Cardiac Catheterization

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 perform diagnostic tests and treatments on your heart.

• 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, you’re kept on your back and awake. That way you can follow your doctor’s instructions during the procedure. You’re 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.

What To Expect During Cardiac Catheterization

During a cardiac catheterization, you’re kept on your back and awake. That way you can follow your doctor’s instructions during the procedure. You’re 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 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 then uses it to conduct tests or treatments. For example, your doctor may perform 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. The 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. An x ray taken when the dye is in the heart’s ventricles is called a ventriculogram. 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 heart’s 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 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 it’s 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 you’re 75 years old or older. The risk of complications also is greater in women and people having cardiac catheterization on an emergency basis.

Written by Dr. Mark Steiner, Cardiologist in Orlando