Heart (cardiac) catheterization

Overview

Cardiac catheterization (kath-uh-tur-ih-ZAY-shun) is a test or treatment for certain heart or blood vessel conditions, such as clogged arteries or irregular heartbeats. It uses a thin, flexible tube called a catheter. A doctor guides the tube through a blood vessel to the heart.

Results from cardiac catheterization give important details about the heart muscle, heart valves and blood vessels in the heart. During the procedure, a doctor can open a narrowed artery or test the pressures in the heart. Sometimes a piece of heart tissue is removed for examination.

Heart catheterization, cardiac catheterization, cardiac cath and heart cath all refer to the same minimally invasive procedure. A doctor reaches the heart through a blood vessel instead of opening the chest, so the procedure is not open-heart surgery. Depending on why it is done, a heart cath can be a test, a treatment or both.

Cardiac catheterization care at Mayo Clinic

Types

Heart catheterization is minimally invasive. It usually is very safe, and major complications are very rare.

The procedure is often described by the side of the heart it reaches and by its purpose. One procedure may include more than one test or both testing and treatment.

By side of the heart

• Left heart catheterization. The catheter usually enters an artery in the wrist or groin. The catheter goes to the blood vessels that bring blood to the heart, called coronary arteries. Sometimes the catheter goes into the heart's main pumping chamber, called the left ventricle.
• Right heart catheterization. The catheter is placed in a vein in the neck or groin. The catheter passes through the right side of the heart and into the artery that carries blood to the lungs.

By purpose

• Diagnostic cardiac catheterization. This type uses different tests to check your heart. It can measure pressure and oxygen levels, take images, or collect a small tissue sample. The procedure helps your care team find a heart or blood vessel condition.
• Interventional cardiac catheterization. This type treats a condition. It may open an artery or valve, place a stent, replace a valve, or close some congenital heart defects.

Why it's done

Cardiac catheterization is a common heart procedure. It may be done to help find or fix many different heart conditions, such as:

• Coronary artery disease.
• Congenital heart disease.
• Heart failure.
• Heart valve disease.
• Damage to the walls and inner lining of tiny blood vessels in the heart, called small vessel disease or coronary microvascular disease.

Your healthcare team may suggest cardiac catheterization if you have symptoms of heart disease, such as:

• Chest pain, called angina.
• Shortness of breath with physical activity.

During cardiac catheterization, a doctor can:

• Look for narrowed or blocked blood vessels that could cause chest pain.
• Check pressure and oxygen levels in different parts of the heart.
• See how well the heart pumps blood.
• Take a sample of heart tissue for examination under a microscope.
• Check the blood vessels for blood clots.

Cardiac catheterization may be done at the same time as other heart procedures or heart surgery.

Heart catheterization in children

A cardiac catheterization procedure is generally the same for children as it is for adults. It often is used for children with heart conditions present at birth, called congenital heart defects. Healthcare professionals use the procedure to look at the heart's structure, measure pressure and oxygen, and sometimes provide treatment.

A pediatric heart team may use balloons, stents or other devices to open narrowed blood vessels or close a hole or other opening. Some catheter procedures may avoid or delay open-heart surgery.

Heart catheterization in older adults

Heart catheterization can be done in older adults. Age is not the only factor in deciding whether the procedure is safe. Before performing the procedure, the care team may consider these safety factors:

• Frailty.
• Memory and ability to reason.
• Kidney function.
• Other health conditions.
• Ability to recover.
• Life expectancy.
• Personal goals.

Older age can raise the risk of complications. When possible, using the wrist as the catheter entry site may lower the risk of bleeding and blood vessel complications in older adults.

Risks

The risk of major complications is generally low.

But possible risks of cardiac catheterization may include:

• Bleeding.
• Blood clots.
• Bruising.
• Damage to the artery, heart or the area where the catheter was inserted.
• Heart attack.
• Infection.
• Irregular heart rhythms.
• Kidney damage.
• Stroke.
• Allergic reactions to contrast material or medicines used during the test.

Death during or after heart catheterization is very rare. The risk is higher when angioplasty or another treatment is added, especially during emergency care for a heart attack.

A small bruise at the catheter entry site often fades over time. Rarely, blood vessel damage can continue and may need another procedure to repair it. If a stent is placed, a blood clot or new narrowing can develop later. Taking prescribed blood-thinning medicines as directed helps lower the risk of a clot in the stent.

How you prepare

If a heart cath is recommended, tell your healthcare team about:

• Kidney disease.
• Any past reaction to iodine-based contrast material.
• Recent illnesses.
• Pregnancy or plans to become pregnant.
• Breastfeeding.

Tell your healthcare team about all medicines and supplements you take. This information helps the team plan the contrast material, medicines and safety checks.

Your healthcare team tells you how to prepare. Some things you may have to do before cardiac catheterization are:

• Do not eat or drink anything for several hours before your test. Follow the instructions your healthcare team gives you. Food or liquids in the stomach can increase the risk of complications from medicines used during the procedure. Usually, you can eat and drink soon after the procedure.
• Tell your healthcare team about all the medicines you take. You may need to temporarily stop taking some medicines before cardiac catheterization. Examples include warfarin (Jantoven), aspirin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto).
• Tell your healthcare team if you have diabetes. Contrast material may be used during cardiac catheterization. Some types of contrast increase the risk of side effects of some diabetes medicines, including metformin. Your healthcare team gives you specific instructions to follow if you have diabetes and need cardiac catheterization.
• Arrange for someone to drive you home if you are going to receive sedation. Do not drive for 24 hours after sedation.
• Plan for time away from work. If you have treatment during a cardiac cath, you may need more observation or an overnight stay. Ask your care team how much time you may need away from work.

What you can expect

Before the procedure

Before the procedure, the care team reviews your health, medicines, kidney function and any past reactions to contrast material. During and after the heart cath, the team checks your heartbeat, blood pressure and catheter entry site.

How long it takes

The time it takes to perform a heart catheterization depends on its type. A diagnostic heart cath often takes less time than one that includes treatment.

The heart cath itself may take less than an hour to several hours. Preparation and recovery add time, so plan to spend at least several hours in the hospital. The procedure may take longer if it includes treatment. For some procedures, you may stay overnight.

A heart cath that includes coronary angioplasty and stent placement can take 30 minutes to a few hours for just the treatment. Preparation and recovery add more time, and you may need to stay overnight.

Before the procedure

Before you go into the room, your healthcare team helps you get ready.

• You may be asked to use the toilet to empty your bladder.
• You change into a hospital gown.
• You remove all jewelry and dentures.

Your healthcare team checks your blood pressure and pulse. Sticky patches with sensors on them go on your chest and sometimes your arms or legs. Wires connect the patches to a computer. The computer constantly checks your heartbeat.

A member of your healthcare team may shave any hair from the area where the catheter will go.

During the procedure

Cardiac catheterization usually is done in a hospital room with special X-ray and imaging machines. The room often is called a cath lab, which is short for cardiac catheterization laboratory.

A doctor with special training performs the procedure with a team of nurses and technicians. Team members help give medicines, make X-ray images and closely monitor how you are doing during the heart cath.

A healthcare professional places an IV into your forearm or hand. Medicine called a sedative goes through the IV. The medicine helps you feel relaxed, calm or sleepy. This is called sedation.

Usually, you are awake during cardiac catheterization. But the amount of sedation needed for cardiac catheterization depends on the reason for the procedure and your overall health. You may be fully awake or lightly sedated. Or you may be given a combination of medicines to put you in a sleeplike state. This is called general anesthesia.

Before the doctor inserts the catheter, the care team cleans the skin and gives you a local anesthetic. This medicine numbs the catheter entry site. You may feel a brief sting when it is given.

To do cardiac catheterization, a doctor inserts one or more thin, flexible tubes called catheters into a blood vessel, usually in the groin or wrist. The doctor guides the tube or tubes to the heart.

You usually do not feel the catheter moving inside the blood vessel, but you may feel pressure where it enters. Tell your care team about pain or other discomfort right away.

Children may receive sedation or general anesthesia for congenital heart catheterization. Sedation may be moderate or deep. Some diagnostic procedures may use a local anesthetic with less sedation. The anesthesia and heart teams choose a plan based on the child's age, health and type of procedure.

What happens next depends on why you're having the procedure. These are some common reasons:

• Coronary angiogram. A coronary angiogram checks for blockages in the arteries leading to the heart. An iodine-based liquid called contrast material flows through the catheter. The contrast material may cause a brief feeling of warmth. The care team then takes X-ray images of the heart arteries. The contrast material helps blood vessels show up more clearly on the X-ray images. Before the procedure, the care team checks kidney function and asks whether you've ever had a reaction to contrast material. The team may use less contrast material, give fluids or take other steps to lower these risks. Serious allergic reactions are rare.
• Cardiac ablation. Heat or cold energy is used to create tiny scars in the heart to block faulty electrical signals. This treatment is done to fix irregular heartbeats.
• Right heart catheterization. A catheter is placed in a vein in the neck or groin. The catheter has special sensors in it. The sensors check the pressure and blood flow in the right side of the heart.
• Balloon angioplasty, with or without stenting. This treatment uses a catheter and a tiny balloon to open a narrowed artery in or near the heart. The catheter is placed in the wrist or groin. A mesh tube called a stent is sometimes placed in the artery to keep it open.
• Balloon valvuloplasty. This treatment helps widen a narrowed heart valve. It uses a catheter and a tiny balloon. The placement of the catheter depends on the specific type of heart valve concern.
• Heart valve replacement. Doctors can use a catheter to replace a narrowed heart valve with an artificial valve. An example is transcatheter aortic valve replacement (TAVR).
• Repair a heart condition present at birth, called a congenital heart defect. Cardiac catheterization may be used to close holes in the heart. Examples are an atrial septal defect or patent foramen ovale.
• Heart biopsy. A doctor removes a sample of heart tissue using a catheter with a small, jawlike tip. The sample goes to a lab, where it is looked at under a microscope.

If you're awake during cardiac catheterization, your doctor may ask you to:

• Take deep breaths.
• Hold your breath.
• Cough.
• Put your arms in different positions.

The table you lie on during the procedure may be tilted at times. But a safety strap keeps you on the table. Tell your healthcare team if you have any discomfort.

When the test or treatment is done, the catheter is removed. A healthcare professional puts pressure on the area to stop any bleeding or uses a small device to seal the opening in the blood vessel. If the catheter was placed into a blood vessel in the groin area, you may need to lie flat for several hours. This helps prevent serious bleeding and lets the artery heal.

After the procedure

You usually spend a few hours in a recovery room after cardiac catheterization. Your healthcare team checks the catheter entry site, heart rate and blood pressure while you recover.

How long you need to stay in the hospital depends on your health and why you had the procedure. Many people go home the same day after a diagnostic heart cath. You may need to stay overnight if you had treatment during the procedure.

The skin where the catheter was placed may feel sore for a few days. Tell your healthcare team if you have:

• Bleeding.
• New or increased swelling.
• Pain.

Recovery at home

Recovery after a diagnostic heart cath without complications is often brief. Many people can return to usual activities by the next day. If you have treatment during the procedure, such as a stent, you may need a few days to a week to recover before returning to work and physical activity. Recovery may take longer after a complex procedure or if complications occur.

You usually can return to your regular diet after the procedure. You may feel sleepy or tired while you recover from sedation, so plan to rest after you go home.

Activity limits and other precautions depend on where the catheter entered and what was done. Common precautions include:

• Driving. If you received sedation, do not drive for 24 hours.
• Activity, lifting and exercise. After a diagnostic heart cath, you may be able to resume usual activities within 8 to 12 hours. After a heart cath that includes treatment, you may need a few days to a week. Your care team provides specific instructions for the type of procedure you have.
• Medicines. Take heart medicines as directed. After some treatments, blood-thinning medicines can help prevent a clot. Do not stop them unless your care team tells you to.
• Catheter site. A small bruise is common. The site may be sore, and your care team can tell you which pain reliever is safe for you. Tell your care team if the site feels numb or tingles, swelling increases, or fluid drains from the site. Also report chest pain or shortness of breath. If the site bleeds, lie flat and press firmly. Call 911 or get emergency medical help if the site swells very quickly or bleeding does not slow with firm pressure.

Follow the recovery schedule and other instructions from your care team.

Results

After cardiac catheterization, your healthcare team explains the results.

Your results depend on why the heart cath was done.

• A coronary angiogram shows where arteries are narrowed or blocked.
• Right heart catheterization gives pressure and blood flow measurements.
• A biopsy provides a tissue sample for testing in a lab.

The care team reviews these findings along with your symptoms and other test results.

If a blocked artery is found during cardiac catheterization, the doctor may treat the blockage right away. Sometimes the doctor places a stent to keep the artery open. Ask your doctor whether this is a possibility before your cardiac catheterization begins.

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