Cardiac Catheterization

Your doctor may recommend cardiac catheterization to help with diagnoses or plan treatment. It can be useful when your doctor wants to do any of the following:

• Better understand the results from other tests and procedures, such as echocardiography (echo), cardiac MRI, and cardiac CT scan, especially if other studies could not define the problem or if the results from other studies differ from what your doctor finds when examining you.
• Diagnose the cause of your chest pain, arrhythmia, or other signs and symptoms of a heart problem or evaluate you during an emergency such as a heart attack. The procedure may help your doctor diagnose heart conditions such as pulmonary hypertension, cardiomyopathy, ischemic heart disease, and heart valve diseases such as aortic stenosis and mitral regurgitation.
• Evaluate you before a possible heart transplant.
• Look at the pulmonary arteries for conditions, including pulmonary embolism, that can occur as a result of venous thromboembolism. The pulmonary arteries are the blood vessels that carry blood from your heart to your lungs, where the blood receives oxygen.
• Measure oxygen levels and pressures of the blood in your heart, such as in your ventricles, atria, and pulmonary arteries.

Your doctor may perform additional procedures to diagnose or treat your condition during cardiac catheterization. Some of these procedures include:

• Biopsies to take small samples of the heart tissue for further laboratory testing. Biopsies can be used for genetic testing or to check for myocarditis, a type of heart inflammation, or transplant rejection.
• Coronary angiography to look at the heart or blood vessels by injecting dye through the catheter.
• Minor heart surgery to treat congenital heart defects and replace or widen narrowed heart valves.
• Percutaneous coronary intervention (PCI) to open narrowed or blocked areas of the coronary arteries. PCI may include balloon dilation, or angioplasty, or stent placement. Most people who have heart attacks or underlying ischemic heart diseases have narrowed or blocked coronary arteries.

Your doctor may wait to do the procedure or recommend that you do not have cardiac catheterization if you have one of the following conditions:

• Abnormal electrolyte levels in your blood
• Acute gastrointestinal bleeding
• Acute kidney failure, or severe kidney disease that is not being treated with dialysis
• Acute stroke
• Blood that is too thin from medicines such as warfarin or other causes
• High blood levels of a heart medicine called digoxin
• Previous severe allergic reaction to the dye that is used during cardiac catheterization
• Severe anemia, which is a lower-than-normal red blood cell count or hemoglobin
• Unexplained fever
• Untreated infection

• Read During Cardiac Catheterization to learn what happens during the procedure and possible risks and complications.

You may have some of the following tests before your catheterization procedure:

• Electrocardiogram (ECG or EKG) to look at your heart’s rhythm and other electrical activity of your heart. It can show arrhythmias, heart attacks, and other problems with the heart.
• Chest X-ray to look at your lungs, your heart, your major blood vessels, and other structures in the chest.
• Echocardiogram (echo) to look at the structure and function of your heart.
• Stress test to look at how well your heart works during physical stress. The stress may be physical exercise such as walking on a treadmill, or it may be a medicine given to have the same effect.
• Cardiac CT scan to look for narrowing of your heart’s blood vessels, and problems with the heart, larger blood vessels, and heart valves. These pictures also may help your doctor plan for procedures to open the coronary arteries.
• Cardiac MRI to provide information on the structure and function of your heart, as well as the type and severity of heart disease.
• Blood tests, including a complete blood count (CBC), to check your hemoglobin and platelet levels; blood chemistry tests to check how well your liver and kidneys are working; and tests to check your blood’s ability to clot.

Talk to your doctor about your medical history, including any medicines you take, other surgical procedures you have had, and any medical conditions you have, such as diabetes or kidney disease.

Your doctor will talk to you about how to prepare for the procedure, including:

• When to arrive at the hospital and where to go
• When you should stop eating or drinking
• If and when you should start or stop taking medicines
• How long you should expect to stay
• What happens during the procedure
• What to expect after the procedure, including potential complications, such as bleeding or soreness
• Instructions to follow after the procedure, including what medicines to take

Before cardiac catheterization, an intravenous line (IV) will be placed in a vein in your arm. Through this IV you will get a medicine to either help you relax or make you sleep during the procedure.

You will get numbing medicine, or local anesthesia, at the site where the doctor will insert the catheter. This site is called the access site and may be in the upper thigh, arm, neck, or under the collarbone. The doctor places a needle into a blood vessel at the access site. A guidewire is inserted into the needle, and the needle is taken out. Then the doctor places a small tube called a sheath in the blood vessel around the guidewire. The guidewire is removed. The catheter is then inserted through the sheath. Your doctor watches X-ray images to see where to place the tip of the catheter.

Once the catheter is in place, your doctor may use it to perform tests or treatments on your heart. For example, he or she may inject a dye into the catheter to look at blood flow in the heart. The dye will enter your blood vessels and make your coronary arteries visible in X-ray pictures.

Cardiac catheterization is a relatively safe procedure, and complications are rare. Possible complications include the following:

• Allergic reaction to the dye used. This reaction may be hives or a more serious reaction.
• Arrhythmias
• Bleeding at the access site or inside your abdomen
• Blood clot formation at the access site, inside your abdomen, in a blood vessel, or in your heart
• Collapsed lung, called pneumothorax, resulting in air in the space between your lung and chest wall
• Damage to blood vessels, heart valves, or your heart
• Heart attack
• Hypothermia, especially in small children
• Infection
• Low blood pressure from bleeding or as a reaction to the procedure
• Need for blood transfusion
• Need for emergency surgery to repair a tear in the aorta or coronary artery and restore blood flow to the heart. This may be done using a coronary artery bypass graft (CABG).
• Side effects of general anesthesia, if used. These can include nausea, vomiting, confusion, or an allergic reaction.
• Stroke

Although not an immediate risk, repeated radiation exposure from X-rays used to place the catheter in the heart, especially with children, may increase the risk of cancer and leukemia, damage to skin, and cataracts later in life.

• Return to Before Cardiac Catheterization to review how to prepare for the procedure.
• Return to Who Needs It to review the conditions that may require cardiac catheterization.

It is important to get routine follow-up care after you have cardiac catheterization. Talk with your doctor about how often you should schedule office visits.

• Adopt a heart-healthy lifestyle, especially if your cardiac catheterization was needed because of ischemic heart disease or heart attack.
• Follow any instructions for when to resume physical activity and lifting and at what levels.
• Follow instructions on how to care for the site where the doctor accessed your blood vessel, including when you can take a bath or swim.
• Keep any follow-up appointments or tests.
• Take any medicines as directed by your doctor.
• Talk to your doctor about any blood tests you may need if you were placed on blood thinners after your procedure.

Complications from cardiac catheterization are rare but can be serious. A small bruise and tenderness at the access site is normal. Call your doctor immediately if you experience any of the following, as they may be signs of serious complications.

• Bleeding from the access site that cannot be stopped with firm pressure
• Chest pain or shortness of breath
• Dizziness
• Fever
• Increased pain, redness, or bruising at the access site
• Irregular, very slow, or fast heartbeat
• Swelling at the access site
• Yellow or green discharge draining from the access site
• Your leg or arm that was used for access becoming numb or weak or any part of it turning cold or blue

Other serious complications after catheterization, although rare, include heart attack and stroke. If you think that you are or someone else is having the following symptoms, call 9-1-1 immediately.

Heart attack signs and symptoms include:

• Chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion.
• Nausea, vomiting, light-headedness or fainting, or breaking out in a cold sweat. These symptoms of a heart attack are more common in women.
• Shortness of breath, which may occur with or before chest discomfort.
• Upper body discomfort in one or both arms or the back, neck, jaw, or upper part of the stomach.

If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.

• F—Face: Ask the person to smile. Does one side of the face droop?
• A—Arms: Ask the person to raise both arms. Does one arm drift downward?
• S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
• T—Time: If you observe any of these signs, call for help immediately. Early treatment is essential.

Read more about the signs and symptoms of a stroke.