Cardiac Catheterization

Cardiac catheterization is an interventional procedure that is used to obtain images of your blood vessels and heart. It can also lead to angioplasty and other interventional treatments in the same setting. Cardiac catheterization can be done to see if a patient has:

A problem with the valves inside the heart.
A problem within the chambers of the heart or the main blood vessels (how they are formed or how they are working).
An abnormal opening between chambers of the heart.
Coronary artery disease (the most common reason for the test). This is the build-up of fatty material (plaque) inside the coronary arteries, which supply blood to the heart muscle. As the plaque becomes larger; it can block the flow of blood to the heart muscle.

Right Heart Catheterization

Your doctor may recommend an interventional procedure called right heart catheterization. It may be done to see if you have:

A problem with the valves inside the heart.
An abnormal opening between chambers in the heart.
Increased pressures in the arteries between the right side of your heart and your lungs (pulmonary hypertension).

It can also be used to obtain samples of your heart muscle (myocardial biopsy) to aid in diagnosing problems which affect the heart's ability to pump blood.

During the Procedure:
You will be taken on your bed to the cardiac catheterization laboratory (cath lab). There you will be assisted onto a padded x-ray table and positioned for the procedure. The area where the catheters will be placed will be shaved and scrubbed with a special soap, and draped with a sterile cover. EKG patches will be put on your chest so that your heartbeat can be monitored, and a clip will be placed on your finger to measure your oxygen level.

A long, thin tube called a catheter is put into one of the large veins in your body and threaded into the right side of the heart. The doctor can measure pressures in the right atrium (upper chamber), right ventricle (lower chamber), and pulmonary artery (the blood vessel leading to the lungs). Blood samples may be taken through the catheter for testing. Your doctor may also give you intravenous medication or ask you to perform simple exercises using light weights as part of the test. Although highly specialized, this test is performed routinely and is not painful.

Your blood pressure will also be taken frequently by the nurse.

During the test:

The area where the catheters will be placed will be numbed by the doctor with a local anesthetic. You will feel a sting as the anesthetic goes in, and pressure at the site as the doctor inserts the sheath. You should tell your doctor or nurse if you feel pain after the numbing medicine is in. This will help your doctor find the right amount of numbing medicine for you.
Using x-ray as a guide, the doctor will position the catheter in the right side of your heart. Pressures in the heart will be recorded, and blood samples may be obtained through the catheter for testing.
While the catheter is being inserted into the heart you may feel palpitations or "skipping" of your heart. The palpitations are caused by the tip of the catheter "tickling" the inside of the heart, and are very common during this procedure.
When pressures are being measured the doctor may ask you to hold your breath for a moment to obtain a better recording of the pressures.
Medications may be given through your IV line, or you may be asked to perform simple exercises during the procedure. This helps your doctor make a diagnosis and decide the best treatment for you.

Left Heart Catheterization

In the cath lab, you will be helped onto a padded x-ray table. The nurses, technicians, and doctors will be wearing caps and masks; the doctors will also wear gowns and gloves. EKG patches will be put on your chest so that your heartbeat can be watched. Here is a brief description of what will happen:

The area where the catheters are to be placed will be shaved and washed.
The doctor will numb this area with a local anesthetic, just like the one used by dentists.
Through a small incision or puncture, the catheter will be put in the artery or vein and threaded to your heart. You may be able to sense the passage of the catheter; but there is usually no pain.
Pressure readings, blood samples, and pictures of your coronary arteries will be taken. When contrast (dye) is injected into your heart, you will feel a hot flushing sensation (hot flash) through your body. This is normal and will last only a few seconds.
You may be asked to breathe deeply, hold your breath, or cough hard. It's important that you follow these requests.
The dye will cause your kidneys to make more urine, so be sure to ask for a bedpan or urinal if you need one. If you have any itching, chills, chest pain, or trouble breathing during the test, tell the doctor right away.
If an angioplasty is to be done, it would be at this point. Your doctor will tell you as each step is done.
When the test is over; the catheter will be removed. If the catheter site is in your groin, firm pressure will be applied over the site for about 15 to 20 minutes. If the site is in your arm, firm pressure will be applied for 15 to 20 minutes or a few stitches will close the incision. A bandage will then be applied to the site.

After Your Test

You will be taken to an observation area or to your hospital room on a cart. You'll need to stay in bed for a specified number of hours determined by your physician with your leg or arm remaining motionless.

Medical staff will:

Frequently check your blood pressure, pulse, and catheter site often.
Ask frequently about how you feel and if you need any assitance.
Give you medication for any discomfort.
Give you fluids through your IV line after the test.
Help you get out of bed for the first time.
Answer questions and review discharge instructions before you go home.
Discuss the results of your test with you as well as plans for the future.
Give you follow-up instructions.
You will be told how to apply pressure over your groin dressing if you have the urge to cough or sneeze or need to use the bedpan.
You will be asked to drink plenty of liquids to help flush the dye out of your system.
If you feel numbness, tingling, warmth, or burning in your leg or arm, let your nurse know right away.
If you see or feel any bleeding from the incision, apply pressure to the site and immediately call your nurse.

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