catheterization is a test
to check your heart. This test uses a thin flexible tube called a catheter that is inserted into the heart through blood vessels. 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. PCI includes:
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?
Health Tools help you make wise health decisions or take action to improve your health.
Cardiac catheterization is done to:
A coronary angiogram is done to:
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.
This test is performed in the cardiac catheterization laboratory ("cath lab") by a
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.
device called a
pulse oximeter that measures oxygen levels in your
blood and monitors your pulse may be clipped to your finger.
intravenous (IV) needle will be inserted into a vein in one of your
arms to give you fluids or medicine during the procedure. Through the IV line you will receive a
medicine to help you relax (sedative). 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.
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. There are a few options for where the catheter is inserted. If you are having a cardiac catheterization to check the right side of your heart, the catheter is inserted into a vein in your neck or groin. If the test will check the left side of your heart or your coronary arteries, the catheter is inserted into an artery in your groin or arm.
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
During an angiogram, a small amount of dye (contrast material) will be
injected through the catheter into 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 you may be asked to take a deep breath and hold it.
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 the area where the catheter is inserted because you may contaminate the sterile areas and increase the risk of
Your doctor may allow you to watch the video monitor so
you can see the images of your heart and coronary arteries.
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
You may be asked to breathe into a special mouthpiece
to help measure the flow of oxygen in your circulating blood.
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. You may be given medicine to relieve pain.
If the catheter was inserted in
your groin, you may have to lie in bed with your leg extended for several hours
(such as 1 to 4 hours), depending on the exact procedure used and your medical
condition. After that, you can move about freely. If the catheter was inserted in your arm, you can sit up and get out of bed right away. But you will need to keep your arm still for several hours.
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.
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. Do not do strenuous exercise and do not lift anything heavy until your doctor says it is okay. This may be for a day or two.
If you are breast-feeding and had an angiogram in which dye was injected into your body, do not breast-feed your baby for 2 days after this test. During this time, you can give your baby breast milk you stored before the test, or you can give formula. Discard the breast milk you pump for 2 days after the test.
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
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.
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
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
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
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
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, in most cases, 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:
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.
Reasons you may not be able to
have the test or why the results may not be helpful include:
Other Works Consulted
Balaji NR, Shah PB (2012). Radial artery catheterization. Circulation, 124(16): e407–e408.
Bangalore S, Bhatt DL (2011). Right heart catheterization, coronary angiography, and percutaneous coronary intervention. Circulation, 124(17): e428–e433.
Bashore TM, et al. (2012). 2012 ACCF/SCAI Expert consensus document on cardiac catheterization laboratory standards update. Journal of the American College of Cardiology, 59(24): 2221–2305.
Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
Glowny MG, Resnic FS (2012). What to expect during cardiac catheterization. Circulation, 125(7): e363–e364.
May 24, 2013
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
& George Philippides, MD - Cardiology
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