Cardiac Catheterization

(Coronary Angiography; Coronary Arteriography; Coronary Angiogram)

Click here to view an animated version of this procedure.

Definition

Cardiac catheterization is a test that uses a catheter (tube) and x-ray machine to assess the heart and its blood supply.

Reasons for Procedure

It is used to find the cause of symptoms, like chest pain, that could mean heart problems.

Cardiac catheterization helps doctors to:

Identify narrowed or clogged arteries of the heart
Measure blood pressure within the heart
Evaluate how well the heart valves and chambers function
Check heart defects
Evaluate an enlarged heart
Decide on an appropriate treatment

Possible Complications

If you are planning to have a cardiac catheterization, your doctor will review a list of possible complications, which may include:

Bleeding at the point of the catheter insertion
Damage to arteries
Heart attack or arrhythmia (abnormal heart beats)
Allergic reaction to x-ray dye
Blood clot formation
Infection

Some factors that may increase the risk of complications include:

Allergies to medicines or x-ray dye
Obesity
Smoking
Bleeding disorder
Age: 60 or older
Recent pneumonia
Recent heart attack
Diabetes
Kidney disease

What to Expect

Prior to Procedure

Your doctor may order:

Blood and urine tests
Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
Chest x-ray
Stress test

Talk to your doctor about your medicines. You may be asked to stop taking some medicines before the procedure, like:

Anti-inflammatory drugs (eg, ibuprofen)
Blood thinners, like or warfarin (Coumadin)
clopidogrel (Plavix)
Metformin (Glucophage) or glyburide and metformin (Glucovance)

Leading up to your procedure:

Arrange for a ride to and from the procedure.
The night before, do not eat or drink anything after midnight.

Anesthesia

Local anesthesia will be used at the insertion site. A mild sedative may be given one hour before or through IV during the procedure. This will help you relax.

Description of the Procedure

During the procedure, you will receive IV fluids and medicines. An EKG will be monitoring your heart's activity.

You will be awake but sedated so that you will be more relaxed. Your doctor will ask you to do basic functions such as coughing, breathing out, and holding your breath. If you feel any chest pain, dizziness, nausea, tingling, or other discomfort, tell your doctor.

The area of the groin or arm where the catheter will be inserted is shaved, cleaned, and numbed. A needle will be inserted into a blood vessel. A wire will be passed through the needle and into the blood vessel. The wire will then be guided through until it reaches your heart. A soft, flexible catheter tube will then be slipped over the wire and threaded up to your heart.

The doctor will be taking x-ray pictures during the procedure to know where the wire and catheter are. Dye will be injected into the arteries of the heart. This will make the arteries and heart show up on the x-ray images. You may feel warm during the dye injection.

Insertion of Catheter with Guide Wire

Once in place, the catheter can be used to take measurements. Blood pressure can be taken within the heart's different chambers. Blood samples may also be taken. Multiple x-ray images will be taken to look for any disease in the arteries. An aortogram may also be done at this time. This step will give a clear image of the aorta (large artery leaving the heart). Once all the tests and images are complete, the catheter will be removed.

Sometimes, the doctor will perform balloon angioplasty and stenting if he finds an area in your arteries that is narrow or clogged. These are procedures that help to open narrowed arteries.

Finally, a bandage will be placed over the groin or arm area.

How Long Will It Take?

The procedure takes about 1-2 hours. Preparation before the test will take another 1-2 hours.

How Much Will It Hurt?

Although the procedure is generally not painful, it can cause some discomfort, including:

Burning sensation (when skin at catheter insertion site is anesthetized)
Pressure when catheter is inserted or replaced with other catheters
A flushing feeling or nausea when the dye is injected
Headache
Heart palpitations

Pain medicine will be given when needed.

Average Hospital Stay

0-1 days

Postoperative Care

At the Care Center

EKG and blood studies may be done.
You will likely need to lie still and flat on your back for a period of time. A pressure dressing may be placed over the area where the catheter was inserted to help prevent bleeding. It is important to follow the nurse's directions.

At Home

When you return home, do the following to help ensure a smooth recovery:

Do not drive for 72 hours.
Do not lift heavy objects or engage in strenuous exercise or sexual activity for at least 5-7 days.
Change the dressing around the incision area as instructed.
Your doctor will explain to you which medicines you can take and which ones to avoid. Take medicines as instructed.
Ice may help decrease discomfort at the insertion site. You may apply the ice for 15-20 minutes each hour, for the first few days.
To lower your risk for further complications of heart disease, you can make lifestyle changes. These include eating a healthier diet, exercising regularly, and managing stress.
Be sure to follow your doctor’s instructions.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Extreme sweating, nausea, or vomiting
Change in sensation to affected leg, including numbness, feeling cold, or change in color
Redness, swelling, increasing pain, excessive bleeding, or discharge at point of catheter insertion
Cough, shortness of breath, or difficulty breathing
Extreme pain
Chest pain
Drooping facial muscles
Changes in vision or speech
Difficulty walking or using your limbs

In case of an emergency, CALL 911.

RESOURCES:

American Heart Association
http://www.americanheart.org/

Heartinfo.org
http://www.heartinfo.org/

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca/

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com/

REFERENCES:

Cardiac Catheterization: A Patient Guide. Center for Cardiovascular Education website. Available at: http://www.heartinfo.org/ . Accessed June 10, 2008.

Medical encyclopedia: cardiac catheterization. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003419.htm . Accessed June 10, 2008.

Last reviewed November 2009 by Craig Clark, DO, FACC, FAHA, FASE
Last Updated: 2/9/2010