What is a Cardiac Catheterization?
Cardiac catheterization (also referred to as cardiac cath, heart cath, or coronary angiogram) is a procedure that helps the doctor to see how well your heart supports your blood vessels. The doctor inserts a long, narrow tube called a catheter into a blood vessel in your arm or leg during the procedure, and uses a special X-ray machine to direct it to your heart. The catheter is threaded through the blood vessel until the catheter reaches the heart.
For example, using a special X-ray machine, a dye may be inserted into the catheter that allows the doctor to look at the arteries and chambers of the heart.
Why Cardiac catheterization is Perfomed?
Cardiac catheterization is performed to check if a person is having any heart problem, this can be done as part of the procedure to correct a known heart problem. If a person is undergoing cardiac catheterization as a test for assessing heart disease, the doctor can:
- Locate blockages or narrowings that may cause chest pain in the blood vessels (angiogram)
- Measure the levels of pressure and oxygen in various parts of the heart (hemodynamic assessment)
- Verify the heart's pumping function (right or left ventriculogram)
- Take a tissue sample from your heart (biopsy)
- Diagnose heart defects from birth (congenital heart defects)
- Check for issues with the cardiac valves
Cardiac Catheterization Uses
The next step depends on why you are having a cardiac catheterization. Here are some of the common uses for cardiac catheterization:
Coronary angiogram
A dye will be administered into the catheter, and X-ray images of the heart arteries will be taken. This procedure is conducted to search for blockages in the arteries leading to your heart. Typically, in a coronary angiogram, the catheter is first placed in the artery of the groin or wrist region.
Right heart catheterization
This operation assesses the right side of your heart for pressure and blood flow. The catheter is inserted into the vein in your neck or groin for this operation. The catheter has special sensors in it to monitor the pressure and blood flow in your heart.
Heart biopsy
If a heart tissue sample (biopsy) is taken by your doctor, the catheter will usually be inserted into the vein in your neck. To extract a small sample of tissue from your heart, a catheter with a small, jaw-like tip is used. As this catheter is being used, you can feel the strain but you certainly won't feel the actual tissue being snipped.
Balloon angioplasty with or without stenting
This technique is used in or around the heart to open up a narrowed artery. For this operation, the catheter would possibly be put in the artery in the groin. The narrowed artery in the heart will be threaded with a long, flexible catheter through your arteries. A smaller balloon catheter would then be guided through the flexible catheter and inflated to open it in the narrow field. The majority of patients, who have an angioplasty will have a stent implanted in their blocked artery. A stent, which resembles a small coil of wire mesh, protects the walls of your artery and prevents it from narrowing again after angioplasty.
Repair of heart defects
If your doctor finds blocks/holes in your heart, such as an atrial septal defect or a patent foramen ovale, both the arteries and the veins of the groin and neck will possibly have catheters implanted. To close the opening in your heart, a device is then inserted into the hole.
Balloon Valvuloplasty
This operation is performed to open up heart valves that are narrowed and diseased. The placement of the catheters depends on which valve you have a problem with. The catheter is threaded across the valve and a balloon is then blown up inside the heart valve, to make the valve open more readily. When the catheters are inserted into your body, you may feel pressure but you shouldn't feel pain from the balloon procedure itself.
Valve replacement
This operation is similar to balloon valvuloplasty, except that, to repair a leaky or narrowed heart valve, an artificial valve would be inserted in your heart. This is in addition to the expanding of the balloon in the heart valve to facilitate better placement of the new valve.
Heart ablation
In this operation, generally, you will have numerous catheters inserted in the arteries and veins of the groin or neck region. During the procedure, radiofrequency energy is guided to the part of your heart that triggers irregular heartbeats.
Risks of Cardiac Catheterization
Mostly the procedure done on heart and blood vessels has some risks, however major complications are very rare.
Some of the risks associated with Cardiac Catheterization are:
- Bruising
- Bleeding
- Heart attack
- Stroke
- Damage of the artery or the area where the catheter is inserted (access site injury
- Irregular heart rhythms
- Kidney damage
- Access site infection
- Blood clots
Cardiac Catheterization Procedure
What happens before cardiac catheterization?
- During the 24 hours prior to the test, you will be given instructions on what to eat and drink.
- Usually, for six to eight hours prior to the cath operation, you will be instructed not to eat or drink anything.
- Tell your doctor of any medications you are taking (including, over-the-counter medicines, herbs, and vitamins). Before the cath procedure, the doctor will ask you not to take the medicine. Don’t stop your medications until you are asked to.
- Talk to your doctor if you are allergic to anything, especially iodine and latex
What happens during a cardiac catheterization?
- Nurse will insert an intravenous (IV) line into a vein in your arm prior to the cath procedure so that you can get a drug (sedative) to help you relax, but during the procedure, you will be awake and able to obey instructions.
- The nurse will clean the area where the doctor will be operating and shave it. Typically this is in the region of the groin
- In order to numb the needle puncture site, a local anesthetic is generally given.
- A needle puncture is performed by the doctor through your skin and through a large blood vessel. The vessel would have a narrow straw-sized tube (called a sheath) inserted into it. A catheter (a long, thin tube) will be gently directed by the doctor into your vessel through the sheath.
- At the tip of the catheter, various instruments can be placed. This includes instruments for measuring the pressure of blood in each heart chamber and in the blood vessels, which are connected to the heart; viewing the inside of the blood vessels; taking blood samples from various areas of the heart; or extracting a sample of tissue (biopsy) from the inside of the heart.
What happens after a cardiac catheterization?
- For a few hours after the procedure, you'll go to the rehabilitation room. You have to lie flat during this time.
- To stop the bleeding, pressure will be applied to the puncture spot.
- You will be asked to keep your leg straight and should not get out of the bed
- During your healing, your heartbeat and other vital signs (pulse and blood pressure) will be tested.
- Report any swelling at the puncture site, discomfort or bleeding, or chest pain to the attending doctor/nurse.
- Before leaving the hospital you will receive written instructions on what to do at home.
Benefits of Cardiac Catheterization Procedure
Cardiac catheterization helps the doctor to diagnose and treat the problems that may cause some serious issues like a heart attack or stroke. A future heart attack or stroke can be prevented if the doctor is able to correct any problems that may be discovered during the procedure.
