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Cardiac catheterization is a common nonsurgical procedure. It is used to help diagnose a heart
problem. In some cases, catheterization is also used to treat heart disease. During the procedure, a
long, flexible tube called a catheter is inserted into a blood vessel. It is then gently guided toward your
heart. Once the catheter is in place, x-rays and other tests are done. These test help your doctor learn
how well your heart is working.
Why Is Cardiac Catheterization Done?
You may have had symptoms of heart trouble. Symptoms include shortness of breath, angina (pain or
discomfort in the chest, arm or jaw), dizziness, or palpitations. Or perhaps your doctor found signs of
heart problems during a physical exam. As a result, you may have had special tests, including a
treadmill test, an echocardiogram, or a nuclear scan. The next step may be cardiac catheterization,
which can help your doctor pinpoint your heart problem. Cardiac catheterization can show:
- If the blood vessels in your heart are clogged
- If your heart is pumping normally and blood is flowing correctly
- If you were born with any heart problems
Be Sure To Tell Your Doctor If:
- You are pregnant. Cardiac catheterization will most likely be postponed until after your baby is
born. - You’ve had an allergic reaction to iodine (found in some shellfish and some x-ray contrast dyes).
You may be given medication before the procedure to help prevent an allergic reaction.
How A Healthy Heart Works
To understand why catheterization may be needed, it helps to know how a healthy heart works. The
heart is a muscle. It pumps blood throughout the body. To work right, your heart needs a steady supply
of oxygen. It gets this oxygen from blood supplied by the coronary arteries. The heart’s chambers and
valves keep blood flowing in the proper direction.
Coronary Arteries: Supplying Oxygen To The Heart Muscle
To do its work, the heart muscle needs a constant supply of oxygen-rich blood. This blood is supplied
by the coronary arteries (blood vessels that wrap around the surface of the heart).
- The left main coronary artery splits into two branches: the left anterior descending and the
circumflex. These supply blood to the front, left side and back of the heart muscle. - The right coronary artery supplies blood to the right side, bottom and back of the heart muscle.
Your Heart: An Inside View
Your heart is divided into two sides, with four chambers and four valves. The chambers and valves keep
blood moving in the proper direction through your heart, and out to your lungs and the rest of your body.
Two Sides
The right side of your heart pumps blood through your lungs. There the blood receives oxygen. The left
side pumps the oxygen-rich blood throughout your body.
Four Chambers
The right atrium, right ventricle, left atrium and left ventricle are chambers (compartments) that hold
blood as it flows through the heart. The right and left atria pump blood into the right and left ventricles.
The ventricles then pump blood away from the heart.
Four Valves
The four valves act like one-way doors that keep blood moving forward. When your heart beats, valves
open to let blood through. After each beat, valves close to keep blood from flowing backward.
Diagnosing Heart Problems
Cardiac catheterization can help locate artery, valve or heart muscle problems. This helps your doctor
decide if you need treatment and what that treatment should be.
Coronary Artery Disease
Cardiac catheterization can show whether you have coronary artery disease. This condition is caused by
atherosclerosis. Atherosclerosis occurs when plaque (a fatty substance) builds up within artery walls.
This buildup can reduce blood flow to the heart muscle. As a result, the heart muscle may not get all the
oxygen-rich blood it needs.
Healthy Artery
In healthy coronary arteries, blood flows easily to the heart muscle.
Damaged Artery
As plaque forms, blood flow to the heart muscle is reduced. When there is little blockage, you most
likely won’t feel any symptoms.
Narrowed Artery
In narrowed arteries, blood flow to the heart muscle is partly blocked. This can cause angina.
Blocked Artery
Plaque buildup or a clot can cut off the flow of oxygen-rich blood to part of the heart muscle. This may
cause a heart attack.
Heart Valve Problems
Problems can occur if a heart valve doesn’t open or shut all the way. Cardiac catheterization can provide
a closer look at your heart’s valves. This helps your doctor find out if they’re working properly.
Normal Valve
With each beat of the heart, a valve opens to let blood into the next chamber. When the beat ends, the
valve shuts. This keeps blood from flowing backward.
Abnormal Valve
If a valve doesn't open or shut completely, blood can build up or flow backward. The heart must then
work harder to pump out the extra blood. The sound of blood flowing through an abnormal valve is
called a heart “murmur”. It can be heard through a stethoscope.
Heart Muscle Of Structural Problems
Some people are born with problems in their heart structure or holes in the walls between the heart’s
right and left chambers. This can cause blood to flow in the wrong direction. Other heart muscle
problems may develop later in life. Cardiac catheterization can help detect these problems.
Tests for Diagnosing Heart Problems
To find out if you have a heart problem, tests may be performed during cardiac catheterization. These
tests create pictures of your heart and measure your heart’s blood flow and pressure. The test results
give your doctor details about your heart’s condition. They can help you and your doctor decide on the
best treatment.
Coronary Angiography
Angiography is a special type of x-ray that allows a blockage to be viewed and recorded on film.
Ventriculography is also a type of x-ray. It allows the heart’s chambers and pumping action to be viewed
and recorded on videotape. These types of x-rays can do the following:
- Reveal abnormal movements of the heart chambers
- Detect abnormal valves, artery blockages and holes between the heart’s right and left sides.
Other Tests
During cardiac catheterization, other tests may be done. These include tests that:
- Measure the amount of blood your heart pumps.
- Measure blood pressure in the heart chambers. This is done to see if blood is flowing properly
through your valves. It can also show if the heart muscle is pumping as it should.
Treating Heart Problems
Cardiac catheterization may also be used to treat certain heart problems. The catheter can enter the
heart and coronary arteries without surgery. For this reason, catheterization can be used for nonsurgical
treatment of blood clots and coronary artery disease.
Angioplasty
Angioplasty opens clogged arteries. It does this by compressing plaque against the artery wall. A
catheter with a small balloon at its tip is moved to where the artery is clogged. The balloon is inflated
and deflated a few times. This compresses the plaque, opens the artery and increases blood flow.
Then the balloon-tipped catheter is removed.
Other Treatments
Other treatments for coronary artery disease may be done using cardiac catheterization:
- Stents are metal devices that are placed permanently inside an artery to help keep it open.
- Atherectomy removes plaque from artery walls using a special catheter.
- Medications can be delivered through the catheter to dissolve a blood clot in an artery.
Preparing For Your Catheterization
Before your cardiac catheterization, your health care provider explains the procedure’s risks and
benefits. You’ll also receive instructions on what to expect and how to prepare. Follow all instructions
carefully. And be sure to ask any questions you may have.
Understanding The Risks
The risks of cardiac catheterization are fairly low. They are most often outweighed by the benefits of
knowing your heart’s condition. Your doctor will discuss any risks and side effects with you. Then you’ll
be asked to sign a legal consent form. This gives your permission for the procedure. The risks of
cardiac catheterization may include:
- Bleeding or clotting
- Minor tearing or cracking of the artery lining
- Abnormal heartbeat (arrhythmia)
- Allergic reaction to the special contrast dye
- Emergency bypass surgery
- Heart attack, stroke or death
Before Your Procedure
The night before your catheterization, you may be asked not to eat or drink anything after midnight. You’ll
most likely be admitted to the hospital on the day of the procedure. Before catheterization begins, you
may be given medication to help you relax. The skin where the catheter will be inserted may be shaved.
Then you’ll be taken to the catheterization laboratory.
In The Catheterization Lab
The lab may feel cool, but you’ll be covered with sterile drapes. The nurse can also bring you a blanket.
Only the patch of skin where the catheter will be inserted is exposed. The doctor, nurses and
technicians wear sterile gowns, gloves and possibly, masks. It may take 30 minutes for the lab team to
prepare for the procedure once you’re there.
During The Procedure
Cardiac catheterization tends to take an hour or less. The skin is cleaned and numbed where the
catheter will be inserted. You remain awake during the procedure. This allows you and the team to
communicate as needed.
Inserting The Catheter
A local anesthetic is given by injection. This keeps you from feeling pain at the insertion site. The
insertion site may be a blood vessel in your groin, wrist or arm. The injection feels like a bee sting. This
is probably the least comfortable part of catheterization.
An introducing sheath is inserted into a blood vessel. You may briefly feel a little pressure when it is
inserted.
The catheter is inserted through the sheath and gently guided toward the heart. Your doctor watches the
catheter’s movement on video monitors. You should not feel the catheter moving through your body and
into your heart.
Performing Tests
- A number of tests may be done in the heart and coronary arteries. To do them, the doctor may
change the position of the catheter, insert new catheters, or move the x-ray machine. - For some tests, a contrast dye is used. It is injected through the catheter and travels to the
coronary artery or heart chamber. You may be asked to hold your breath. The dye may cause a
hot flush over your body for about 10 seconds. You may be asked to cough to help move the dye
through your heart.
Removing The Catheter
- After the tests are finished, the catheter is removed first, then the sheath.
- If the sheath was in your arm, the site may be closed with stitches.
- For other insertion sites, pressure may be used to stop any bleeding. If the groin site was used,
it may be clamped or held under pressure for at least 15 minutes. - Sometimes a special stitch, plug or pressure device may be applied to the site.
After Your Catheterization
After your catheterization, you may need to remain lying down for a few hours. If the catheter was
inserted in your groin, you may be asked not to move your leg. This is done to prevent bleeding. Most
people have no pain after catheterization. Many patients go home the same day. Others go home the
next day.
Close Monitoring
You’ll be watched carefully after the procedure. Your blood pressure and insertion site will be checked
often to make sure there is no bleeding. Your doctor may also come in to check on you. The contrast dye
may cause you to urinate more than usual. And you may be asked to drink a lot of fluid to help flush the
dye out of your system.
Tell Your Nurse If:
- You feel any chest pain or discomfort at the insertion site.
- The arm or leg used for insertion becomes numb or cold.
- You feel warmth or wetness around the insertion site, a sign that you may be bleeding.
Finding Out Your Results
Your doctor will discuss your test results with you. The results may show that your heart is working
normally. If there is a problem, your doctor will explain it to you and discuss treatment choices.
Going Home
Have a family member or friend drive you home from the hospital. Most people can return to normal
activities a day or two after going home. But avoid heavy lifting, and do only light activities for a few days.
The skin near the insertion site will most likely be black and blue. You may also find a lump about the
size of an olive. These common side effects should go away within a few weeks.
Call Your Doctor If:
- The insertion site begins to bleed.
- You feel any chest pain or discomfort at the insertion site.
- The arm or leg in which the catheter was inserted feels cold or numb.
- The bruising or swelling increases.
Planning The Next Step
After your cardiac catheterization, ask your doctor when you can return to your daily activities. If you do
have a heart problem, the catheterization results will help you and your doctor decide on a treatment
plan.
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