Cardiac Catheterization

Basic Facts

  • Cardiac catheterization is a minimally invasive procedure that allows access to the heart in order to perform tests or treatments for a number of heart issues without the need for surgery. 
  • It involves the insertion of a very thin tube called a catheter into a blood vessel in the groin, arm, or wrist area. Using X-rays as a guide, the catheter is threaded up the blood vessels to the heart.  
  • Different tools can then be run up and down the catheters to perform many procedures.

There are “Right” and “Left” heart catheterizations, and sometimes both are performed during one procedure. They have key important differences: 

  • Right – catheter goes through a vein in the arm or groin area to access the right side of the heart. Used to see how well the heart is pumping by measuring pressures inside the heart and in the main blood vessels in the lungs (pulmonary arteries). 
  • Left – catheter goes through an artery in the wrist, arm, or groin into the left side of the heart. Used to measures pressures, assesses the aortic and mitral valve(s), the aorta, and/or check the coronary arteries for blockages via angiography (which is often simply called “cardiac cath”). 

Pre-Test Guidelines 

Prior to the procedure, the patient should:

  • Review their medications with their provider, especially diuretics and/or medications to control diabetes.
  • Notify their provider of any iodine contrast allergies. People who are allergic to iodine will be given allergy medications before the test to prevent any symptoms.
  • Stop eating and drinking the night before the procedure.
  • Additional specific instructions will be provided prior to testing.

Testing

This procedure is performed in a hospital by a doctor with specialty training in the specific procedure, whether an interventionalist, EP, or structural heart specialist, along with a team of specialized cardiovascular nurses and technicians: 

  1. Under gentle sedation, the doctor inserts a flexible tube (catheter) into a blood vessel in the wrist, arm, or groin area.  

  2. With the help of x-ray images, this catheter is guided to the heart, the blood vessels of the heart, and the main blood vessels leaving the heart to perform one or more of above procedure(s).  

  3. When catheters are inserted, most people feel only a slight pressure or a sensation of mild tugging. Because there are no nerve endings inside the arteries, people being catheterized cannot feel the catheters as they move through the body. 

  4. When the procedure is completed, the catheter is removed, and pressure may be applied on the insertion site for 15 to 30 minutes to allow the puncture area to close and prevent bleeding. When the femoral artery in the groin is used as the access point, the patient may have to rest in bed with the leg held straight for one to four hours. Other techniques that may be used to close the puncture site include a cork-like device inserted into the wound to seal the area or a stitching device with sutures that close the incision and eventually dissolve.  

  5. Cardiac catheterization usually takes between 45 minutes and three hours to complete.  

  6. Patient will be monitored for several hours afterwards, as the anesthesia wears off. 

  7. Depending on the procedure or test performed during cardiac catheterization, many patients can go home later the same day, once the access site is stable. Others will need monitoring overnight. 

Post-Test Guidelines

The Virginia Heart Care Team will provide each patient with specific pre- and post-procedure instructions, including which medications to take or not. Other general guidelines include:

  • If leaving the same day as the procedure, a patient needs to have someone else drive them home, as they were under sedation.
  • No heavy lifting / pushing / pulling (over 10 lbs) for a few days after, to protect the access site.
  • Avoid baths for a few days (showers are usually permitted within 24 hours).
  • Sexual activity can usually be resumed within three to five days.
  • Soreness around an access site is common afterwards, but it should not last more than one week.
Follow-up office visit should be about 2 weeks after the procedure.