Cardiac Catheterization
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Definition
Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin or the arm.
Alternative Names
Catheterization - cardiac; Heart catheterization
How the test is performed
You will be given medicine before the test to help you relax. The health care provider cleans a site on your arm, neck, or groin and inserts a line into one of your blood vessels. This is called an intravenous (IV) line.
A thin tube called a catheter is placed through the IV and into your blood vessel in the leg or neck. The health care provider is carefully moved up into the heart using live x-rays as a guide. Then the doctor can:
Collect blood samples from the heart
Measure pressure and blood flow in the heart's chambers and in the large arteries around the heart
Measure the oxygen in different parts of your heart
Examine the arteries of the heart
The test may last 30 - 60 minutes. After the test, the catheter is removed. If the catheter is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding.
How to prepare for the test
If possible, you will be asked not to eat or drink for 6 - 8 hours before the test. The test takes place in a hospital and you will be asked to wear a hospital gown. Sometimes, you will need to spend the night before the test in the hospital. Otherwise, you will be admitted as an outpatient or an inpatient the morning of the procedure.
Your health care provider should explain the procedure and its risks. A witnessed, signed consent for the procedure is required.
Tell your doctor if you:
How the test will feel
The study is done by trained cardiologists with the assistance of trained technicians and nurses.
You will be awake and able to follow instructions during the test.
You may feel some discomfort or pressure where the catheter is placed. Some people have some discomfort from lying still during the test or from lying fat on your back after the procedure.
Why the test is performed
In general, this procedure is done to get information about the heart or its blood vessels or to provide treatment in certain types of heart conditions. It may also be used to determine the need for heart surgery.
Your doctor may perform cardiac catheterization to diagnose or evaluate:
The following procedures may also be done using cardiac catheterization:
Repair of certain types of heart defects
Repair of a stuck (stenotic) heart valve
Opening of blocked arteries or grafts in the heart
References
In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 20 Cardiac catheterization
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.
Review Date: 5/23/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Catheterization - cardiac; Heart catheterization
What the risks are
Cardiac catheterization carries a slightly higher risk than other heart tests, but is very safe when performed by an experienced team.
Generally, the risks include the following:
Possible complications of any type of catheterization include the following:
- Bleeding, infection, and pain at the IV site
- Damage to the blood vessels
- Blood clots
- Kidney damage due to the contrast dye (particularly in patients with diabetes)
References
In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 20 Cardiac catheterization
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.
Review Date: 5/23/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Catheterization - cardiac; Heart catheterization
What abnormal results mean
The procedure can identify heart defects or disease, such as:
Valve problems
Heart enlargement
The procedure also may be performed for the following:
References
In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 20 Cardiac catheterization
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.
Review Date: 5/23/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Dr. Robert J. Applegate describes the radial approach to cardiac catheterization and its benefit to patients.
From your wrist to your heart: a new cardiac catheterization option
Millions of cardiac catheterization procedures have been performed since the technique was first used to detect blockages in the heart in the 1950s. At the time, the idea of threading a thin tube through a patient’s artery toward the heart, using the body’s circulatory system to clear blockages, deliver medication, and position stents was revolutionary.
For decades, the most commonly used entry point to the circulatory system for catheter-based procedures has been the femoral artery in the groin, but Wake Forest Baptist Medical Center and about 10 percent of medical centers throughout the country have switched to a new access point, the radial artery, located in the wrist. This innovative cardiac catheterization technique reduces recovery time and bleeding and may provide a less stressful option for patients who need the procedure.
What is cardiac catheterization?
Cardiac catheterization is a method doctors use to perform many tests and procedures to diagnose and treat coronary artery disease. The method involves threading a long, thin tube (called a catheter) through an artery (traditionally the femoral artery in the groin) into the heart.
Depending on your condition, different things may happen during a cardiac cath. For example, you may have an angioplasty in which a balloon-tipped catheter is inserted through an artery and advanced through the circulatory system until it reaches the blocked artery of the heart. There the balloon is inflated, flattening the plaque against the artery wall, allowing blood to flow more easily. You may also have a stent placed in the artery. A stent is a mesh-like metal device that acts as a scaffold inside a vessel.
Interventional cardiologists are performing more and more specialized catheter-based procedures to treat a wider variety of heart and vascular diseases.
Why are physicians switching from the femoral artery to the radial artery?
The femoral artery has been used more frequently because its large size can accommodate balloons, stents and almost any size catheter. However, the femoral artery can be difficult to access especially in overweight individuals. Stopping bleeding once the procedure has been completed requires heavy pressure at the needle insertion site, and patients need to remain in the hospital lying quietly on their backs for as long as six hours to ensure there is no bleeding. This can be difficult and painful for some patients, particularly elderly patients and those with hip or back pain. In some cases, there can be internal bleeding that is not immediately visible.
The radial artery in the wrist is close to the skin surface, making the needle puncture more straightforward for the cardiologist and less uncomfortable for the patient. When the procedure has been completed, a band similar to a wristwatch is placed around the wrist, which supplies pressure and prevents bleeding. Most patients are able to get up almost immediately and walk. Unlike the femoral, any bleeding from the radial artery is readily apparent.
Patients who undergo this newer technique have less bruising and bleeding, fewer complications and a faster recovery overall.
Why wasn’t the radial approach used earlier?
It was used in the 1990s for some diagnostic catheterizations, but the early equipment used for balloon angioplasties and stents was too large to use in the smaller radial artery. The development of smaller, easier to manipulate, better-designed catheters and stents has now made the radial approach possible for most catheter-based procedures.
Can the wrist artery approach be used on all patients and for all procedures?
While most people needing a cardiac catheterization would be candidates for the wrist-access approach, each patient must be evaluated individually to determine the most appropriate strategy.
There are two arteries that supply blood to the hand, and it’s important that both are functioning well before undergoing a cardiac cath via the wrist. Doctors do a simple test, called an Allen test, which can be performed in the office, to determine if both arteries are functioning well. If not, the femoral approach may be the safer alternative.
Also, complicated stentings or technologically difficult procedures such as aortic valvuloplasties (heart valve repairs) are best done through the femoral artery.
Is the wrist approach safe?
Yes. Major studies have shown that the radial artery is as successful as the femoral artery approach and has lower rates of bleeding and other complications.
The challenge is the artery near the wrist is roughly half the size of its counterpart in the groin, so increased precision and state-of-the-art technology are required to perform the procedure. The radial approach is more challenging for the physician to learn, and not as many interventional cardiologists in the U.S. have been trained in the technique as in some other countries. Those who have learned the technique tend to use it for most of their patients.
All interventional cardiologists at Wake Forest Baptist Medical Center are experienced practitioners of the radial approach and have switched to the wrist as their access of first choice for appropriate patients. Nearly 1,000 of our patients have been treated using this new technique with great success.
Having this innovative technique available in addition to the traditional approach to catheterization is part of the WFBMC Heart Center’s commitment to offer the most advanced treatments to their patients.
Review Date: 5/23/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.