Cardiac catheterization is a test to check your heart. This test can include a coronary angiogram, which checks the coronary arteries.
A cardiac catheterization can check blood flow in the coronary arteries, check blood flow and blood pressure in the chambers of the heart, find out how well the heart valves work, and check for defects in the way the wall of the heart moves. In children, this test is used to check for heart problems that have been present since birth (congenital heart defect).
A coronary angiogram is used to find out if you have disease in your coronary arteries (atherosclerosis). If you have atherosclerosis, this test can pinpoint the size and location of fat and calcium deposits (plaque) that are narrowing your coronary arteries.
Percutaneous coronary intervention (PCI) is similar to coronary angiogram, but it is used to open up a narrowed coronary artery with special tools. The two common types of PCI are:
For help deciding about having this test for coronary artery disease, see Heart Disease: Should I Have an Angiogram?
Other tests can be done during cardiac catheterization to find heart problems. An X-ray test called a ventriculogram measures how well blood flows through the left side of your heart. The test looks at the movements of the wall of the left ventricle and the heart valves.
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Why It Is Done
Cardiac catheterization and coronary artery disease
Cardiac catheterization is done to:
Other reasons for having a cardiac catheterization
Cardiac catheterization is also done to:
How To Prepare
Tell your doctor if you:
Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).
Arrange for someone to take you home after the test. You may not have to stay in the hospital overnight.
Do not eat or drink (except for a small amount of water) for 6 to 12 hours before the test.
Take your medicines as directed by your doctor. You might stop taking certain medicines before your test and start taking them again after your test.
Before the test, remove any necklaces, bracelets, rings, or other jewelry. You should also remove nail polish from your fingernails and toenails.
Be sure to empty your bladder completely just before the test.
How It Is Done
Before the test
You will be asked to lie on a flat table under a large X-ray machine. Several small metal leads (electrodes) will be attached to your legs and arms with a special paste or gel. These leads are connected to an electrocardiogram (EKG, ECG) machine that continuously records the electrical activity of your heart during the test.
A device called a pulse oximeter that measures oxygen levels in your blood and monitors your pulse may be clipped to your finger.
An intravenous (IV) needle will be inserted into a vein in one of your arms to give you fluids or medicine during the procedure. You will receive a medicine to help you relax (sedative) through the IV line. You may be awake during the procedure. But even if you are awake, the sedative may make you so sleepy that you may not remember much about the procedure.
During the test
The thin flexible tube (cardiac catheter) is usually inserted in your groin (femoral artery). Other sites that may be used are the crease of your elbow (brachial artery), your wrist (radial artery), or your neck. The catheter insertion area will be shaved and cleansed with an antiseptic solution before the test. Sterile towels will be draped over you, except for the area over the catheter insertion site.
A local anesthetic will be injected into the skin at the insertion site. A blood vessel is punctured by a special needle or exposed by making a small cut in the skin so that the catheter can be passed into the blood vessel. The catheter is slowly advanced through the blood vessel into your body. The catheter tip is moved into various positions in the heart's vessels and chambers while the doctor watches its progress on the imaging screen. Pressures within the heart chambers can be measured. Blood and heart tissue samples may also be removed through the catheter, if necessary.
You may be asked to hold your breath or move your head slightly to provide clear views of the heart and its blood vessels.
A small amount of dye (contrast material) will be injected through the catheter into your heart chamber or one of your coronary arteries. Pictures show the arteries as the dye moves through them. You may be asked to cough to help clear the contrast material out of your heart or breathe deeply and hold your breath.
It is important to lie as still as possible, since motion can make the images blurry or hard to interpret. A health professional will help you stay comfortable and will help you resist the urge to move around. Be careful not to touch the sheets or reach for your groin area because you may contaminate the sterile areas and increase the risk of infection.
Your doctor may allow you to watch the video monitor so you can see the images of your heart and coronary arteries.
You may be given nitroglycerin to help open up your coronary arteries. Or you may be given an injection of a medicine that causes the coronary arteries to narrow. You may be asked to breathe into a special mouthpiece to help measure the flow of oxygen in your circulating blood.
After the test
The catheter will be removed from the insertion site. To prevent bleeding, the site may need to be closed using pressure, stitches, or a special seal. For example, if the catheter was inserted in your wrist or groin, firm pressure will be applied to the area for about 10 minutes to stop the bleeding. Then a pressure dressing will be placed over the area. If the catheter was inserted in your elbow, a few stitches will be used to close the wound.
The test takes about 30 minutes. But you need time to get ready for it and time to recover. It can take up to 6 hours total. The length of the test is not an indication of the seriousness of your condition. After the test, you will be taken to an observation room and a health professional will periodically monitor your heart rate, blood pressure, and temperature and check for signs of bleeding at the insertion site. The pulse, color, and temperature of the arm or leg in which the catheter was inserted will also be checked periodically.
If the catheter was inserted in your leg, you may have to lie in bed with your leg extended for several hours (such as 4 to 12 hours), depending on the exact procedure used and your medical condition. After that, you can move about freely, but you should avoid strenuous activity for at least 1 to 2 days. A child who has had cardiac catheterization may need to be held by a parent for several hours after the test to prevent the child from moving his or her leg.
You should drink plenty of liquids for several hours after the test. This will prevent dehydration and help flush the contrast material out of your body.
Depending on the results of the test, you may be sent home either after a short observation period (such as 6 hours) or on the next day. If any stitches were placed in your arm, they may be removed in 5 to 7 days.
If you are breast-feeding, use formula for 1 to 2 days after the test.
How It Feels
You will feel a sharp sting when the local anesthetic is injected to numb your skin over the catheter insertion site. When the catheter is inserted, you may feel a brief, sharp pain. The movement of the catheter through your blood vessel may cause a feeling of pressure, but it is not usually considered painful. People commonly experience skipped heartbeats for a few seconds when the catheter touches the walls of the heart.
If a dye (contrast material) is injected, you may feel warm and flushed and have a metallic taste in your mouth. Some people feel sick to their stomach or have a headache. You also may feel nauseous or lightheaded, have chest pain, irregular heartbeats, an urge to cough, mild itching, or hives from the contrast material. If you have any of these symptoms, tell your doctor how you are feeling.
The temperature in the catheterization lab is kept cool so that the equipment does not overheat. For many people, the hardest part of the test is having to lie still for an hour or more on the hard table. You may feel some stiffness or cramping.
You may experience some soreness and bruising at the insertion site. This is temporary and should disappear within 2 weeks. It is normal for the site to feel tender for about a week. Call your doctor immediately if:
Complications related to the catheter include:
Serious complications are rare, but they can be life-threatening. Serious complications are more likely to occur in people who are critically ill or elderly. These complications may include:
Radiation risk. There is always a slight risk of damage to cells or tissues from being exposed to any radiation, including the low levels of X-ray used for this test. But the risk of damage from the X-rays is usually very low compared with the potential benefits of the test.
Cardiac catheterization is a test to check your heart and coronary arteries.
Test results will be reviewed by a cardiologist and will be available after the procedure. Your doctor will be able to talk to you about some of the results immediately after the test.
Results will include whether:1
Many conditions can affect the results of a cardiac catheterization. Your doctor will discuss any significant abnormal results with you in relation to your symptoms and past health.
What Affects the Test
Reasons you may not be able to have the test or why the results may not be helpful include:
What To Think About
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