Cardiac catheterization is a procedure that can provide your cardiologist with a large amount of information about your heart. It is often considered the "gold standard" exam in regard to assessment of blockages in the arteries that feed the heart as well assessment of certain diseases which affect the aortic and mitral valves. Both blockages and valve problems can cause symptoms such as chest discomfort or shortness of breath and possibly swelling of the feet. Typically patients are scheduled for this procedure after a stress test or ultrasound of the heart is inconclusive or concerning for heart disease that may not benefit from medical therapy alone.

The procedure itself takes approximately 15-30 minutes. It is performed under local anesthesia with mild to moderate sedation but not general anesthesia. (General anesthesia will increase the risk for complications with the procedure).The patient is then placed on a table in the cardiac catheterization lab and local anesthesia is administered through a small small needle to the access site which is typically the top of the right leg. A tiny incision is made to access the femoral artery and a small (<2mm in diameter), hollow plastic tube ("catheter") is inserted up through the artery in the leg into the heart. Nothing is felt in the chest, but the patient typically feels a light pushing at the top of the leg as the catheter is manipulated at the access site.

Once the catheter is placed into the arteries that feed the heart, a liquid dye ("contrast") is injected. A camera is then placed over the chest and takes a movie. The cardiologist may have the patient hold their breath to allow the diaphragm to get out of the way for the pictures. At one point when the left ventricle (pumping chamber) is imaged, the patient may feel a hot sensation throughout the body. After the procedure, a plug is often placed in the artery to stop the bleeding or otherwise the site is compressed for about 10 or 15 minutes by hand. It is not a painful test. There is a mandatory bed rest period after the procedure lasting from 2 – 6 hours. The nurses and cardiologist will talk the patient through it as it happens. Most patients report that overall the anticipation of the cardiac catheterization was much worse than the actual procedure.

Results of the test are known immediately and will be discussed with the patient and family members shortly after the exam is complete. Depending on the findings, recommendations may be made for a stent/angioplasty, open heart surgery ("bypass") or continued medical therapy. If no further are procedures are needed immediately, the patient typically goes home the same day of the procedure.

What to expect before the procedure:

1. If you have had a reaction to contrast, shellfish or iodine in the past, please let your cardiologist know immediately
2. Nothing to eat after the midnight before the procedure.

3. You may bring a CD of your favorite music to help you relax

What to expect after the procedure:

1. There may be soreness at the incision site and possibly some swelling and bruising.

2. Avoid any significant physical activity or heavy lifting for the first few days after the procedure
3. The patient may resume driving the day following the procedure
4. Avoid taking a bath for a few days; showers may be taken within 24 hrs

When to call your physician or 911:

1. Bleeding at the access site

2. Severe tenderness, discharge or fever 

Complications:
Complications of the procedure are rare but could include a blood vessel tear or bleeding, reaction/allergy to medication or contrast, kidney complications or very rarely stroke or heart attack. Life-threatening complications are extremely rare.

It is our hope that a cardiac catheterization will help your cardiologist learn more about your heart to improve your health.

To learn more about Cardiac Catheterization, click here or here.