Test Overview
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:
Results from a coronary angiogram help determine whether treatment with
medicines, bypass surgery, or percutaneous coronary intervention
(PCI), such as
angioplasty, may be effective.
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.
Why It Is Done
Cardiac catheterization and coronary artery disease
Cardiac catheterization is done to:
- Check blood flow and blood pressure in the
chambers of the heart.
- Check blood flow in the coronary arteries
and, if you have
coronary artery disease (CAD), determine whether
surgery or another type of procedure, such as angioplasty with stenting, is
needed to open the blocked blood vessels.
Other reasons for having a cardiac catheterization
Cardiac catheterization is also done to:
- Check the pumping action of the
heart.
- Find out if a congenital heart defect is present and how
severe it is. Cardiac catheterization sometimes can also be used to help
correct the defect.
- Check blood flow through the heart after
surgery.
- Find out how well the heart valves work.
How To Prepare
Tell your doctor if you:
- Are allergic to the iodine dye used in the
contrast material or any other substance that contains
iodine.
- Are allergic to any substances that might be used during the procedure, such as latex or talc.
- Are allergic to any medicines.
- Take any medicines, vitamins, supplements, and herbal remedies. Some of these can increase your risk of bleeding. Some medicines can cause other problems during the test. Your doctor will tell you which medicines to stop before your test and which medicines you can take safely. Medicines to mention include:
- Blood-thinning medicine, such as warfarin, clopidogrel (Plavix), or aspirin.
- Erection-enhancing medicines, such as sildenafil (Viagra), tadalafil
(Cialis), or vardenafil (Levitra).
- Are or might be
pregnant.
- Have
asthma or have ever had a serious allergic reaction
(anaphylaxis) from any substance, such as the venom
from a bee sting.
- Have any bleeding problems.
- Have
kidney disease. The contrast material used during
cardiac catheterization can cause kidney damage in people who have poor kidney
function. If you have a history of kidney problems, blood tests (creatinine,
blood urea nitrogen) may be done before and after the test to
confirm that your kidneys are functioning properly.
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
This test is performed in the cardiac catheterization laboratory ("cath lab") by a
cardiologist.
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.
Call your doctor immediately if you have chest pain,
extreme shortness of breath, dizziness, trouble speaking or swallowing, or
paralysis in any part of your body during or after the
test.
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:
- Your arm or leg becomes pale, cold, painful, or
numb.
- Redness, swelling, or discharge from the catheter insertion
site develops.
- You have a fever.
Risks
Complications related to the catheter include:
- Pain, swelling, and tenderness at the catheter
insertion site.
- Irritation of the vein by the catheter (superficial
thrombophlebitis). This can usually be treated with warm
compresses.
- Bleeding at the catheter site.
- A bruise
where the catheter was inserted. This usually goes away in a few
days.
- Trouble urinating after the procedure.
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:
- Sudden closure of the coronary artery.
- Small
tear in the inner lining of the artery.
-
Allergic reaction
to the contrast material, with hives
and itching and, rarely, shortness of breath, fever, and
shock. These allergic reactions can usually be
controlled with medicines.
- Kidney damage. In rare cases, the
contrast material can damage the kidneys, possibly causing
kidney failure. People with diabetes and kidney
disease are at greatest risk for kidney damage.
- Heart attack or stroke.
- Need for more procedures or surgery for complications.
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.
Results
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
- Coronary arteries are normal or have narrowing or blockage.
- The heart's
pumping action (ejection fraction) and pressures inside the heart
chambers and blood vessels are normal.
- The heart valves
are working normally.
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:
- Extreme anxiety that causes high blood pressure and irregular
heartbeats.
- Kidney or liver failure.
- Inability to
follow directions during the procedure.
What To Think About
- This test usually is not done on people who have had
severe
allergic reactions to contrast material, poorly
controlled
heart failure, life-threatening heart rhythm problems,
or advanced
kidney disease.
- Cardiac catheterization
is not usually done during pregnancy because the radiation could damage the
developing
fetus. But in a life-threatening emergency, this
procedure may be necessary to help save a pregnant woman's life. In such cases,
the fetus is protected as much as possible from radiation exposure with a lead
apron.
Other Places To Get Help
Organizations
|
Society for Interventional Radiology
|
| 3975 Fair Ridge Drive |
| Suite 400 North |
| Fairfax, VA 22033 |
| Phone: |
1-800-488-7284
|
| Web Address: |
www.sirweb.org |
| |
|
The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies.
Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.
|
|
|
American Heart Association (AHA)
|
| 7272 Greenville Avenue |
| Dallas, TX 75231 |
| Phone: |
1-800-AHA-USA1 (1-800-242-8721) |
| Web Address: |
www.heart.org |
| |
|
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
|
|
References
Citations
-
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
|
Specialist Medical Reviewer
|
George Philippides, MD - Cardiology |
|
Last Revised
|
July 20, 2011 |