All You Need to Know About Heart Catheterization

Cardiac Catheterization procedure is an invasive imaging procedure performed to diagnose and treat cardiovascular conditions. It involves insertion of a catheter into a vessel or chamber of the heart for interventional or diagnostic purposes. You may also call it cardiac cath or heart cath or coronary angiogram.

When is the Need of a Cardiac Catheterization Procedure?

The doctor may recommend the cardiac catheterization procedure for diagnosis or evaluation of a heart problem. While diagnosing a problem, the cardiac catheterization procedure is done to-

• Identify and confirm the presence of a congenital heart defect
• Identify narrow/ blocked blood vessels leading to chest pain
• Find problems/ defects with the heart valves
• Diagnose coronary artery disease or disease of the aorta
• Measure level of oxygen in the parts of the heart (hemodynamic assessment)
• Perform tissue biopsy from the heart
• Evaluate the need for further treatments such as an interventional procedure or coronary artery bypass graft, or CABG, surgery.

What other procedures depend on the completion of Cardiac Catheterization?

This procedure also completes some of the procedures to treat heart diseases. Some of these procedures include-

• Angioplasty with or without stent placement- It is a minimally invasive procedure that widens, narrow or obtuse arteries or veins.
• Fixing congenital defects- It includes procedures to treat defects since birth. For example, by threading a catheter to the hole in the heart closes it ( as a plug) instead of open heart surgery.
• Repair or replace heart valves- It is a procedure to repair or replace the narrowed/ leaking heart
• Balloon valvuloplasty- It is a procedure that widens the narrow heart valve/
• Heart arrhythmia treatment- It aims to correct/ control certain types of abnormal heart rhythms.
• Closing off part of the heart to prevent blood clots- It involves closing off a part of the upper chamber of the heart known as the left atrial appendage.
• Right heart catheterization. It the blood flow and pressure in the right side of the heart.
• Heart biopsy- A doctor can perform the procedure if he/she is taking samples for biopsy.
• Alcohol septal ablation- It treats the thick heart muscle in the patient by injecting alcohol into the muscle causing it to shrink.

The Procedure

Cardiac catheterization is an umbrella term for a variety of procedures that can be diagnostic or therapeutic. A long, flexible, thin tube that is known as a catheter is inserted into an artery or vein in the arm or groin (upper thigh) or neck area, which is then threaded to the heart. Some of the procedures done afterward are Angioplasty with or without stent placement, Fixing congenital defects, Repair or replace heart valves, Balloon valvuloplasty, Heart arrhythmia treatment, Closing off part of the heart to prevent blood clots, Right heart catheterization, Heart biopsy and Alcohol septal ablation. The doctor adds a special dye in the catheter that will flow through the bloodstream to the heart. Then an X-ray of the heart which is clearer because of the dye helps in making the coronary arteries visible in pictures. This part of the procedure is coronary angiography. The dye helps in the identification of any waxy substance (plaque) built up inside the coronary arteries. The presence of plaque is likely to narrow or block the arteries and restrict the blood flow to the heart and that's what the coronary artery disease is! During the procedure, doctors give a mild sedative to relax the patient and local anesthesia to numb the catheter insertion site. However, the patient is very much conscious and awake. While the procedure takes around 30 minutes, preparation and post-procedure recovery may take up t0 9-12 hours.

What happens during the procedure?

Only an expert doctor in this field can perform the procedure. Here is what happens during the procedure:

• The nurse puts an IV (intravenous line) in the arm to load the patient with sedatives.
• A local anesthetic is given to numb the area where the doctor would work
• A needle puncture is made through the skin into a large blood vessel and a small tube, known as a sheath, is inserted. A catheter is then guided into the vessel through the sheath. The catheter is monitored throughout on a video screen as it is threaded through the major blood vessels.
• Depending on the type of procedure, various instruments are placed at the tip of the catheter.
• Once the procedure is complete, the doctor removes the catheter and the sheath. And, the pressure is put on the site to prevent bleeding.

What to expect after the procedure?

The cardiac catheterization procedure is really fast but one still requires several hours to recover. After the procedure, they shift the patient to the recovery room to ensure the effect of sedatives goes away. What actually happens post recovery, depends on for what they shift the patient. To prevent severe bleeding and healing time for the blood vessel, adequate rest is advisable after the procedure. Usually, the doctors relieve the patient on the same day. But, there could be a requirement of longer stays in case of any additional procedure, afterward. The doctors can determine this during the catheterization procedure itself. However, it is only on the basis of the result of the catheterization that the doctor would recommend the future course of action.

Are there any side-effects of this procedure?

Cardiac catheterization procedure is a low-risk procedure. However, depending on the severity of the problem, some risks are the outcomes of the process. Chances of complications increase if the patient has a history of kidney or blood sugar problem, or is above 75 years of age. Some of the risks that you may face are:

• Allergic reaction due to the contrast medications and material used for the procedure
• Bleeding, bruising, infection at the site of catheter insertion
• Blood clot triggering a heart attack, stroke or other issues
• A damaged artery at the site of catheter insertion or to the arteries as the catheter travels the body
• Arrhythmias or irregular heart rhythm
• Tearing of the heart tissue
• Low Blood Pressure
• Kidney damage caused due to contrast material insertion leading to Kidney failure
• Infection
• Chest Pain (Angina)
• Skin reaction from X-ray exposure
• Acute closure of the coronary artery

The doctor should be able to comment on the success of the procedure soon after its completion. Diagnostic results like biopsy results may take a while. Before taking a leave from the hospital, one must ask for safety instructions (like if they can drive) from the doctor.