Cardiac catheterization is a procedure for diagnosing and treating cardiovascular disease.
During cardiac catheterization, a long thin tube, called a “catheter,” is inserted into an artery or vein in the groin, neck, or arm and enters the blood vessels to the heart.
With this catheter, doctors can diagnose tests as part of a heart catheterization. Some heart disease treatments, such as coronary angioplasty, are also performed with heart catheterization.
You are usually awake during heart catheterization, but you will receive medication to help you relax.
The cardiac catheterization recovery time is fast and the risk of complications is low.
How long does a heart cath take?
A cardiac cath procedure usually takes about 30 minutes (and longer if you undergo an intervention), but the preparation and recovery time add several hours.
Why is it done?
Heart catheterization is performed to determine if you have a heart condition or as part of a procedure to correct a heart condition that your doctor already knows.
If you need to have a heart catheterization test for heart conditions, your doctor may:
- Locating narrowing or blockage of blood vessels that can cause chest pain (angiography)
- Measures pressure and oxygen levels in different parts of the heart (hemodynamic assessment)
- Check the pump function of the heart (right or left ventriculogram)
- Take a sample of the heart tissue (biopsy)
- Diagnosis of present heart defects at birth (congenital heart defects)
- Search for problems in heart valves
Heart catheterization is also used as part of some procedures for the treatment of heart conditions. These procedures include the following:
- Angioplasty with or without stent. Angioplasty involves the temporary insertion and expansion of a small balloon at the blocking site to enlarge a narrowed artery.
- Angioplasty is often associated with the implantation of a small metal coil, called a “stent,” into the blocked vein to hold it open and reduce the risk of narrowing (restenosis).
- Closing holes in the heart and repairing other birth defects. Some congenital heart defects involving holes in the heart can be treated by inserting a catheter into the hole to close it, such as a plug, instead of open heart surgery.
- Narrow areas of the blood vessels, such as aortic coarctation, can be opened with a balloon. A stent is then usually placed to keep the blood vessel open.
- Repair or replacement of heart valves. With heart catheterization, doctors can sometimes repair or replace a leaking or narrowing heart valve. Sometimes doctors use catheterization to repair a leaking replacement valve.
- One approach uses an implantable clip to repair the mitral valve. In another procedure, doctors can use catheters to repair an artificial valve with a leak by inserting a device in the area of the leak to close the leak.
- Doctors can perform a procedure with a catheter to replace a valve by inserting the new valve into the catheter and leading it toward the heart.
- Valvuloplastic with balloon. This procedure can open the narrowed heart valves by inserting a balloon catheter into the portion of the narrowed heart valve and inflating it.
- Treatment of cardiac arrhythmias (ablation). Ablation is a procedure used to treat heart rhythm problems. Radio frequency energy (heat), laser or nitric oxide (extreme cold) can be applied to abnormal heart tissue through the tip of a catheter. This is done to divert electrical signals or destroy areas (excise duties) that cause cardiac arrhythmias.
- Close a part of the heart to prevent blood clots. In addition to closing the holes in the heart, heart catheterization can also be used to close the upper chamber of the heart called the left atrial heart ear. This part of the heart is sensitive to blood clots during irregular heart rhythms, such as atrial fibrillation. Closure can be an alternative to taking anticoagulants.
- Alcohol septum ablation. With heart catheterization, doctors can treat heart muscle with abnormal thickening in patients with obstructive hypertrophic cardiomyopathy by injecting alcohol into the muscle, resulting in a reduction in size.
The risks: as with most cardiovascular procedures, cardiac catheterization entails some risks. However, major complications are rare.
The risks of heart catheterization are:
- Heart attack
- Cerebrovascular accident
- Damage to the artery where the catheter is inserted, which may require extra attention (pseudoaneurysm)
- Irregular heart rhythm (arrhythmias)
- Allergic reactions to colorant or medicines
- Tearing heart or arterial tissue
- Kidney lesions
- Blood clots
If you are pregnant or plan to become pregnant, tell your doctor before continuing with cardiac catheterization.
Cardiac catheterization indications – how do you prepare yourself?
Heart catheterization is usually done in the hospital. This test requires preparation.
Before the test:
Do not eat or drink for at least 6 hours before testing or as directed by your doctor. No food or drink in the stomach can increase the risk of anesthesia complications. Ask the doctor or nurse if you need to take your medication with a small amount of water.
If you have diabetes, ask for instructions about diabetes and insulin medication. You can usually eat and drink something immediately after the test.
Your doctor will advise you to stop taking anticoagulants such as warfarin (Coumadin, Jantoven) or anti-inflammatory drugs (NSAIDs) including aspirin, ibuprofen (Advil, Motrin IB) and naproxen (Aleve).
Take all medicines and supplements with you on the test. It is better to take the original package so that your doctor knows the correct dosage that you are using.
Try to relax People with heart catheterization can feel anxious or nervous. You receive medication so that you can relax.
The test can show that you must immediately undergo a procedure such as angioplasty, or you may have a side effect of the drug you have during catheterization. If you are nervous, your heart may beat faster or irregularly and the procedure may be complicated.
Cardiac catheterization purpose – what you can expect for the procedure
After your catheterization has been checked, your blood pressure and pulse will be checked. They will ask you to use the bathroom to empty the bladder.
They will ask you to remove your dentures and you may need to remove the jewelry, especially the necklaces that could hinder the images of the heart. You wait in a pre-operation room until the moment of the procedure, it is possible that someone there can wait with you.
During the procedure
Cardiac catheterization is performed in an operating room with special X-ray and imaging equipment that normal operating rooms do not have.
Heart catheterization is usually done when you are awake, but are numb. However, certain procedures, such as ablation, repair or replacement of the valve, can be performed under general anesthesia.
An intravenous line will be inserted into your hand or arm and will be used to deliver any additional medication that you may need during the procedure. You will also be equipped with monitors (electrodes) on your chest to control the heart rate during the test.
Just before the procedure, a nurse or technician can shave the hair from where the catheter is inserted. Before you insert the catheter into the vein, you will receive an anesthetic injection to numb the area. You can feel a quick, throbbing pain before feeling numb.
After feeling the anesthetized area, the catheter will be inserted. A small cut is made, if the leg is used, to gain access to an artery. A plastic sheath is placed in the head to allow the physician to insert the catheter.
What happens next depends on the reason for heart catheterization
Here are some of the most common applications :
Coronary angiography. If you undergo this test to check the obstructions from the arteries to the heart, a dye will be injected through the catheter and X-rays will be made of the arteries of the heart. In coronary angiography, the catheter is usually placed first in the artery of the groin or wrist.
Catheterization of the right heart. This procedure checks the pressure and heart blood flow on the right. For this procedure, the catheter is inserted into the vein of the neck or groin. The catheter has special sensors to measure the pressure and blood flow of the heart.
Cardiac biopsy. If your doctor takes a sample of the heart tissue (biopsy), the catheter is usually placed in the vein of the neck. Less often it can be placed in the groin. A catheter with a small piece of jaw is used to take a smaller sample of the heart tissue. You may feel pressure when using this catheter, but you may not feel when you cut the actual tissue.
Balloon angioplasty, with or without placement of the stent. This procedure is used to open a narrow artery in or near the heart. The catheter can be inserted into the wrist or groin for this procedure.
A long, flexible catheter will be introduced through the arteries to the narrow artery. A smaller balloon catheter will then be introduced through the flexible catheter and inflated in the narrow area to open it. In many cases, your doctor also places a spiral-shaped wire mesh, called a stent, in the narrow area to keep the artery open.
Repair of heart defects. If your doctor closes a hole in your heart, such as an atrial septal defect or persistence of the foramen ovale, it is likely that catheters are inserted into the arteries and veins of the groin and neck. A device is then placed in the heart to close the hole. If a leak in the heart valve is repaired, a clip or cap can be used to stop the filtration.
Valvuloplastic with balloon. This procedure is performed to open the narrow heart valves. The placement of the catheters will depend on the problem encountered by the valve.
A catheter is inserted through the valve. A balloon is then inflated to open the valve more easily. You may feel pressure when the catheters are placed in the body, but you should not feel discomfort about the balloon itself.
Replacement of the valve. This procedure is similar to balloon fall vuloplasty, except that an artificial valve is implanted in the heart to replace a leaky or narrowed heart valve.
Cardiac ablation. In this procedure, multiple catheters are usually inserted into the arteries and veins of the groin or neck, so that radio frequency energy can be directed to the part of the heart that causes the abnormal heart rhythm.
If you are awake during the procedure, they may ask you to take a deep breath, hold your breath, cough or place your arms in different positions. The table can be tilted several times, but you have a safety belt to hold you back.
Inserting the catheter should not be painful, and you will not feel it when it moves into the body. Inform your healthcare team if you feel unwell.
After the procedure
A few hours are needed to recover from heart catheterization. Once the procedure is complete, you will be taken to a recovery room during anesthesia. It usually takes around an hour. The plastic sleeve that is inserted into the groin, neck or arm will be removed shortly after the procedure unless you continue to receive anticoagulants.
After leaving the recovery room, you go to a joint hospital or outpatient clinic. After the catheter has been removed, the doctor or nurse who has removed the sleeve will exert pressure on the insertion sites. If the groin is used, you must lie down for a few hours after the procedure to prevent severe bleeding and to heal the artery.
You can eat and drink after the procedure. The duration of your stay in the hospital depends on your illness. You can go home on the same day of catheterization or stay in the clinic or stay longer if you perform extra operations such as angioplasty or stent.
If you need a heart catheterization test, the doctor must explain the results.