What is cardiac catheterization?
In cardiac catheterization (often called cardiac cath), a very small, flexible, hollow tube (called a catheter) is put into a blood vessel in the groin, arm, or neck and advanced through the vessel into the aorta and into the heart. Once the catheter is in place, several tests may be done. The tip of the catheter can be placed into various parts of the heart to measure the pressures within the heart chambers.
The catheter can also be guided into the coronary arteries and a contrast dye can be injected to check blood flow through them. (The coronary arteries are the vessels that carry blood to the heart muscle.)
Fluoroscopy (a special type of X-ray that’s like an X-ray "movie") can be used to find any blockages in the coronary arteries as the contrast dye moves through them.
These are some of the other procedures that may be done during or after a cardiac cath:
Angioplasty, a tiny balloon is used to press plaque buildup against the artery wall and improve blood flow through the artery
Stent placement, where a tiny metal coils or tubes are placed inside an artery to keep it open
Fractional flow reserve, a pressure management technique that’s used in catheterization to determine the severity of an artery occlusion (blockage)
Intravascular ultrasound (IVUS), a technique that uses a computer and a transducer that sends 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.
A small sample of heart tissue(called a biopsy) may be taken out to be examined later under the microscope for abnormalities.
During the test, you will be awake, but a small amount of sedating medication will be given before starting to help you be comfortable during the procedure.
What are the risks of cardiac catheterization?
Possible risks associated with cardiac cath include:
- Bleeding and/or bruising where the catheter is put into the body (the groin, arm, neck, or wrist)
- 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:
- Ischemia (decreased blood flow to the heart tissue), 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
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray exams and/or treatments over a long period.
If you are pregnant or think you may be pregnant, tell your doctor due to risk of injury to the fetus from a cardiac cath. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should be sure to tell your doctor.
There is a risk for allergic reaction to the dye used during the cardiac cath. If you are allergic to or sensitive to medications, 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 prior to the procedure.
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 12 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 the sheath is removed. After the sheath is removed, you may be given a light meal.
You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, 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 medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.
You will be encouraged to drink 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 otherwise.
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 regarding the type of closure device that was used and 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.
You may be advised not to participate in any strenuous activities for a few days after the procedure. Your doctor will tell you when you can return to work and resume normal activities.
Contact your doctor if you have any of the following:
- Fever and/or chills
- Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
- Coolness, numbness and/or tingling, or other changes in the affected arm or leg
- Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.