What is a Heart Catheterization?

A heart catheterization, or coronary angiography, is performed when it is necessary to know where you have coronary (heart) artery narrowings, and how severe they are. The coronary arteries supply the blood flow to the heart muscle. During a heart catheterization, the doctor can determine where you have heart narrowings, the blood pressures in your heart, and measure your heart’s pumping ability. In addition, a "right heart catheterization" can be used to determine whether there is a problem with a heart valve, or a structural problem with the heart.

During a heart catheterization, the doctor inserts a thin plastic tube (catheter) from the leg or arm and guides it up to the heart using X-ray. The doctor then injects liquid X-ray dye through the catheter into the heart arteries. High-speed X-ray movie pictures are taken, which allow the doctor to identify narrowings.

There are three main arteries that provide blood flow to the heart. The LAD, or Left Anterior Descending artery, provides blood flow to the front of the heart. The LCx, or Left Circumflex, provides blood to the back side of the heart. The RCA, or Right Coronary Artery, provides blood flow to the bottom of the heart. The Left Main artery is a main artery that divides into the LAD and LCx.

You should not eat or drink anything the night before your heart catheterization. However, you should take your normal medicines with water, as directed by your doctor.

During a heart catheterization, you will go into a Cardiac Catheterization Laboratory. There, you will lie on a table. Your groin, or occasionally your arm, will be cleaned off with soap and surgical drapes will be placed. It is important that you not touch on top of the covering since this needs to remain clean. You may be given a mild sedative.

You will then feel a brief prick and burning as the doctor numbs up the area. You will feel a brief pressure as the doctor inserts the catheter. The doctor then advances thin plastic catheters with pre-formed shapes, designed to go toward the heart arteries. The cardiologist then uses X-ray pictures and the X-ray dye to take pictures of the heart arteries and heart pumping function. During the picture of your heart pumping function, you may feel hot all over for about 30 seconds.

After completion of the heart catheterization, if no further procedures are to be performed, the catheter is removed from the groin or arm. Usually, pressure is applied for about 15-20 minutes, and you will be told to lie flat for about 4 hours. Occasionally, a small plug or suture may be used to close off the insertion site.

After the catheter has been removed, a nurse will continue to monitor your heart rate and blood pressure. The nurse will also check to makes sure there is no bleeding. When you are allowed to sit up, your nurse will initially assist you and make sure there are no problems.

Each person is different. However, in general, the risk of a major complication is less than 4 in a thousand. These major complications can include emergency surgery, heart attack, stroke or death. There is also a small chance that the X-ray contrast can affect your kidney function; this chance is increased if you already have abnormal kidney function or have diabetes. There is also a very small chance of allergic reaction to the contrast; this can usually be treated with medications. In addition, there is a small chance of bleeding or blood clot formation, enough to require a blood transfusion or surgical repair.

From the heart catheterization, your doctor will be able to determine whether you should be treated with medication, an angioplasty, or with coronary artery bypass surgery, or whether you require additional testing. If you have a severe narrowing, you may be admitted to the hospital for additional treatment.

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