Cardiac catheterization is a procedure that provides information on how well the heart is working. To perform this procedure, a healthcare professional inserts flexible tubing into the heart through a blood vessel in the neck, arm, or groin.

The healthcare professional may perform other procedures during the test, depending on the findings of the cardiac catheterization.

This article discusses what cardiac catheterization is. It also looks at who might need it and outlines what happens during the procedure.

A surgeon performing a cardiac catheterization.Share on Pinterest
monkeybusinessimages/Getty Images

Cardiac catheterization is an imaging procedure that allows healthcare professionals to examine how well a person’s heart is working or how the blood vessels around the heart look.

During the procedure, a healthcare professional may:

  • Check the pressure in each chamber of the heart.
  • Take blood samples to measure oxygen levels.
  • Evaluate how well the pumping chambers in the heart contract.
  • Locate any defects in the valves and chambers.

There are two types of cardiac catheterization procedures: right heart catheterization (RHC) and left heart catheterization (LHC).

During RHC, a healthcare professional will insert a thin tube called a catheter into a blood vessel from the neck, elbow, or leg to access the right side of the heart. RHC helps measure blood pressure and oxygen levels.

During LHC, the healthcare professional will insert the catheter into an artery from the wrist, arm, or leg to enter the left side of the heart. They may perform LHC to conduct angiography to help determine how blocked the coronary arteries are.

According to Johns Hopkins, once the tube is in place, the healthcare professional may perform different tests, including:

  • Fractional flow reserve: This procedure measures blood flow and blood pressure through a part of a coronary artery. It can evaluate blockages and the need for angioplasty or stenting.
  • Intravascular ultrasound: Intravascular ultrasound provides images of the insides of blood vessels through the use of sound waves. It can help find blood clots and areas that require stents or angioplasty.
  • Biopsy: During a biopsy, the healthcare professional will take a small tissue sample from the heart muscle for examination. This procedure may help diagnose cardiomyopathy, heart transplant rejection, and infections.

Vs. angiogram

An angiogram is a procedure performed during cardiac catheterization, typically during LHC.

The healthcare professional can guide the catheter into the coronary arteries and inject a contrast dye that is visible in X-rays. The X-ray images will show the dye as it flows through the arteries to show where they are blocked.

A healthcare professional may perform cardiac catheterization to identify any potential heart conditions and allow surgeons to perform procedures to open any blocked arteries, including angioplasty and stent placement.

Angioplasty is a procedure to open a blocked or narrowed artery. The healthcare professional will inflate a tiny balloon at the end of the catheter to hold the blood vessel open. They will then insert a stent, which is a small, tube-like device that holds open the narrowed or blocked artery more permanently.

A person may require cardiac catheterization if they experience one or more of the following symptoms:

A healthcare professional may order cardiac catheterization if a heart screening exam suggests that the heart needs exploration.

They may also suggest cardiac catheterization to evaluate blood flow if a person experiences chest pain after a heart attack, coronary artery bypass surgery, or coronary angioplasty.

Cardiac catheterization can help diagnose the following conditions:

  • atherosclerosis, which is when the arteries are clogged with fatty substances
  • cardiomyopathy, which is a term to refer to diseases of the heart muscle
  • congenital heart disease, which occurs when there is a defect in the structure of the heart at birth
  • heart failure, which occurs when the heart muscle is too weak to pump the blood well
  • heart valve disease, which is the malfunction of one or more heart valves

According to the American Heart Association (AHA), cardiac catheterization is typically very safe.

However, some common risks include bleeding or bruising.

Some rare risks include:

  • itching or hives if a person has an allergic reaction to the contrast dye
  • an abnormal heart rhythm
  • infection
  • impaired kidney function

Some extremely rare complications include:

  • stroke
  • heart attack
  • a need for heart surgery

A person should tell a healthcare professional if they are pregnant, breastfeeding, or lactating before undergoing cardiac catheterization.

Before the procedure, a person should speak with a doctor about what to expect and how they should prepare.

Generally, the person may not be allowed to eat or drink 6–8 hours before the procedure.

The person should also discuss their medications, including any supplements and over-the-counter drugs, with the doctor. The doctor may advise the person to stop taking them before the procedure.

During this conversation, the person should also inform the doctor of any allergies and other medical conditions they have, including kidney problems or a history of bleeding disorders.

Questions to ask before the procedure

A person should ask the following questions before undergoing cardiac catheterization:

  • When should I stop eating and drinking before the procedure?
  • What should I expect during the procedure?
  • When will the doctor have the results of any tests I undergo during the procedure?
  • How long will my recovery take?

The AHA notes that a healthcare professional will perform the procedure in a hospital or outpatient facility catheterization laboratory. It can take place as an outpatient procedure or during a hospital stay.

The entire process should take approximately an hour, but it may depend on what tests the healthcare professional is carrying out.

Before the procedure begins, the person should remove all jewelry, empty their bladder, and change into a hospital gown.

A nurse will then clean and shave the area where the healthcare professional will be inserting the catheter and place an IV line so that they can inject the dye and IV fluids.

During LHC, the traditional access site is the femoral artery. However, a healthcare professional is more likely to use the radial artery located in the wrist. Using the wrist can be more comfortable for the person undergoing the procedure. Additionally, it can reduce risks associated with bleeding.

During RHC, the access point may be the neck, elbow, or groin. The healthcare professional will place a sterile towel over the chest or groin, depending on the entry site.

Throughout the procedure, the person will be connected to an electrocardiogram machine to monitor their heart. There will also be several screens in the room that show the person’s vitals, the images of the catheter, and the structures of the heart.

The healthcare professional will then inject the local anesthetic, which can cause some stinging for a few seconds.

Once the anesthetic has taken effect, the healthcare professional will puncture the skin using a needle and insert a sheath, which is a plastic tube to help insert the catheter.

The healthcare professional may place different tools at the tip of the catheter. These tools include:

  • instruments to measure the blood pressure in the heart’s chambers and the blood vessels connected to the heart
  • an imaging device to view the inside of the blood vessels
  • a tool to take blood samples from the heart
  • an instrument to take a biopsy

They will then guide the catheter into the heart using an X-ray for guidance.

Once the catheter is in place, the healthcare professional will perform any required procedures and take X-ray images of the heart and blood vessels around it. If they inject the dye, the person may experience a flushing sensation, a brief headache, or a salty taste in the mouth.

After the procedure, the healthcare professional will remove the catheters and may use a closure device on the entry site.

The National Health Service (NHS) notes that if the healthcare professional inserts the catheter into the groin, a nurse will apply pressure for 10 minutes to stop bleeding. If they insert the catheter into the arm, the nurse may apply a tight dressing or cuff for 2–3 hours.

When the procedure is over, healthcare professionals will monitor the person in a recovery room for a few hours.

The person should follow all the instructions the healthcare professional gives them — both immediately following the procedure in the hospital and at home — to ensure a smooth recovery.

In the facility

According to Johns Hopkins, if the healthcare professional entered the catheter through the neck, the person will be able to sit up comfortably. If they entered it through the groin, however, the person will need to lie in bed for a few hours to allow the puncture site to heal.

The person will not require bed rest if the healthcare professional entered the catheter through the wrist or arm. Once awake and alert, the person will be able to sit up immediately and walk to the bathroom with assistance.

If a person notices any swelling, bleeding, or chest pain during this time, they should immediately tell the nurse or healthcare professional.

At home

The nurse or healthcare professional will give the person instructions before releasing them from the recovery room. The person should follow all of those instructions.

According to the AHA, most people will be able to return to their normal activities within the next day.

A person should contact a doctor if they notice any of the following after cardiac catheterization:

  • shortness of breath or difficulty breathing
  • increased pain, swelling, or bleeding or other drainage
  • chest pain or pressure
  • nausea
  • vomiting
  • profuse sweating
  • dizziness
  • fainting
  • fever of 100.4ºF (38ºC) or more
  • chills
  • a feeling of coolness or numbness on affected the body part

A person should call 911 and seek immediate emergency medical attention if the puncture site swells very rapidly or if they experience bleeding from the site that does not slow or stop with firm pressure.

The cost of cardiac catheterization will vary greatly.

Some factors that may affect cost include:

  • the type of health insurance a person has
  • whether or not a healthcare professional conducts any additional tests or procedures during cardiac catheterization
  • whether or not the person needs any extra time in the hospital after the procedure
  • the facility’s fees and policies

If a person does not have health insurance, most hospitals have a financial services office that can work with the person to lower the cost of the procedure or break it down into monthly payments.

Cardiac catheterization is an imaging test that allows healthcare professionals to view a person’s blood vessels and heart by inserting a thin, flexible tube. The healthcare professional may perform cardiac catheterization to see how well a person’s heart is working and to diagnose any potential heart conditions.

During cardiac catheterization, the healthcare professional may perform other procedures and tests as well.

Cardiac catheterization is generally safe, with short recovery times. A person should discuss their questions and concerns with the healthcare professional before the procedure.