be used to measure hemodynamic values that may be needed prior to surgery in congenital heart disease, a condition caused by heart defect at birth. Cardiac catheterization is also indicated when percutaneous interventional approach (insertion of wires and catheters through the skin to treat cardiovascular problems) is selected to correct defects in congenital heart disease.
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 (most often a heart specialist called a cardiologist) will make a small puncture on your body near one of your arteries. A flexible tube (catheter) is inserted into and threaded 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.
How to Prepare for the Test
In most cases, you should not eat or drink for 8 hours before the test. (your cardiologist 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.
You will wear a hospital gown. Your cardiologist 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 be done with angioplasty to 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)
Normal Results
A normal result means the heart is normal in:
- Size
- Motion
- Thickness
- Pressure
The normal result also means arteries are normal.
What Abnormal Results Mean
Abnormal results may be a sign of cardiac disease or heart defects, including:
Risks
Complications may include:
- Cardiac arrhythmias
- Cardiac tamponade
- Embolism from blood clots at the tip of the catheter to the brain or other organs
- Heart attack
- Injury to the artery
- Infection
- Kidney damage from contrast (dye)
- Low blood pressure
- Reaction to the contrast material
- Stroke
References
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.
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.
Lawton J, Tamis-Holland, J. et al. 2021 ACC/AHA/SCAI Guideline for coronary artery revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(2):e21–e129. PMID: 34895950
Version Info
Last reviewed on: 7/14/2024
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.
