Cardiac Catheterization: Everything You Need to Know About This Common Heart Procedure
Key takeaways:
A cardiac catheterization — or heart cath — is a common procedure that helps diagnose and treat heart problems. This includes coronary artery disease, heart failure, abnormal heart rhythms, and valve problems.
The procedure is done by passing catheters through blood vessels to the heart. It’s generally quick, lasting 1 hour or less. Many people can go home on the same day.
A heart cath provides information about your heart health. It can show how well the heart muscle is pumping and provide information about the health of different heart structures. It can sometimes treat heart conditions, like heart attacks, without surgery.
More than 1 million cardiac catheterizations are done annually in the U.S. It’s one of the most trusted tests when it comes to diagnosing and treating heart problems. Cardiologists (heart specialists) use this test to find blockages in the heart arteries — and open them up. They can also use it to measure heart function and evaluate how well the different parts of the heart are working.
A heart cath is performed by a cardiologist who has been specifically trained in the procedure. Many times, it can be planned ahead of time if your provider suspects you have a heart problem. Other times, it’s used in an emergency — like when someone has a heart attack. We’ll go over how a heart cath works, what the procedure looks like, and the risks you should know about.
How does cardiac catheterization work?
A heart cath takes place in the cath lab. It looks like an operating room, with a table in the center that is surrounded by special equipment. But a heart cath is different from surgery. The entire procedure is done through blood vessels, so there’s no need to cut through tissues or look at the heart directly.
Here is what to expect during the procedure:
First, a provider will place an IV (intravenous) line so that you can get medications before and during the procedure.
Your provider will likely give you some medications to make you sleepy.
The cardiologist will use an ultrasound to look at your blood vessels. This will help them decide whether to use a blood vessel in the wrist or the top part of the leg.
After they choose the best blood vessel, they’ll inject numbing medication into the skin in that area. This prevents any pain when they insert the catheter into the blood vessel.
After you’re numb, they’ll insert a needle into the vessel. This helps guide the catheter inside of the vessel. Once the catheter is inside the blood vessel, they remove the needle.
Then, they thread a small catheter through the blood vessel and into the heart. This isn’t painful.
When the catheter is inside the heart and big blood vessels, your provider can use it to take pressure measurements or inject dye for pictures.
A special X-ray machine helps keep track of the catheter at different times throughout the procedure.
Sometimes, the cardiologist can use a special catheter to place a stent or even a heart valve in the heart. (We’ll explain more about what a heart cath can treat.)
At the end of the procedure, they’ll take out the catheter and put a small bandage over the vessel.
Which conditions is a cardiac catheterization used for?
A heart cath can gather information about the heart and diagnose different heart conditions. It can also treat some of those conditions.
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Conditions cardiac catheterization can diagnose
Cardiologists can see and measure things in the heart during a cath procedure, including:
How much oxygen is in the blood in different parts of the heart
The shape and size of the heart chambers
How much pressure is in the different heart chambers
How blood flows through the heart and across the heart valves
How blood flows through the coronary arteries (the blood vessels that supply oxygen to the heart muscle)
Your provider can use these measurements to diagnose:
Coronary artery disease (CAD): CAD is a blockage of the coronary arteries. This is a condition that leads to heart attacks.
Heart failure: Heart failure occurs when the heart muscle is weak and doesn’t squeeze as well as it should.
Heart valve problems: Valves in the heart separate the four chambers and help keep blood flow moving forward. Valves can become leaky or stiff, which prevents normal blood flow through the heart.
Pulmonary hypertension: This condition happens when the pressure in the lung arteries is abnormally high. It can affect the way blood moves through the lungs as well as the heart.
Congenital heart disease: Some people are born with heart abnormalities. A cardiologist can directly visualize these defects and sometimes even fix them with a cath.
Conditions cardiac catheterization can treat
Many of the above conditions can also be treated during a cardiac cath:
CAD: A cath can open blockages in the coronary arteries. To fix a blockage, a cardiologist places a stent (metal tube) inside the artery to keep the blood vessel open and improve blood flow.
Valve disease: Sometimes, a cardiologist can replace or fix a heart valve with a cath instead of open-heart surgery.
Abnormal heart rhythms (arrhythmias): Many arrhythmias — like atrial fibrillation — can be traced to areas of abnormal heart tissue. A cath can get rid of them in an ablation procedure.
How do you prepare for cardiac catheterization?
Now that you know what to expect during your procedure, let’s go through tips to help you before and afterward.
Before the procedure
Ask your provider if you need to take a break from any medications, especially if you take blood thinners or diabetes medications. It’s often OK to take other medications, like blood pressure meds, on the day of the procedure.
Your provider may want to check some blood tests, either the same day or a few days before your procedure.
Avoid eating and drinking at least a few hours before your procedure. Your provider will give you specific instructions for timing. But, if your cath is an emergency, it won’t be delayed because of eating.
Pack an overnight bag in case you need to stay the night after your procedure.
Plan ahead to have a ride home, since you’ll be sleepy after the procedure.
After the procedure
If the cardiologist does the procedure through the blood vessels in your leg, you’ll need to lie flat for a few hours.
The care team will put a special bandage over the area where they inserted the catheter. This will help prevent bleeding and infection.
It’s very important that you start any new medications right away. Have a plan for picking up your new medication before you leave the hospital.
After your procedure, plan to take it easy for a few days. Avoid heavy lifting or strenuous activity for 2 to 5 days.
Don’t submerge the cath site in water for several days after the procedure.
Some people have a small bruise at the cath site for a short time. Call your provider if you have new bleeding, swelling, or pain at the site.
Call your provider and seek care if you develop chest pain that does not go away after the procedure. This could be a sign of a new or worsening blockage.
What are the risks of cardiac catheterization?
With new techniques and improved equipment, the risks of a cardiac cath are lower than ever before. In fact, less than 1% of people have a complication from a cardiac cath. Still, there are some risks, including:
Mild pain: You may experience discomfort from lying in the same place for an extended period of time.
Bruising or bleeding: When the catheter is removed, there is a risk of bleeding from the catheter site. Serious bleeding is rare and can usually be stopped by holding pressure at the site.
Infection: To prevent infection, the cath lab is disinfected between each case, and the care team uses sterile equipment and techniques. But infection is a risk anytime something is inserted into the skin.
Kidney problems: The kidneys filter the dye that is used in the procedure. Too much dye can affect how the kidneys work in people with underlying kidney problems.
Blood vessel damage: In rare cases, there can be damage to the blood vessels during the procedure.
Stroke: When catheters pass through the blood vessels, small clots of plaques can get dislodged and travel to the brain. This is rare and only happens in less than 1% of caths.
Heart attacks: Although a cath can help open blood vessels, sometimes other vessels become blocked in the process. Similar to a stroke, this can happen when the catheter dislodges a plaque.
Abnormal heart rhythms: Sometimes the heart muscle gets irritated from the catheters. These abnormal rhythms typically go away on their own or are easily treated.
Like any procedure, there’s a risk that some of the above complications can lead to death. But rest assured that this is very rare when it comes to heart caths. And these rare cases are usually because someone has a life-threatening condition before the procedure.
Common questions about cardiac catheterizations
An angiogram refers to the portion of the procedure when the cardiologist injects dye into the blood vessels. This may or may not be followed by an angioplasty — the part when the provider unblocks or repairs the blood vessel.
Usually, you don’t need general anesthesia for a cath, so you will not be completely asleep. But you will get sedatives — medications to help you relax and feel a little sleepy.
The medication to numb you can sting, but this will go away after a few seconds. The cath itself usually is not painful, although lying still and flat can be uncomfortable.
Your cardiologist uses a special X-ray to see how much blockage is in the arteries. If there’s an area that is particularly narrow, they may insert a stent, depending on where it is.
At the end of the procedure, the cardiologist removes the catheters they used for the procedure. If you need a stent, it will stay in your heart artery. Devices to fix valves or abnormal heart structures will also stay in your heart.
You can usually go home a few hours after a scheduled cath. You might need to stay in the hospital if you had an emergency cath, if you’re sick, or if you had a complex procedure.
This depends on why you had a cath. If you didn’t need any intervention during the cath, you may be able to follow up with your primary care provider. If you have something treated, you’ll probably follow up with a cardiologist in 2 to 4 weeks.
If you have a stent or a device put in, you’ll likely take antiplatelet medications for several months. This prevents blood from clotting around the device, so it’s very important that you don’t miss even one dose. These are different from other blood thinners, like warfarin. So ask your provider before stopping any other medications.
The bottom line
Cardiac catheterization can diagnose and treat many heart problems, even those that used to require surgery. Every procedure has risks, but a heart cath is generally safe. To prevent complications after a cath, the most important thing is to take your medications. Even after an intervention like a stent, you can usually return to your normal activities in about 1 week.
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References
Dukkipati, S. D., et al. (2004). Characteristics of cerebrovascular accidents after percutaneous coronary interventions. Journal of the American College of Cardiology.
Mozaffarian, D., et al. (2016). Heart disease and stroke statistics-2016 update: A report from the American Heart Association. Circulation.
Tavakol, M., et al. (2012). Risks and complications of coronary angiography: A comprehensive review. Global Journal of Health Science.
