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 do diagnostic tests and
treatments on your heart.
For example, 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 coronary (heart)
arteries show up on an x ray. This test is called
coronary
angiography (an-jee-OG-ra-fee).
The dye can show whether a substance called plaque
(plak) has narrowed or blocked any of your coronary arteries. Plaque is made up
of fat, cholesterol, calcium, and other substances found in your blood.
Plaque narrows the inside of the arteries and, in
time, may restrict blood flow to your heart. When plaque builds up in the
coronary arteries, the condition is called
coronary
heart disease (CHD) or coronary artery disease.
Blockages in the coronary arteries also can be seen
using ultrasound during cardiac catheterization. Ultrasound uses sound waves to
create detailed pictures of the heart's blood vessels.
Doctors may take samples of blood and heart muscle
during cardiac catheterization and do minor heart surgery.
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 used to diagnose and/or
treat many heart conditions. Doctors may recommend this procedure for various
reasons. The most common reason is to evaluate chest pain.
Chest pain may be a symptom of
coronary
heart disease (CHD). Cardiac catheterization can show whether plaque is
narrowing or blocking your heart's arteries.
Doctors can treat CHD 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 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
It may not be safe to drive after having cardiac
catheterization, so you must arrange arrange for a ride home.
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.
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 do 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 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 (VEN-trih-kuls). 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.
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. Through the catheter, doctors can
do diagnostic tests and treatments.
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.
Links to Other Information About Cardiac
Catheterization
DCI Home:
Heart and Blood Vessel Diseases:
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