Cardiac catheterization

Answer 1

Definition

Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin or the arm.

Alternative Names

Catheterization - cardiac; Heart catheterization

How the test is performed

You will be given a mild sedative before the test to help you relax. An intravenous (IV) line is inserted into one of the blood vessels in your arm, neck, or groin after the site has been cleansed and numbed with a local numbing medicine (anesthetic).

A catheter is then inserted through the IV and into your blood vessel. The catheter is carefully threaded into the heart using an x-ray machine that produces real-time pictures (fluoroscopy). Once the catheter is in place, your doctor may:

• Collect blood samples from the heart
• Measure pressure and blood flow in the heart's chambers and in the large arteries around the heart
• Measure the oxygen in different parts of your heart
• Examine the arteries of the heart with an x-ray technique called fluoroscopy (which gives immediate, "real-time" pictures of the x-ray images on a screen and provides a permanent record of the procedure)
• Perform a biopsy on the heart muscle

How to prepare for the test

If possible, you will be asked not to eat or drink for 6 - 8 hours before the test. The test takes place in a hospital and you will be asked to wear a hospital gown. Sometimes, you will need to spend the night before the test in the hospital. Otherwise, you will be admitted as an outpatient or an inpatient the morning of the procedure.

Your health care provider should explain the procedure and its risks. A witnessed, signed consent for the procedure is required.

Tell your doctor if you:

• Are allergic to seafood
• Have had a bad reaction to contrast material or iodine in the past
• Are taking Viagra
• Might be pregnant

How the test will feel

The study is done by trained cardiologists with the assistance of trained technicians and nurses.

You will be awake and able to follow instructions during the test. You will usually get a mild sedative 30 minutes before the test to help you relax. The test may last 30 - 60 minutes.

You may feel some discomfort at the site where the catheter is placed. Local anesthesia will be used to numb the site, so the only sensation should be one of pressure at the site. You may experience some discomfort from having to remain still for a long time.

After the test, the catheter is removed. You might feel a firm pressure, used to prevent bleeding at the insertion site. If the catheter is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.

Why the test is performed

In general, this procedure is done to get information about the heart or its blood vessels or to provide treatment in certain types of heart conditions. It may also be used to determine the need for heart surgery.

Your doctor may perform cardiac catheterization to:

• Diagnose or evaluate coronary artery disease
• Diagnose or evaluate congenital heart defects
• Diagnose or evaluate problems with the heart valves
• Diagnose causes of heart failure or cardiomyopathy

The following may also be performed using cardiac catheterization:

• Repair of certain types of heart defects
• Repair of a stuck (stenotic) heart valve
• Opening of blocked arteries or grafts in the heart

What abnormal results mean

The procedure can identify heart defects or disease, such as:

• Coronary artery disease
• Valve problems
• Ventricular aneurysms
• Heart enlargement

The procedure also may be performed for the following:

• Primary pulmonary hypertension
• Heart valve defects, such as pulmonary valve stenosis, mitral valve regurgitation, aortic stenosis, and others
• Pulmonary embolism
• Birth defects, such as Tetralogy of Fallot, transposition of the great vessels, ventricular septal defect, coarctation of the aorta, and others
• Cardiac amyloidosis

What the risks are

Cardiac catheterization carries a slightly higher risk than other heart tests, but is very safe when performed by an experienced team.

Generally, the risks include the following:

• Cardiac arrhythmias
• Cardiac tamponade
• Heart attack
• Bleeding
• Low blood pressure
• Reaction to the contrast medium
• Stroke
• Trauma to the artery caused by hematoma

Possible complications of any type of catheterization include the following:

• A risk of bleeding, infection, and pain at the IV site
• A very small risk that the soft plastic catheters could damage the blood vessels
• Blood clotscould form on the catheters and later block blood vessels elsewhere in the body.
• The contrast material could damage the kidneys (particularly in patients with Diabetes).

Special considerations

Cardiac catheterization may include coronary angiography.

References

Davidson CJ, Bonow RO. Cardiac catheterization. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.

Answer 2

Definition

Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin or the arm.

Alternative Names

Catheterization - cardiac; Heart catheterization

How the test is performed

You will be given medicine before the test to help you relax. The health care provider cleans a site on your arm, neck, or groin and inserts a line into one of your blood vessels. This is called an intravenous (IV) line.

A thin tube called a catheter is placed through the IV and into your blood vessel in the leg or neck. The catheter is carefully moved up into the heart using live x-rays as a guide. Then the doctor can:

• Collect blood samples from the heart
• Measure pressure and blood flow in the heart's chambers and in the large arteries around the heart
• Measure the oxygen in different parts of your heart
• Examine the arteries of the heart
• Perform a biopsy on the heart muscle

The test may last 30 - 60 minutes. After the test, the catheter is removed. If the catheter is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding.

How to prepare for the test

If possible, you will be asked not to eat or drink for 6 - 8 hours before the test. The test takes place in a hospital and you will be asked to wear a hospital gown. Sometimes, you will need to spend the night before the test in the hospital. Otherwise, you will be admitted as an outpatient or an inpatient the morning of the procedure.

Your health care provider should explain the procedure and its risks. A witnessed, signed consent for the procedure is required.

Tell your doctor if you:

• Are allergic to seafood
• Have had a bad reaction to contrast dye or iodine in the past
• Take any medicines, including Viagra
• Might be pregnant

How the test will feel

The study is done by trained cardiologists with the assistance of trained technicians and nurses.

You will be awake and able to follow instructions during the test.

You may feel some discomfort or pressure where the catheter is placed. Some people have some discomfort from lying still during the test or from lying flat on your back after the procedure.

Why the test is performed

In general, this procedure is done to get information about the heart or its blood vessels or to provide treatment in certain types of heart conditions. It may also be used to determine the need for heart surgery.

Your doctor may perform cardiac catheterization to diagnose or evaluate:

• Coronary artery disease
• Heart defectsthat are present at birth (congenital)
• Problems with the heart valves
• Causes of heart failure or cardiomyopathy

The following procedures may also be done using cardiac catheterization:

• Repair of certain types of heart defects
• Repair of a stuck (stenotic) heart valve
• Opening of blocked arteries or grafts in the heart

What abnormal results mean

The procedure can identify heart defects or disease, such as:

• Coronary artery disease
• Valve problems
• Ventricular aneurysms
• Heart enlargement

The procedure also may be performed for the following:

• Primary pulmonary hypertension (high blood pressure in the lungs)
• Heart valve defects, such as pulmonary valve stenosis, mitral valve regurgitation, and aortic stenosis
• Pulmonary embolism (blood clots in the lungs)
• Birth defects, including tetralogy of Fallot, transposition of the great vessels, ventricular septal defect, and coarctation of the aorta
• Cardiac amyloidosis
• Cardiomyopathy

What the risks are

Cardiac catheterization carries a slightly higher risk than other heart tests, but is very safe when performed by an experienced team.

Generally, the risks include the following:

• Cardiac tamponade
• Heart attack
• Irregular heart beat
• Low blood pressure
• Reaction to the contrast dye
• Stroke

Possible complications of any type of catheterization include the following:

• Bleeding, infection, and pain at the IV site
• Damage to the blood vessels
• Blood clots
• Kidney damage due to the contrast dye (particularly in patients with diabetes)

References

In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 20 Cardiac catheterization

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.

Reviewed By

Review Date: 05/23/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.