When Jill was 15, she started having episodes where she got short of breath. Her parents took her to a doctor, who listened to her heart and told Jill she might have an arrhythmia, or irregular heartbeat. He referred Jill and her parents to a cardiologist, a doctor who specializes in heart conditions. The cardiologist did some tests on Jill and scheduled her for a procedure called a cardiac catheterization.
What Is Cardiac Catheterization?
During cardiac doctors insert a long, thin tube called a catheter through the skin into a blood vessel. The doctor then threads the catheter through blood vessels to the heart. Once the catheter is in place, doctors use it to do tests on the heart or treat certain heart problems.
Cardiac catheterization is done through just one tiny cut in the skin, so it's not considered surgery. In fact, cardiac catheterization often makes open-heart surgery unnecessary. Doctors call it a minimally invasive procedure. Most of the time, a person will have only a small puncture hole where the catheter was put in.
Doctors usually insert a catheter in the groin area. Sometimes they put it in the arm or neck. Cardiac catheterization almost never involves any pain and the risk of complications is low.
Why Do Doctors Do Cardiac Catheterization?
Doctors use cardiac catheterization for two reasons. First, it helps them gather information about the heart and its blood vessels. Second, it can treat certain types of heart conditions.
Using cardiac catheterization as a way to gather information lets doctors:
- take a sample of heart tissue (known as a biopsy)
- evaluate congenital heart defects (heart defects that are present from birth)
- measure the blood pressure inside the heart
- measure the amount of oxygen in the heart
- check for problems with heart valves
- locate narrowed or blocked blood vessels
- determine the need for further treatment or surgery
In addition, some treatments for heart conditions can be done using a cardiac catheterization, including:
- closing small holes inside the heart
- repairing leaky or narrow heart valves
- treating a heart arrhythmia by destroying the abnormal heart tissue that's causing the heart to beat irregularly
- removing blood clots
- performing angioplasties (a procedure to widen a narrowed blood vessel) or valvuloplasties (a procedure to open a narrowed heart valve) by inflating tiny balloons in blood vessels or heart valves to increase the flow of blood
- placing wire devices called stents in narrowed blood vessels to help keep them open
What Happens Before a Cardiac Catheterization?
Before recommending a cardiac catheterization, your doctor will probably do some tests — such as an electrocardiogram (also known as an EKG or ECG), which records the heart's electrical activity.
Doctors also might do an echocardiogram (ECHO), a test that uses sound waves to create a picture of the heart. In rare cases, the doctor may also call for a cardiac MRI (magnetic resonance imaging) scan or a CT (computerized tomography) scan.
If your doctor decides to schedule a cardiac catheterization, let him or her know if you have any allergies. That's especially important if you know you are allergic to any of these:
- contrast material (a special dye that shows up on X-rays)
If you take medication, let the doctor know. The doctor may want you to you stop taking certain medicines or adjust your doses for a few days before the catheterization. Bring a list of your medicines to the hospital and let the doctors know how much you take and how often you take them.
The doctor will probably tell you not to eat or drink for about 8 to 12 hours before the catheterization. Having something in your stomach can increase the risk of complications from anesthesia. You'll be able to eat and drink soon after.
When it's time to go to the hospital, wear comfortable clothes that are easy to fold, and remove any jewelry, especially necklaces that may interfere with the pictures that will be taken of your heart. If there's a chance you may have to stay in the hospital after your cardiac catheterization, bring toiletries and any other items you might want to make your stay more comfortable.
What Happens During a Cardiac Catheterization?
A specially trained cardiologist will do the cardiac catheterization in a catheterization lab. The lab contains X-ray and imaging machines not found in normal operating rooms.
First, nurses will insert an intravenous (IV) line into your arm so you can be given medications and fluids during the procedure. You will then be given a sedative to help you relax and sleep.
You'll lie on a small table surrounded by heart monitors and other equipment. A team of doctors and nurses will make sure that you're comfortable and the procedure goes smoothly. Catheterization labs are normally kept cool to protect sensitive equipment, so your medical team might give you blankets to keep you warm.
A nurse will place small, sticky patches called electrodes on your chest. These are attached to an electrocardiograph (ECG) monitor, which monitors your heartbeat during the procedure.
A nurse will clean and maybe shave the area where the catheter is going to be inserted. You'll get an injection of a numbing medication. At this point you may feel a momentary stinging pain. Once the area is numb, a plastic sheath (a short, hollow tube used to guide the catheter into your blood vessel) will be inserted into your groin or arm, and then the catheter itself will follow.
The cardiologist will use X-rays to help guide the catheter as it moves up the blood vessels toward your heart. When the catheter is in place, doctors inject a small amount of special dye (contrast material) into your blood vessels and heart. The contrast material allows the doctors to see the vessels, valves, and chambers of your heart more clearly.
As the contrast material flows through your heart, the medical team will take X-rays. If your doctors are doing the catheterization to fix a problem or take a biopsy, they'll do these procedures after the X-rays are done.
What Are the Risks of Cardiac Catheterization?
Cardiac catheterization is usually a very safe procedure, especially when compared with open-heart surgery. Complications are rare.
But any procedure involving the heart and blood vessels does carry some risks. The doctor will discuss these with you and your parents before doing the catheterization.
Some of the risks of cardiac catheterization include bleeding where the catheter goes into the skin, an allergic reaction to the medications or contrast material used during the procedure, and blockage of the groin artery. Doctors can treat all of these complications immediately.
What Happens After a Cardiac Catheterization?
After the cardiac catheterization is finished, the medical team will take out the catheter. Nurses will bandage the place where the tube went into your skin. Then they'll take you to a room to recover for several hours while they monitor your progress. If the catheter was inserted into your groin, you'll be told to keep your leg straight for a few hours to minimize the chances of bleeding.
If you have a long drive home, stop every hour and walk for 5 to 10 minutes. If you'll be on an airplane, get up, stretch your legs, and walk in the aisle at least once an hour.
You can take off the bandage the day after the catheterization. This is easiest to do by getting the bandage wet in the shower and removing it. Once the area is dry, replace the bandage with a small adhesive bandage. It's normal for the site to be black and blue, red, or slightly swollen for a couple of days after the procedure.
Gently wash the site with soap and water at least once a day. Avoid baths, hot tubs, and swimming for 1 week after the catheterization. Don't use any creams, lotions, or ointments on the site.
The doctor will tell you when it's safe to go back to your normal activities after a cardiac catheterization. In general, you can expect to feel tired and weak the day after the procedure, and you'll need to take it easy for the first couple of days. This means no heavy lifting (nothing over 10 pounds) and no sports. After about a week, you should be able to get back to doing the things you like to do.