Cardiac Catheterization

The heart is a muscular pump about the size of your fist and is made up of four chambers. The two upper chambers are called atria. The two lower chambers are called ventricles. A natural electrical system stimulates the heart muscle to contract.

Cardiac catheterization (cardiac cath or heart cath) is a procedure that examines the condition of the heart, in particular the heart muscle and the coronary arteries that supply it. The procedure requires the physician to access a major blood vessel, usually in the groin or arm and to thread a catheter to the patient’s heart.

Diagnostic exams can then be performed to determine disease of the heart muscle, valves, or coronary arteries. In coronary angiography, iodinated contrast dye is injected through the catheter directly into the coronary arteries making them visible on X-ray. Narrowings and/or blockages can be clearly identified and then treated. Complications during these diagnostic procedures are extremely rare.

Why do people have cardiac catheterization?

Usually the patient has had a non-invasive cardiac test(s) such as a treadmill stress test, or echocardiogram that has shown potential abnormalities in the heart. However non-invasive tests often produce “false positive or negative results.” The Gold Standard examination is the cardiac catheterization.

If an abnormality is identified such as a narrowed or blocked coronary artery, it can be safely treated with coronary angioplasty and stenting.

Pressures inside the four heart chambers of the heart, and the condition of the heart muscle can also be evaluated. Samples of blood within the heart structures can be measured to determine oxygen content thereby measuring heart/lung function. Possible defects in the valves within the heart can be identified.

All the data collected during the procedure can greatly benefit the patient, by enabling the physician to prescribe the best possible treatment plan and improve the patient’s quality of life.

What are the risks of cardiac catheterization?

Routine cardiac catheterizations are very safe. A small number of people have minor problems such as bruising at the insertion site. The iodinated contrast dye that illuminates the coronary arteries on X-rays may induce nausea, skin irritation, and mild allergic reactions.

How do I prepare for cardiac catheterization?

You will be given instructions about diet during the 24 hours before the test. Usually, you will be asked not to eat or drink anything for six to eight hours before the procedure.

• Tell your doctor about any medicines you take (including over-the-counter, herbs, and vitamins). Some medicines are important to continue, others may be important to stop.
• Tell your doctor or nurse of any allergies, especially to iodine, shellfish, or X-ray contrast, latex or rubber products, and medicines, for example penicillin or aspirin.
• Arrange to have someone drive you home after your procedure.
• If you usually wear a hearing aid you can wear it during your procedure. If you wear glasses, bring them with you.

What should a patient expect during a cardiac catheterization?

A doctor with specialist training in intervention cardiology performs the procedure with a team of highly trained cardiac nurses and radiological technologists.

• Before the procedure, a nurse will place an intravenous line into your vein, clean and shave the area where the doctor will be accessing your blood vessel, hook up the EKG, and perform a thorough nursing assessment.
• Usually the physician will order a mild sedative for your comfort. It is often important that you remain awake during the procedure in order to follow instructions from the physician and staff. A local anesthetic is given to numb where the catheter is to be inserted; you may feel some pressure in your groin or arm but you should not feel pain.
• During the heart catheterization, you will lie flat on the X-ray table in a cardiac catheterization laboratory/procedure room. The physician and radiological technologist are wearing surgical attire, i.e., hat, gowns, masks, etc. The area of insertion is surgically prepped and draped, then the physician will numb the skin where the catheter is to be inserted. The physician will then insert a sheath that allows a flexible guiding catheter access into the blood vessel that leads directly to the heart.
• The physician then injects contrast dye through the catheter which illuminates the arteries that supply blood to the heart muscle. The arteries are clearly visualized on the monitor.
• If a narrowing or blockage is discovered, your cardiologist will decide if it needs treating. A coronary balloon is threaded to the narrowing and expanded to open up the vessel. This is called an angioplasty. Once open, a coronary stent is deployed to prevent the narrowing from recoiling back to the original state.
• Once the procedure is complete the physician will remove the balloon and catheters and the nurse or technologist will remove the sheath and hold pressure on the site to prevent bleeding. On most occasions a special “closure device” is used that speeds healing of the puncture site.
• The whole procedure usually takes 1-2 hours in total.

What happens after cardiac catheterization?

There will be a recovery period in which you will have to lie relatively flat in bed. It is important to follow instructions to avoid post procedural complications such as bleeding from the site. You will be asked not to lift your head from the pillow, keep your leg straight and avoid coughing. Your vital signs (pulse and blood pressure) will be checked throughout your recovery.

• Report immediately to the nurse if you have any chest pain, swelling, pain or bleeding at the puncture site.
• Upon discharge you will receive written instructions on postoperative care.
• What happens once I get home?
• Be sure to carefully follow all instructions. It is important to TAKE YOUR MEDICATIONS as directed by your healthcare provider and to make follow up appointments before leaving the hospital.

Most people can return to their normal activities the day after the procedure depending on whether any additional treatments were done during or after the procedure.

A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it for a few minutes. Then, recheck to see if the bleeding has stopped.