Cardiac catheterization is a medical procedure used to diagnose and treat certain heart conditions.
- A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, doctors can do diagnostic tests and treatments. For instance, dye may be injected into the cathether that can show whether the arteries going to the heart have become narrowed or blocked by plaque. When plaque builds up in the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.
- Cardiac catheterization most often is used to evaluate chest pain. It also may be done during a heart attack to identify narrowed or blocked coronary arteries. You also may need this procedure if other tests suggest you have coronary heart disease (also called coronary artery disease).
- Before having cardiac catheterization, discuss with your doctor how to prepare for the test and any special steps you need to follow. It may not be safe to drive after the procedure, so you must arrange for a ride home.
- Cardiac catheterization is done in a hospital. During the procedure, you'll be kept on your back and awake. This allows you to follow your doctor's instructions during the procedure. You'll be given medicine to help you relax.
- After the procedure, you'll be moved to a special care area. You will rest there for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the catheter was inserted.
- A small bruise may develop at the site where the catheter was inserted. That area may feel sore or tender for about a week. You need to let your doctor know if you have a lot of bleeding from that area or signs of infection. You may have to avoid doing certain activities, such as heavy lifting, for a short time after the procedure.
- Cardiac catheterization is a common medical procedure that rarely causes serious complications. The risk of complications is higher in people who have diabetes and kidney disease, and in older people and women.
- Cardiologists (heart specialists) usually do cardiac catheterization in a hospital. You're awake during the procedure, and it causes little to no pain. However, you may feel some soreness in the blood vessel where the catheter was inserted. Cardiac catheterization rarely causes serious complications.
Who Needs Cardiac Catheterization?
Cardiac catheterization is most commonly performed to evaluate chest pain and determine whether plaque is narrowing or blocking your heart's arteries. This is called Coronary Heart Disease (CHD).
Doctors can treat CHD during cardiac catheterization with a procedure called angioplasty. During angioplasty, a tiny balloon is put through the catheter and into the blocked artery. When the balloon is inflated, it pushes the plaque against the artery wall. This creates a wider pathway for blood to flow to the heart.
Sometimes a stent is placed in the artery during angioplasty. A stent is a small mesh tube that's used to treat narrowed or weakened arteries in the body.
Most people who have heart attacks have partly or completely blocked coronary arteries. Thus, cardiac catheterization may be done on an emergency basis while you're having a heart attack. When used with angioplasty, the procedure allows your doctor to open up blocked arteries and prevent more damage to your heart.
Cardiac catheterization also can help your doctor figure out the best treatment for your CHD if you:
- Recently recovered from a heart attack, but are having chest pain
- Had a heart attack that caused major damage to your heart
- Had an EKG (electrocardiogram), stress test, or other test with results that suggested heart disease
You also may need cardiac catheterization if your doctor suspects you have a heart defect or if you're about to have heart surgery. The procedure shows the overall shape of your heart and the four large spaces (heart chambers) inside it. This inside view of the heart will show certain heart defects and help your doctor plan your heart surgery.
Sometimes doctors do cardiac catheterization to see how well the valves at the openings and exits of the heart chambers are working. Valves control the flow of blood in the heart.
To check your valves, your doctor will measure blood flow and oxygen levels in different parts of your heart. Cardiac catheterization also can check how well a man-made heart valve is working and how well your heart is pumping blood.
If your doctor thinks you have a heart infection or tumor, he or she may take samples of your heart muscle through the catheter. With the help of cardiac catheterization, doctors can even do minor heart surgery, such as repair certain heart defects.
What To Expect Before Cardiac Catheterization
Before having cardiac catheterization, discuss with your doctor:
- How to prepare for the procedure
- Any medicines you're taking, and whether you should stop taking them before the procedure
- Whether you have diabetes, kidney disease, or other conditions that may require taking extra steps during or after the procedure to avoid complications
Your doctor will let you know whether you need to arrange for a ride home after the procedure.
What To Expect During Cardiac Catheterization
Cardiac catheterization is done in a hospital. During the procedure, you'll be kept on your back and awake. This allows you to follow your doctor's instructions during the procedure. You'll be given medicine to help you relax, which may make you sleepy.
Your doctor will numb the area on the arm, groin (upper thigh), or neck where the catheter will enter your blood vessel. A needle is used to make a small hole in the blood vessel. Through this hole your doctor will put a tapered tube called a sheath.
Next, your doctor will put a thin, flexible wire through the sheath and into your blood vessel. This guide wire is then threaded through your blood vessel to your heart. The wire helps your doctor position the catheter correctly. Your doctor then puts a catheter through the sheath and slides it over the guide wire and into the coronary arteries.
Special x-ray movies are taken of the guide wire and the catheter as they're moved into the heart. The movies help your doctor see where to position the tip of the catheter.
When the catheter reaches the right spot, your doctor will use it to do tests or treatments on your heart. For example, your doctor may do angioplasty and stenting.
During the procedure, your doctor may put a special dye in the catheter. This dye will flow through your bloodstream to your heart. Once the dye reaches your heart, it will make the inside of your heart's arteries show up on an x ray called an angiogram. This test is called coronary angiography.
Coronary angiography can show how well blood is being pumped out of the heart's main pumping chambers, which are called ventricles. When the catheter is inside your heart, your doctor may use it to take blood samples from different parts of the heart or to do minor heart surgery.
To get a more detailed view of a blocked coronary artery, your doctor may do intracoronary ultrasound. For this test, your doctor will thread a tiny ultrasound device through the catheter and into the artery. This device gives off sound waves that bounce off the artery wall (and its blockage) to make an image of the inside of the artery.
If the angiogram or intracoronary ultrasound shows blockages or other possible problems in the heart's arteries, your doctor may use angioplasty to open the blocked arteries.
After your doctor does all of the needed tests or treatments, he or she will pull back the catheter and take it out along with the sheath. The opening left in the blood vessel will then be closed up and bandaged. A small weight may be put on top of the bandage for a few hours to apply more pressure. This will help prevent major bleeding from the site.
What To Expect After Cardiac Catheterization
After cardiac catheterization, you will be moved to a special care area. You will rest there for several hours or overnight. During that time, your movement will be limited to avoid bleeding from the site where the catheter was inserted.
While you recover in this area, nurses will check your heart rate and blood pressure regularly. They also will check for bleeding from the catheter insertion site.
A small bruise may develop on your arm, groin (upper thigh), or neck at the site where the catheter was inserted. That area may feel sore or tender for about a week. Let your doctor know if you develop problems such as:
- A constant or large amount of bleeding at the insertion site that can't be stopped with a small bandage
- Unusual pain, swelling, redness, or other signs of infection at or near the insertion site
Talk to your doctor about whether you should avoid certain activities, such as heavy lifting, for a short time after the procedure.
What Are the Risks of Cardiac Catheterization?
Cardiac catheterization is a common medical procedure that rarely causes serious problems. However, complications can include:
- Bleeding, infection, and pain where the catheter was inserted.
- Damage to blood vessels. Rarely, the catheter may scrape or poke a hole in a blood vessel as it's threaded to the heart.
- An allergic reaction to the dye used.
Other, less common complications of the procedure include:
- Arrhythmias (irregular heartbeats). These often go away on their own, but may need treatment if they persist.
- Damage to the kidneys caused by the dye used.
- Blood clots that can trigger stroke, heart attack, or other serious problems.
- Low blood pressure.
- A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.
As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with cardiac catheterization.
The risk of complications with cardiac catheterization is higher if you have diabetes or kidney disease, or if you're aged 75 or older. The risk of complications also is greater in women and in people having cardiac catheterization on an emergency basis.
Reference: The National Heart, Blood, and Lung Institute
Last updated April 28, 2017