What is cardiac catheterization?
In cardiac catheterization (or cath), your doctor puts a very small, flexible, hollow
tube (catheter) into a blood vessel in the groin, arm, or neck. Then he or she threads
it through the blood vessel into the aorta and into the heart. Once the catheter is
in place, several tests may be done. Your doctor can place the tip of the catheter
into various parts of the heart to measure the pressures within the heart chambers
or take blood samples to measure oxygen levels.
Your doctor can guide the catheter into the coronary arteries and inject contrast
dye to check blood flow through them. The coronary arteries are the vessels that carry
blood to the heart muscle. This is called coronary angiography.
These are some of the other procedures that may be done during or after a cardiac
Angioplasty. In this procedure, your doctor can inflate a tiny balloon at the tip of the catheter.
This presses any plaque buildup against the artery wall and improves blood flow through
Stent placement. In this procedure, your doctor expands a tiny metal mesh coil or tube at the end of
the catheter inside an artery to keep it open.
Fractional flow reserve. This is a pressure management technique that’s used in catheterization to see how
much blockage is in an artery
Intravascular ultrasound (IVUS). This test uses a computer and a transducer to send out ultrasonic sound waves to create
images of the blood vessels. By using IVUS, the doctor can see and measure the inside
of the blood vessels.
Biopsy. Your doctor may take out a small tissue sample and examine it under the microscope
During the test, you will be awake, but a small amount of sedating medicine will be
given before starting to help you be comfortable during the procedure.
Why might I need cardiac catheterization?
Your doctor may use cardiac cath to help diagnosis these heart conditions:
Atherosclerosis. This is a gradual clogging of the arteries by fatty materials and other substances
in the blood stream.
Cardiomyopathy. This is an enlargement of the heart due to thickening or weakening of the heart muscle
Congenital heart disease. Defects in one or more heart structures that occur during fetal development, such
as a ventricular septal defect (hole in the wall between the 2 lower chambers of the
heart) are called congenital heart defects. This may lead to abnormal blood flow within
Heart failure. This condition, in which the heart muscle has become too weak to pump blood well,
causes fluid buildup (congestion) in the blood vessels and lungs, and edema (swelling)
in the feet, ankles, and other parts of the body.
Heart valve disease. Malfunction of one or more of the heart valves that can affect blood flow within
Rejection after heart transplant. A biopsy is a common procedure after a heart transplant to monitor for rejection.
Rejection is a process of your body's immune system attacking the donor heart. Medicines
must be taken life-long following a transplant to prevent rejection.
You may have a cardiac cath if you have recently had one or more of these symptoms:
Chest pain (angina)
Shortness of breath
If a screening exam, such as an electrocardiogram (ECG) or stress test suggests there
may be a heart condition that needs to be explored further, your doctor may order
a cardiac cath.
Another reason for a cath procedure is to evaluate blood flow to the heart muscle
if chest pain occurs after the following:
Coronary artery bypass surgery
Coronary angioplasty. This is opening a coronary artery using a balloon or other method.
Placement of a stent. A stent is a tiny metal coil or tube placed inside an artery
to keep the artery open.
There may be other reasons for your doctor to recommend a cardiac cath.
What are the risks of cardiac catheterization?
Possible risks of cardiac cath include:
Bleeding or bruising where the catheter is put into the body (the groin, arm, neck,
Pain where the catheter is put into the body,
Blood clot or damage to the blood vessel that the catheter is put into
Infection where the catheter is put into the body
Problems with heart rhythm (usually temporary)
More serious, but rare complications include:
Less blood flow to the heart tissue (ischemia), chest pain, or heart attack
Sudden blockage of a coronary artery
A tear in the lining of an artery
Kidney damage from the dye used
If you are pregnant or think you could be, tell your doctor due to risk of injury
to the fetus from a cardiac cath. Radiation exposure during pregnancy may lead to
birth defects. Also be sure to tell your doctor if you are lactating, or breastfeeding.
There is a risk for allergic reaction to the dye used during the cardiac cath. If
you are allergic to or sensitive to medicines, contrast dye, iodine, or latex, tell
your doctor. Also, tell your doctor if you have kidney failure or other kidney problems.
For some people, having to lie still on the cardiac cath table for the length of the
procedure may cause some discomfort or pain.
There may be other risks depending on your specific medical condition. Be sure to
discuss any concerns with your doctor before the procedure.
How do I get ready for cardiac catheterization?
Your doctor will explain the procedure to you and give you a chance to ask any questions.
You will be asked to sign a consent form that gives your permission to do the test.
Read the form carefully and ask questions if anything is unclear.
Tell your doctor if you have ever had a reaction to any contrast dye; if you are allergic
to iodine; or if you are sensitive to or are allergic to any medicines, latex, tape,
and anesthetic agents (local and general).
You will need to fast (not eat or drink) for a certain period before the procedure.
Your doctor will tell you how long to fast, usually overnight.
If you are pregnant or think you could be, tell your doctor.
Tell your doctor if you have any body piercings on your chest or belly (abdomen).
Tell your doctor of all medicines (prescription and over-the-counter), vitamins, herbs,
and supplements that you are taking.
You may be asked to stop certain medicines before the procedure. Your doctor will
give you detailed instructions.
Let your doctor know if you have a history of bleeding disorders or if you are taking
any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect
blood clotting. You may need to stop some of these medicines before the procedure.
Let you doctor know if you have any kidney problems. The contrast dye used during
the cardiac cath can cause kidney damage in people who have poor kidney function.
In some cases, blood tests may be done before and after the test to be sure that your
kidneys are working properly.
Your doctor may request a blood test before the procedure to see how long it takes
your blood to clot. Other blood tests may be done as well.
Tell your doctor if you have heart valve disease.
Tell your doctor if you have a pacemaker or any other implanted cardiac devices.
You may get a sedative before the procedure to help you relax. If a sedative is used,
you will need someone to drive you home afterward.
Based on your medical condition, your doctor may request other specific preparations.
What happens during a cardiac catheterization?
A cardiac cath can be done on an outpatient basis or as part of your stay in a hospital.
Procedures may vary depending on your condition and your doctor's practices.
Generally, a cardiac cath follows this process:
You'll remove any jewelry or other objects that may interfere with the procedure.
You may wear your dentures or hearing aids if you use either of these.
Before the procedure, you should empty your bladder then change into a hospital gown.
A healthcare professional may shave the area where the catheter will be put in. The
catheter is most often put in at the groin area, but other places used are the wrist,
inside the elbow, or the neck.
A healthcare professional will start an IV (intravenous) line in your hand or arm
before the procedure to inject the dye and to give you IV fluids, if needed.
You will lie on your back on the procedure table.
You will be connected to an ECG monitor that records the electrical activity of your
heart and monitors your heart during the procedure using small electrodes that stick
to your skin. Your vital signs (heart rate, blood pressure, breathing rate, and oxygen
level) will be monitored during the procedure.
Several monitor screens in the room will show your vital signs, the images of the
catheter being moved through your body into your heart, and the structures of your
heart as the dye is injected.
You will get a sedative in your IV before the procedure to help you relax. But you
will likely be awake during the procedure.
Your pulses below the catheter insertion site will be checked and marked so that the
circulation to the limb can be checked after the procedure.
Your doctor will inject a local anesthetic (numbing medicine) into the skin where
the catheter will be put in. You may feel some stinging at the site for a few seconds
after the local anesthetic is injected.
Once the local anesthetic has taken effect, your doctor inserts a sheath, or introducer into
the blood vessel. This is a plastic tube through which the catheter is thread into
the blood vessel and advanced into the heart. If the arm is used, your doctor may
make a small incision (cut) to expose the blood vessel and put in the sheath.
Your doctor will advance the catheter through the aorta to the left side of the heart.
He or she may ask you to hold your breath, cough, or move your head a bit to get clear
views and advance the catheter. You may be able to watch this process on a computer
Once the catheter is in place, your doctor will inject contrast dye to visualize the
heart and the coronary arteries. You may feel some effects when the contrast dye is
injected into the catheter. These effects may include a flushing sensation, a salty
or metallic taste in the mouth, nausea, or a brief headache. These effects usually
last for only a few moments.
Tell the doctor if you feel any breathing difficulties, sweating, numbness, nausea
or vomiting, chills, itching, or heart palpitations.
After the contrast dye is injected, a series of rapid X-ray images of the heart and
coronary arteries will be made. You may be asked to take a deep breath and hold it
for a few seconds during this time. It’s important to be very still as the X-rays
Once the procedure is done, your doctor will remove the catheter and close the insertion
site. He or she may close it using either collagen to seal the opening in the artery,
sutures, a clip to bind the artery together, or by holding pressure over the area
to keep the blood vessel from bleeding. Your doctor will decide which method is best
If a closure device is used, a sterile dressing will be put over the site. If manual
pressure is used, the doctor (or an assistant) will hold pressure on the site so that
a clot will form. Once the bleeding has stopped, a very tight bandage will be placed
on the site.
The staff will help you slide from the table onto a stretcher so that you can be taken
to the recovery area. Note: If the catheter was placed in your groin, you will not
be allowed to bend your leg for several hours. If the insertion site was in your arm,
your arm will be elevated on pillows and kept straight by placing it in an arm guard
(a plastic arm board designed to immobilize the elbow joint). In addition, a tight
plastic band may be put around your arm near the insertion site. The band will be
loosened over time and removed before you go home.
What happens after cardiac catheterization?
In the hospital
After the cardiac cath, you may be taken to a recovery room or returned to your hospital
room. You will stay flat in bed for several hours. A nurse will monitor your vital
signs, the insertion site, and circulation/sensation in the affected leg or arm.
Let your nurse know right away if you feel any chest pain or tightness, or any other
pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
Bedrest may vary from 4 to 6 hours. If your doctor placed a closure device, your bedrest
may be shorter.
In some cases, the sheath or introducer may be left in the insertion site. If so,
you will be on bedrest until your doctor or another team member removes the sheath.
After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate often because of the effects of the contrast dye
and increased fluids. You will need to use a bedpan or urinal while on bedrest so
you don't bend the affected leg or arm.
After the period of bed rest, you may get out of bed. The nurse will help you the
first time you get up, and may check your blood pressure while you are lying in bed,
sitting, and standing. You should move slowly when getting up from the bed to avoid
any dizziness from the long period of bedrest.
You may be given pain medicine for pain or discomfort related to the insertion site
or having to lie flat and still for a prolonged period.
Drink plenty of water and other fluids to help flush the contrast dye from your body.
You may go back to your usual diet after the procedure, unless your doctor tells you
After the recovery period, you may be discharged home unless your doctor decides otherwise.
In many cases, you may spend the night in the hospital for careful observation. If
the cardiac cath was done on an outpatient basis and a sedative was used, you must
have another person drive you home.
Once at home, you should check the insertion site for bleeding, unusual pain, swelling,
and abnormal discoloration or temperature change. A small bruise is normal. If you
notice a constant or large amount of blood at the site that cannot be contained with
a small dressing, contact your doctor.
If your doctor used a closure device at your insertion site, you will be given instructions
on how to take care of the site. There may be a small knot, or lump, under the skin
at the site. This is normal. The knot should go away over a few weeks.
It will be important to keep the insertion site clean and dry. Your doctor will give
you specific bathing instructions. In general, don't soak the access site in water
(no bathtubs, hot tubs, or swimming) until the skin is healed at the site.
Your doctor may advise you not to participate in any strenuous activities for a few
days after the procedure. He or she will tell you when it's OK to return to work and
resume normal activities.
Contact your doctor if you have any of the following:
Fever or chills
Increased pain, redness, swelling, or bleeding or other drainage from the insertion
Coolness, numbness or tingling, or other changes in the affected arm or leg
Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, or fainting
Your doctor may give you other instructions after the procedure, depending on your
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure