Cardiac catheterization (KATH-e-ter-i-ZA-shun) 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 perform diagnostic tests and treatments on your heart.
Sometimes a special dye is put into the catheter to
make the insides of your heart and blood vessels show up on x rays. The dye can
show whether a material called plaque (plak) has narrowed or blocked any of
your hearts arteries (called coronary arteries).
Plaque is made up of fat, cholesterol, calcium, and
other substances found in your blood. The buildup of plaque narrows the inside
of the arteries and, in time, may restrict blood flow to your heart. When this
happens, its called
coronary
artery disease (CAD).
Blockages in the arteries also can be seen using
ultrasound during cardiac catheterization. Ultrasound uses sound waves to
create detailed pictures of the hearts blood vessels.
Doctors may take samples of blood and heart muscle
during cardiac catheterization, as well as do minor heart surgery.
Cardiologists (doctors who specialize in treating
people who have heart problems) usually perform cardiac catheterization in a
hospital. Youre awake during the procedure, and it causes little to no
pain, although you may feel some soreness in the blood vessel where your doctor
put the catheter. Cardiac catheterization rarely causes serious
complications.
Who Needs Cardiac Catheterization?
Cardiac catheterization is used to diagnose and/or
treat various heart conditions. Doctors may recommend this procedure for a
number of different reasons. The most common reason is to evaluate chest pain.
Chest pain can be a symptom of
coronary
artery disease (CAD), and cardiac catheterization can show whether plaque
is narrowing or blocking your hearts arteries.
CAD can be treated during cardiac catheterization
with a procedure called
angioplasty
(AN-jee-oh-plas-tee). During angioplasty, a tiny balloon is put through the
catheter and into the blocked artery. When the balloon is inflated, it
compresses the plaque that has built up inside the artery. 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
thats used to treat narrowed or weakened arteries in the body.
Most people who have
heart
attacks have partially or completely blocked coronary arteries. Thus,
cardiac catheterization may be done on an emergency basis while youre
having a heart attack. When used with angioplasty, the procedure allows the
doctor to open up blocked arteries and prevent more damage to your heart.
You also may have cardiac catheterization to help
your doctor figure out the best treatment for your CAD 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 youre 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 your doctor may do a 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 evaluate the valves, your doctor will measure
blood flow and oxygen levels in different parts of your heart. Cardiac
catheterization also can check how well an artificial heart valve is working or
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 a cardiac catheterization, discuss
with your doctor:
How to prepare for the procedure
Any medicines youre 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
It may not be safe to drive right after having
cardiac catheterization. If your doctor says you can go home the same day as
the procedure, you should arrange for a ride home from the hospital.
What To Expect During Cardiac Catheterization
During a cardiac catheterization, youre kept
on your back and awake. That way you can follow your doctors instructions
during the procedure. Youre 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 small plastic tube (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 theyre 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 then uses it to conduct tests or treatments. For
example, your doctor may perform
angioplasty
and
stenting.
The animation below shows the process of cardiac
catheterization. Click the "start" button to play the animation. Written and
spoken explanations are provided with each frame. Use the buttons in the lower
right corner to pause, restart, or replay the animation, or use the scroll bar
below the buttons to move through the frames.
The animation shows the step-by-step
process your doctor will follow to perform cardiac catheterization.
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 hearts
arteries show up on an x ray called an angiogram. The test is called
coronary
angiography.
Coronary angiography can show how well blood is
being pumped out of the hearts main pumping chambers, which are called
ventricles (VEN-trih-kuls). An x ray taken when the dye is in the hearts
ventricles is called a ventriculogram. (The procedure is called
ventriculography.) 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, your doctor will
thread a tiny ultrasound device through the catheter and into the artery. This
device gives off ultrasound 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 hearts arteries, your doctor
may use angioplasty to open up 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 a cardiac catheterization, you will be moved
to a special care area, where you will rest 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 and see whether there is any
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. Be sure to let your doctor know if you develop
problems such as:
A constant or large amount of bleeding at the
insertion site that cant 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. But complications can
include:
Bleeding, infection, and pain where the catheter
was inserted.
Damage to blood vessels. This is a very rare
complication caused by the catheter scraping or poking a hole in a blood vessel
as its threaded to the heart.
An allergic reaction to the dye used.
Other less common complications of the procedure
include:
An
arrhythmia
(irregular heartbeat), which often goes away on its own, but may need treatment
if it persists.
Damage to the kidneys caused by the dye
used.
Blood clots that can trigger strokes,
heart
attacks, 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, although rarely, be fatal. The risk of
complications with cardiac catheterization is higher if you have diabetes or
kidney disease, or if youre 75 years old or older. The risk of
complications also is greater in women and people having cardiac
catheterization on an emergency basis.
Key Points
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 to do tests or treatments on the
heart.
Cardiac catheterization is most often used to
evaluate chest pain. It may also 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
artery disease.
Before having cardiac catheterization, discuss
with your doctor how to prepare for the test and any special instructions you
need to follow.
It may not be safe to drive right after the
procedure. If your doctor says you can go home the same day, you should arrange
for a ride home from the hospital.
During cardiac catheterization, youre kept
on your back and awake. That way you can follow your doctors instructions
during the procedure. Youre given medicine to help you relax.
After the procedure, you will be moved to a
special care area, where you will rest 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 with diabetes and kidney disease, and in older people and
women.
Links to Other Information About Cardiac
Catheterization